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Supplement to the MBDICAL PRESS AND CIRCULAR, January 13, 1860.
®foe f$dial & tfirratxr.
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Supplement to the MEDICAL PRESS AND CIRCULAR, January 13, 1860.
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THE
% SStttklg fmtml
OF
MEDICINE AND MEDICAL AFFAIRS.
FROM JULY TO DECEMBER,
1868.
LONDON:
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1868.
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mHii CLIMATIC TREATMENT OF CONSUMPTION
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OWEN’S CONSPECTUS:'^
OR, TABULAE SYNOPSIS OF TEH BRITISH
PHARMACOPOEIA, 1887,~ “ '
State* the DtMe;'Operation, mi Chief TTee* of taeli ttttte
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Alnuin, Apocynin, Asclepin, Baptigin, Capsidiit, c4ulo^hylfhi; n Srnfii,
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Contains Short Notes on Aoonella, AldehydyAlfrfhmgiine, A Kan tia n,
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“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY 1, 1868.
CONTENTS.
LECTURE.
Lecture on Inauffidencr of the
Aovtie YelTee. By S. Jaccoud, M.D.,
Phyndan to the Hospital of 8t. Antoine,
Paris. Translated by John Cockle,
H.D., M.A.. pao* :
ORIGINAL COMMUNICATIONS.
Karl id Conditions of the Throat in their
Belauonto Pulmonary Consumption:
their Diagnosis and Treatment. No. I.
By 8. Scott .Alison, M.D. Edin.
On the Action of Aconite and Quinine in
NenralgU. By H. M. Jones, M.D.,
lLChnL.B.C.8.E., LA.H.Dub.
HOSPITAL REPORTS.
Crrr ov Dubux Hospital—
Bemarkable and very Bare Case of
teeading Gangrene of the Left Upper
Extremity, Besnltingfrom Dislocation
of the Heed of the Hnmerns into the
Axilla: Fatal Termination: Post-
PAOX
mortem Appearances. Under the care
of Mr. Croly. 6
Richmond Suboical Hospital—
Epithelioma of Fourteen Years* Dura¬
tion Situated on Left Cheek over the
Malar Eminence. Under the core of
Mr. W. Stokes.. 8
ADDRESS.
Address Delivered at the Opening of the
General Medical Council. By Dr.
g | Burrows, F.B.8., President. 9
LEADING ARTICLES.
Fobtitbb ib Bb. 10
Notbs ox ths Abtssixiaxs. No. HL.... 11
NOTES ON CURRENT TOPICS.
The Carmichael Prizes.—The Next Army
Examination. — Public Prosecutors.—
Convenient Indispositions.—The New
PAOB
Anaesthetic.—The New Penny Paper on
the Public Health.11-1*
CORRESPONDENCE.
A Member of the Profession on the Dis¬
tinction of General Practitioners, Bur¬
geons, and Physicians. 17
Lewis on Treatment of the Apparently
Drowned. 17
Mellin on Liebig's Food for Infants. 18
M*Clelland on Medical Witnesses' Fees.. 18
Griffith on the Turkish Bath in Acute
Bronchitis. 18
Drysdale on Dr. Prosser James' Plan of
Reforming the Medical Council.. 19
MISCELLANEA.
General Council of Medical Education
and Registration. 19
The Meeting of London and Provincial
Poor-law Medical Officers. 16
General Medical Council. 19
Medical News, Notices to Correspon¬
dents, &c.19-90
clinicalTecture
ON INSUFFICIENCY OF THE AORTIC VALVES.
By S. JACCOUD, M.D.,
PHT81C1AX TO TH1 HOSPITAL OP ST. AXTOIX1, PARIS.
TRANSLATED BY JOHN COCKLE, M.D., M.A.
(Continued from page 636, Vol. V.)
The foregoing considerations are applicable to the majority
if the organic diseases of the heart, but, in cases of aortic
ftnsufficiency, a special condition both favours and hastens
the fatty, or fibro-fatty degeneration of its contractile
tissue.
The heart receives the blood destined for its nutrition,
from the coronary arteries, but, by an unique exception,
they do not receive their maximum repletion at the
moment of the ventricular systole. When the blood is
propelled into the aorta by the contraction of the ven¬
tricle, it passes in a direction directly perpendicular to the
orifices of these vessels, consequently, without entering them,
and it would be with difficulty only that the nutritive
arteries received a small portion of the systolic wave. !
This condition (a general one) is further aided in a large
proportion of subjects by the relative position of the
coronary arteries and sigmoid valves. Frequently, in¬
deed, the orifices open so close to the mitral zone of the
aorta that when the valves open during systole, they fall
back towards the orifices ana close them, in which case, it
is certain that the nutritive arteries can receive no blood
at the moment of the ventricular systole. During the
diastole, on the contrary, everything conspires to secure
abundant irrigation of the heart. The valves are closed,
and the column of blood assumes a retrograde direction ;
checked by the closed valves, it finds no egress but by the
orificm of the coronary arteries largely open to admit it;
a portion of blood enters, and the repletion of the arteries
is complete. In fine, the injection of blood into the tissue
of the heart occurs, principally (I do not say entirely) at
the moment of the ventricular diastole, and the pressure
of the retrograde column is the most powerful agent in
the occurrence.
Snob being the mode in which the normal nutrition of
the heart is effected, it is easy to see the great distur¬
bance that would accrue from imperfect closure of the aortic
▼tiros. A portion of the aortic column of blood regurgi¬
tates into the ventricle during the period of diastole,
hence, one reason for a direct diminution of the coronary
wave; but more than this, the abnormal egress opened to
the passage of the blood by the chink of the insufficiency,
lowers, considerably, the retrograde pressure of the blood
column upon the patent orifices of the coronary arteries,
and this pressure affording the vis a tergo for the move¬
ment of the blood in the coronary arteries, imparts, finally,
to aortic insufficiency the two following effects: diminution
of the amount of blood supplied to the coronary arteries, and
diminution of the pressure causing this blood to circulate; in
other words, the heart receives less blood, and that, under lees
than normal pressure. The nutrition of the heart is thus
fundamentally modified and rendered less active. But this
is not all. The diminished volume and tension of the blood
in the coronary arteries necessarily, induces a retardation
of its course in the corresponding veins. This, again, pro¬
duces in the venous radicles and in the intermediate capil¬
lary network, interstitial stasis, augmenting, uselessly, the
volume of the heart, and restricting that free interchange
of elements which constitutes the supreme act of nutrition.
To such source of disorder, another, acting in a similar
manner, may be superadded, viz. : the abnormal pressure
exercised upon the cardiac capillaries during the period of
diastole by the surplus blood which fills, to a maximum,
the left ventricle.
Thus, shackled, in the initial act which prepares it—ad¬
mission of the nutrient blood—shackled in the final act
which constitutes it—interchange of the matcriel---the
nutrition of the heart is fatally defective, and its tissue
degenerates.
While investigating the nature of the muscular tissue
generally, Billroth has shown that it tends to degenerate
into connective tissue whenever its nutrition is com¬
promised, and certain researches of Traube have confirmed
these results in reference to the heart. The change then,
is not simply into fat, as Stokes and Paget supposed, hut
rather one of a fibro-fatty description. The development
of this degeneration is frequently hastened by myocar¬
ditis, contemporaneously existing with the endocarditis
which caused the valvular disease.
The intra-cardiac papillary muscles naturally participate
in these disorders, and end in atrophy, thus direotly com¬
promising the action of the mitral valve. My learned
mend, Professor Bamberger, of Wttrzbuxy, affirms that the
papillary muscles are always hypertrophied in easel of aortic
insufficiency. Traube, on the oontrary, describes them as
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i)R. JACCOUD’S LECTURE.
July 1,18&
being in such cases, always elongated, flattened and
atrophied. It seems to me, that these contradictory
opinions are quite reconcilable, all depending upon the
time the examination is made. At the commencement of
compensation, the papillary muscles become hypertrophous
in common with the left ventricle ; subsequently, when
the disease has produced the changes I have described,
these muscles, also, participate in the change and atrophize.
It is, now, that secondary mitral insufficiency results, as¬
suredly one of the most curious points in the history of the
affection. So long as the hypertrophy of the ventricle and
papillary muscles keeps pace with the dilatation, the re¬
spective dimensions of the mitral orfice and its valves re¬
main unchanged, and the closure of the orifice is complete.
But, when the hypertrophy halts and yields to the abnormal
state of nutrition, when the muscles of the valves, sub¬
mitted to an abnormal elongation, begin to waste, when, in
a word, dilatation acquires the ascendency, the diameter of
the mitral orifice agaments* in the same proportion, the zone
enlarges, and as the valves preserve their original dimen¬
sions, there arises a defect of relation between the curtains
of the valves and the aperture they ought to close; the
closure is now imperfect, and mitral insufficiency results.
Whenever, in the case of a patient known to be suffering
from aortic insufficiency, without mitral disease, a murmur,
during the first period, is heard at the apex of the heart
without anteceding acute disease, we may feel assured of
the existence of mitral insufficiency originated by exag¬
gerated dilatation of the left ventricle. This accident is of
i|l-omen, inasmuch as it denotes a disorder of compensa¬
tion, though not one of immediate peril. Often, on the
contrary, during the first phase of this second period, a
favourable change in the state of the circulation and, con¬
sequently, in the condition of the patient, is observed ; in¬
deed, the mitral incompetence opens out a way of escape
for the blood which over-distends the ventricle, and acts
as an auxiliary by diminishing the sum total of its work.
The ventricle empties itself more easily, the auricles dilate
in their turn, ana this new phase in compensation may re¬
tard for a period more or less long, the accidents of con¬
firmed asystolie. In consequence of the considerable
degree of dilatation of the heart in the case of our patient,
I fancy, that the mitral incompetence, which we have de¬
tected, is a secondary lesion precisely of this description.
Whenever the compensation of a cardiac affection is
compromised the prognosis becomes serious—this is a
general fact; but the gravity of the affection is, neverthe¬
less, not always of the same amount, and, in order to form
an accurate judgment, the conditions under which the
equilibrium is disturbed, must be carefully borne in mind.
Permit me to explain myself. If the disturbance can be
referred to some positive exciting cause—exertion, for
example, unusual fatigue, bronchitis, or other affection
capable of inducing momentary disorder of the circulation
already compromised—the prognosis is, under such circum¬
stances, less serious, the derangement of compensation is
but an accident and not the result of the natural increase
of the cardiac disease, and we may fairly hope that, as
soon as the superadded cause disappears, matters will re¬
vert to their original condition. This confidence is well-
grounded when tne compensating equilibrium is destroyed
for the first time. But, when the disorder results without
any appreciable exciting cause, the prognosis acquires an
absolute gravity, and, I would add, becomes at once un¬
favourable. The asystolie is, then, the immediate result
of changes occurring in the cardiac structure, agd the
mechanism is no longer susceptible of repair because the
direct agents of compensation are destroyed. Two conclu¬
sions are deducible from these facts. In a case of oomplete
or incomplete asystolie , the practitioner should most care¬
fully endeavour to discover the possibly exciting causes of
the disturbance, and he should, moreover, scrupulously in¬
vestigate those cases in which disease is compensated, with
especial regard to the disastrous consequences of over¬
fatigue of every description, dietetic errors, and particu¬
larly those following exposure to oold.
In the case of our female patient, the rupture of com¬
pensation has obviously been the united effect of two ex¬
citing causes, over-exertion and obstinate bronchitis. We
have seen the beneficial results of repose and appropriate
treatment in the case. Nevertheless, I do not believe that
this patient can be restored to the state of health she en¬
joyed prior to her admission into the hospital ; she is 69
years old, and has always lived under bad hygienic condi¬
tions; her disease dates, at least, 15 years; dilatation of the
ventricle has induced secondary mitral insufficiency; the
aorta is dilated and atheromatous, and from the existence
of these conditions, I am persuaded that the nutrition of
the cardiac tissue has been compromised for a long period,
and, that the occurrence of asystolie , has been but slightly
hastened by those extrinsic influences we have alluded tq.
I do not believe that compensation can be completely re¬
established. She has been in the hospital four weeks, and
during three weeks, at least, the alarming symptoms she
first suffered from, have ceased : so long as she remains at
rest in bed, all seems well, but, the moment she rises, dyspnoea
supervenes, the face acquires a cyanotic tint, and the legs
begin to swell; the heart can only perform its proper func¬
tion while she remains in the horizontal position, conse¬
quently, I regard her condition as hopeless. She would,
assuredly, very speedily sink, if she were compelled to
keep the erect position during the day. Repose may, for
a time, prolong existence ; this is the only possible hope
in her case.
I cannot quit this subject, without pointing out to you
the frequency of sudden death in cases of aortic insuffi¬
ciency. No disease of the heart is exempt from this sudden
termination, but it is never more to be dreaded than
in cases of this description, and I would particularly
recommend to your perusal the work that my friend,
and colleague, Dr. Mauriac, has devoted to this point of
pathology. Bear well in mind this fact, every patient
suffering from aortic insufficiency may die suddenly,
whenever the compensation is not perfectly exact. The
mechanism of this accident is easily apprehended. Re¬
member that the left ventricle is both dilated and en¬
feebled ; under the influence of exertion, emotion, or any
other cause influencing the innervation of the heart, either
in a direct or reflex manner, the action of the ventricle is
suddenly arrested, and it ceases to contract; the double
ooluuin of blood from the auricle and the aorta enters and
distends its cavity ; the degenerated muscular walls have
no reactive power, the pause of a second—becomes a de¬
finite paralysis, and the mintness,—a mortal syncope.
The cases of Williams, EUiotson, Hope, and many
others, demonstrate the fact and the explanation I have
offered of it. Occasionally, even, the cessation of the
heart’s action occurs without any obvious exciting cause.
The ventricle, for an instant, forgets its functions as it
were, and taken by surprise by the blood which over dis¬
tends it, loses all power of action, ceases to contract, and
the patient dies.
The statistics of Aran enables us to appreciate approxi¬
mately, the comparative frequ^pcy of this termination in
aortic insufficiency. This acute observer found that in 113
instances of sudden death from disease of the heart, 25
cases occurred in isolated disease of the aortic valves, and
in 9 other cases, simultaneous disease of these valves
existed. Thus, 34 deaths out of 113, were to be imputed
to disease of the aortic orifice.
This special danger inherent in cases of aortic insuffi¬
ciency, is of great practical importance. It imposes upon
the practitioner a paramont obligation. Under such cir¬
cumstances he should forewarn the relatives of the patient
of the possible danger which threatens life. No other re¬
source remains to lessen beforehand our share of responsi¬
bility.
Three months subsequently our patient died, and the
autopsy, made by my friend Dr. Pierreson, who discharged
temporarily, the duties of chef de dinique, confirmed the
diagnosis in every particular. The heart was hypertrophied
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Hi* Medical Pnm and Circular.
ALISON ON CONSUMPTION.
July 1,1868. 3
and presented considerable dilatation of the left ventricle .
the aortic insufficiency was complete ; the aorta itself,
sensibly dilated at its ascending portion, was studded by
atheromatous deposit, and the curtains of the mitral valve,
tough, rigid, and uneven, could no longer close the en
larged orifice.
rostcript .—The translator would remark that many
points of detail alluded to had already been pointed out
by him in his memoir on “ Insufficiency of the Aortic
Valves, in connection with Sudden Death , mth Notes ,
Historical and Critical” published by Darvies (Hardwicke),
1861. For some years prior to the thesis of Mauriac, he
had been investigating the mechanism of the cardiac cir¬
culation in health ana disease, and had advocated the
view of the repletion of the coronary arteries during
the period of ventricular diastole. This view was
adopted by the late Dr. Snow, in his work on “ Chloro¬
form,” published in 1858, and, indeed, is now generally
adopted.
He had, moreover, shown that there are, practically,
three well marked stages of aortic insufficiency. First, the
irritative stage—here, in many cases, the earliest symptoms
are those of obstruction and general cardiac excitement,
from the impediment offered to the onward passage of the
blood, by the tumid state of the aortic valves, and it is
only after a certain interval, when this tumid state sub¬
sides, that the process of contraction of the valves begins ;
they then permit regurgitation of the blood into the cavity
of the ventricle, causing it to dilate. The speedy accession
of hypertrophy of the chamber compensates the disorder
thus induced, and forms the second, or physiological stage,
which, in many cases, if rightly managed, may persist for
years, and maintain the proper balance of the circulation.
Sooner or later, according to circumstances, the third, or
degenerative stage occurs, and in its train, the symptoms so
well described by Jaccoud, as those of asystole. This stage,
the translator has shown, may, in some cases, often be
foreshadowed by the gradual lessening of the collapse of
the superficial arteries—a fact occasionally noticed even by
non-professional observers of the cases.
In concluding this Lecture the Translator feels specially
called upon to acknowledge the great and ready courtesy
of Professor Jaccoud and Monsieur De la Haye, in per¬
mitting its publication. The work from which it is ex¬
tracted —"Lecons de Clinique Medicate” Paris, 1867 —
cannot be too strongly commended to the attention of our
countrymen as equally calculated by its rare excellence to
sustain the high character of the School of Medicine of
Paris, and to enhance the reputation of one of its most
brilliant teachers.
- »-
MORBID CONDITIONS
OF THE THROAT IN THEIR RELATION
TO PULMONARY .CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
Bt S. SCOTT ALISON, M.D. Edin.,
NSLLOW or THE BOYAL COLL BOX OF PHYSICIANS, LONDON, AND
PHYSICIAN TO TUB HOSPITAL FOB CONSUMPTION AND DISBASBS OF TIIB
CHEST, BBOMPTON, AND THB SCOTTISH HOSPITAL.
No. I.
Thk importance of a knowledge of the relations of the
disorders of the trachea and adjacent parts, including the
larynx, the tonsils, and the pharynx, to pulmonary consump¬
tion, has been long admitted by practical physicians.
Before I joined the Consumption Hospital at Brompton,
I was sensible of the importance of these relations, but it
was after this that its real magnitude was duly impressed
upon my mind. Disorders of the trachea and the adjacent
parts above indicated have been observed in a very large
proportion of the entire cases coming under my care in the
hospital. Amongst the forty-three patients—not merely
the consumptive—now under my charge in the hospital,
no less than twenty-eight present disorders of the parts
indicated, thus giving the result of 65 per cent.
The chief relations which have been held to subsist
between these throat disorders and pulmonary consump¬
tion, are four in number—1. That of a precursor ; 2. That
of a coincident; 3. That of a sequela ; and 4. That of a
simulator. These relations are all worthy of note, but in
this paper most attention will be given to the fourth rela¬
tion—viz., that of a simulator.
Precursor .— As a precursor, the disorders above-named
perform a comparatively unimportant part. In many
cases of phthisis declaring itself soon after the advent of
the disorders referred to, I am satisfied the priority was
more apparent than real, and that tubercle in the lung was
really present before the disorders of the trachea were
manifested, and that diligent search for the physical signs
of tubercle instituted at the first departure from health
would have resulted in the discovery of physical evidence
of tubercular disease of the lung. I have met with
numerous examples of pulmonary consumption in the
history of which, it has been declared by the patient that,
the first disordered condition was that of the throat aud
voice, and that the chest was only secondarily affected.
These cases have come before me in large numbers, but I
have generally found that the amount of disease in the
lungs at my first examination has been so great, as to sug¬
gest its comparatively long duration, and the probability
of its having been really the primary disorder. In fact,
the evidence in a large proportion of cases of phthisis in
which throat affections have been held as precursors, the
pulmonary disease was the real and primary one, and the
supposed precursor was truly a secondary one.
In one sense throat affections may be regarded as pre¬
cursors—viz., as antecedents, for, of course, persons suffer¬
ing, or who have suffered, from these complaints are, like
all others, more or less liable to become affected with
phthisis. Many persons who have suffered from throat
complaints become the subjects of pulmonary consumption,
but these disorders are more truly antecedents merely—
that is, independent prior disorders, performing no
part in the production of tubercle in the lung. Primary
tubercle of the trachea, if it ever occur at all, we have reason
to believe, is an exceedingly rare affection, and the ordinary
inflammatory disorders of the trachea and the congested and
hypertrophied conditions of the mucous membrane are very
different in their nature from tubercle, and seldom or never
give rise to it either in the parts primarily disordered or in
the lungs. Such is my experience, and such is that of most
enlightened practical physicians and pathologists of the pre¬
sent day. True it is, in non-professional parlance, we often near
of neglected colds of the throat spreading down into the lung
and producing consumption, and in some not highly es¬
teemed professional writings we read of the same relation.
It was Dr. Hunter, of inhalation notoriety, who most re¬
cently pressed upon the public this error and false induction.
A Coincident ,—Affections of the trachea and adjacent
parts do occasionally manifest themselves by hoarseness
and other throat indications at the same time that pulmo¬
nary consumption gives signs of its development, and the
two classes of disorder seem to arise at the same time.
We see this alliance or double development to hold
almost exclusively in cases of ^cute pulmonary consump¬
tion. But even in cases of acute consumption signs of
tracheal complication seldom develop themselves until the
pulmonary and more grave form of disease, together with
constitutional disturbance, has held in a marked manner
for days or weeks. Therefore as a coincident (beginning
at the same time) of pulmonary consumption, tracheal
disorder is of comparatively little import.
Sequela .—It is as a sequela of pulmonary consumption that
traoheal disorders assume their most grave aspect. In¬
cluding all forms of pulmonary consumption, and all its
stages, we may safely say that few cases are met with which
do not present some material evidence of.tracheal dis¬
turbance.
2
Digitized by v^ooQle
4 The Medical Pro* and Circular.
ALISON ON CONSUMPTION.
Jaly 1,1866.
In the first stage of phthisis the non-implication of the
trachea and adjacent parts is most common, but even in
such cases a majority will show a not entirely healthy
condition of the parts in question. In the second stage a
much larger proportion of cases is found to be implicated
with these minor affections ; and in the third, nearly every
case reveals, either by the voice or by respiratory auscultatory
signs, evidence of the implication of the windpipe. The task
of connecting the disorder of the trachea with the more
grave disease of the lung in such cases is, on the whole,
an easy one. If there be any difficulty it is in cases of,
hthisis in its first stage. The aberrations from the
ealthy amount and quality of the respiration sounds of
the chest, serve at once, in the later stages of pulmonary
consumption, to indicate the dependence of the minor
disorders upon pulmonary mischief.
Of twenty-six cases of all forms of phthisis in all stages
of the disease now in the Hospital at ferompton, under my
care, nineteen, or 73 per cent., give full evidence of dis¬
order of the upper air-tube apparatus.
Some of the local complications are grave, while others
are of less serious significance.
Of eighteen cases of phthisis in the third stage, only
three are free from implication of the trachea, and other
parte of the upper air-tube apparatus. These figures give
a percentage of 83.
The diseases of the trachea, larynx, and adjoining
parts, which we observe in pnlmonary consumption, are
almost invariably found to hold this relation, viz.—that
of sequela. In examples of acute pulmonary consumption,
it is consistent with my observation to say, that the dis¬
orders of the windpipe, &c., that occur, depend upon the
extension to the parte first involved, of that tubercular vas¬
cular over-action which originated in the lungs. This
morbid action is propagated by continuity of structures.
In chronic cases of phthisis, the disorders of the trachea,
larynx, and adjoining parte, seem to proceed from the pro¬
duction of congestive action from neighbouring irritative
disease, and in the second and third stages from inflamma¬
tory conditions, sometimes simple and sometimes tuber¬
cular, caused by the actual passage of irritant secretions,
and the debris of destroyed material from the diseased lung,
over hitherto healthy parts.
The morbid alterations of structure which I have ob¬
served in the trachea and the adjacent parte, in pulmonary
consumption, are various. These conditions are often
simply an injected and turgid, and somewhat swollen state
of the mucous membrane of the rima of the glottis, the
epiglottis, the tonsils, and the posterior wall of the pharynx,
ana of the larynx and trachea. These parts may be all
equally affected, but it is more frequently the case that
only some parts are materially involved. In the more
advanced cases of phthisis the larynx and trachea are
chiefly diseased, but in many examples, rapidly progress¬
ing to a fatal issue, all parte are implicated. Rea and
injected conditions, with small elevations of swollen glan¬
dules of the posterior wall of the pharynx are common.
Indented or serrated conditions of the epiglottis are often
presented, and a thin and shaven-off like edging is not un¬
frequent. A red and scarlet state of the epiglottis, re¬
sembling the petal of a scarlet geranium, is often met with.
The larynx is often inflamed, congested, ulcerated, and
totally, or almost totally, deprived of its vocal cords. A
very general condition, in extremely bad cases, is one of
total Toss of the cords, with deep uloeration between the
thyroid and cricoid cartilages, and a general ulceration,
and rough or granulated surface of the entire mucous
membrane of the larynx.
The symptoms during life attending the allied disease
of the trachea, &c., are, in slight cases, huskiness and
occasional hoarseness, sense of irritation in the throat, and
more or less frequent attempts to clear the parte of mucus,
producing a sound like the word “ hem,” more or less
forcibly formed. The hoarseness frequently becomes con¬
tinuous, and when ulceration of the larynx is extensive,
aphonia or whispering is produced. When the vocal cords
are totally destroyed, the aphonia is complete, and the
attempt to speak simply produces a roaring and inarticu¬
late sound, very painful to hear. In these latter cases de¬
glutition is painful, and when the epiglottis is greatly
ulcerated, particles of food are wont to fall into the larynx
and to give rise to partial suffocation, and to severe local
convulsive efforts.
An cedematous state of the rima glottidis is occasionally
found in the last stages of pulmonary consumption, ana
this gives rise to great difficulty of respiration. The lung
is not duly inflated, and it is impeded in the expulsion of
its aeriform contents. The voice is destroyed, or becomes
whispering, and the sound of respiration, heard through
the medium of the open atmosphere, or through the stethos¬
cope placed upon the neck, is hissing and constricted. The
greater intensity of the hissing or constriction at the im¬
mediate region of the glottis, points to the seat of the con¬
strictive disease.
Tubercular matter, grouped in masses even so small as
mustard-seeds, I have never seen in the larynx and trachea,
and this product seems, when deposited, to affect very fine
forms, scarcely visible to the naked eye, such as I have
observed in the aorta and pulmonary artery. The distinct
masses of tubercle which we find imbedded in the mucous
membrane of the bowels, both small and large, I have never
seen imitated in the mucous membrane of the tubular ap¬
paratus leading to the lungs. The addition of important
throat affections to pulmonary consumption adds seldom to
the danger of the patient, but exposes him to grave incon¬
venience. Difficulty of swallowing tends to hasten dis¬
solution.
The discovery of even advanced disease of the lung is in
some cases impeded by the presence of strongly marked
signs of disorder of the trachea, &c. The coarse and loud
constrictive respiration sound through the upper portion
of the air-tube apparatus, tends by descending into the
lung structure to mask fine and single humid crackles in
cavernules and in cavities. The cavernous voices is with
some difficulty made out in cases marked by partial
aphonia, and weak and whispered voice. The articulated
voice, superficial and very near so valuable as a sign of
cavity is, of course, lost in cases of aphonia. I have seen
several cavity cases in which, even after very diligent ex¬
ploration, I have been left in doubt until a second ex¬
amination has been made. The proportion of such cases
is small, for careful listening will generally detect some
amount of crackling, either cavemulous or cavernous, and
the voice over the diseased lung will generally show an
unusual amount of distinctness and dearness. Besides in
advanced softening and in cavity cases, the motion is re¬
duced, and the percussion is either dull or of manifestly
short duration. Coughing will sometimes give the requi¬
site evidence. In cases of tubercular, perforation of the
pleura, the amphoric respiration and voice, and the clear
percussion at first throughout the diseased side, and in the
stage of effusion the clear percussion above, and the abso¬
lutely dull percussion below will almost always suffice to
lend certainty to the judgment.
It is right, however, to mention that cases of cavity do
sometimes present themselves in which the cavity has been
altogether overlooked when such oversight is scarcely to
be justified, and this has happened from the marked char¬
acter of the throat complication causing the chest' to be
exempted from all exploration. Since very much atten¬
tion has been given to the laryngoscope, and so much time
expended upon its use, these over-lookings seem to have
become more than usually frequent. Perhaps this is in some
measure to be explained by the fact that the laryngoscope
has been largely adopted, and most usefully too, by some
members of the profession, who had not previously seen
much disease of the chest, or been familiar with the me¬
thods of exploration of that portion of the body. Such over¬
sights are not only an injustice to the patient, but discredit
the medical attendant, and are likely to prove injurious
to him. To avoid all chance of such results it should be
made a rule that, in. cases of throat disease of*any im-
Digitized by v^ooQle
The Medical Prwa and Circular.
JONES ON NEURALGIA.
July 1,1866. 5
portance, either through the urgency or intractability of local
symptoms, or suffering of the general health, the entire
chest should be subjected to the tests of expansion, per¬
cussion, and auscultation, I would almost say of differential
auscultation. With this chest examination such errors
will not often occur, and should disease subsequently
manifest itself, it will be felt that non-discovery did not
rest upon culpable neglect.
- * -
ON THE ACTION OF ACONITE AND QUININE
IN NEURALGIA.
By H. M. JONES, M.D., M.Ch., L.R.C.S.E., L.A.H.Dub.,
THTSICLAM OOBJC CXTT DISPENSARY, DKMOE8TBATOB OV ANATOMY AT THE
QUEEN'S COLLEGE, CORK.
(A paper read before the Cork Medical Association.)
Gentlemen,— It is not with a view to enunciate any new
theory regarding the action of a drug often experimented
with before by such men as Pereira, Sesner, Fleming, and
others, that I bring these few remarks under your notice,
nor to propound any new doctrine on its therapeutic
effects, but being struck often, while conversing with
medical men on the action of aconite, by their dislike to
administer it internally at all, I was tempted to bring the
following case under your notice to-night.
Now, it has not been the ardour of the young physician,
nor the love of new and extraordinary means of aid that
has occasionally led me to use it, but that like others,
struck as a student with the startling effects of aconite,
I subsequently became practically convinced of its thera¬
peutic value, and have not been afraid to administer it in¬
ternally when cases presented themselves which demanded
its use. I now wish to allnde to its action in neuralgic
affections only, and shall illustrate any remarks I make by
rather a curious case which I attended this year. In
cases where as yet I have had to use aconite, such 'as in
the varying shades of facial neuralgia, cephalagia, &c., I
have invariably combined it with quinine, and with as¬
tonishing good effect, that is to say, cases that quinine was
administered in without any result, on combining
aconite with it, I afforded relief.
Thus, having often seen the good results from the com¬
bination of these two powerfm drugs, I determined to
nse them as a first means on this particular instance, and
then thought that it might be a good example to add to
the list of those brought before the profession of the use
of aconite.
Mrs. H., aged 72, apparently very strong and robust, I
saw on January 16th, 1867, about six p.m., suffering the
most excruciating torture, quite unable to speak coherently
and shrieking dreadfully from pain. Her daughter ex¬
plained to me that this had come on violently since three
p.m. of the same day, but that for a few days previously,
ahe had suffered slignt neuralgic attacks in the arm and
aide. The old lady writhing in agony directed my atten¬
tion to her thumb, and from her daughter I learned the
following history :—Twenty-five years previously she had
injured her hand; the bones of the thumb got affected,
and Sir P. Crampton wished to take away a piece of one.
This she would not consent to, and five years subsequently,
daring a period of extreme cold and frost, she got a bad
attack of neuralgia, and went to her physician, requesting
bun to amputate the thumb, so bad was the pain in it.
Though shaken greatly in her general health, she had no
return of neuralgia for a period of twenty years, until the
severe frost of January of this year again brought it on.
I was on the point of examining the thumb, but the
moment I touched it, she screamed most violently, and
got into such a state, that it completely prevented any
further examination, and I refrained, satisfied that she
stifftaed from pore nervine pain propagated by the old
lesiin in Hie thumb, and fostered by the extreme cold—she
hating gone out each day to chapel notwithstanding her
daughter’s entreaties. My visit was hurried, as I saw that
her suffering was so intense, and all she could now say was
that if I knew of no other means to alleviate the paip, to
get the thumb amputated forthwith.
I ordered immediately—Tinct. aconiti, £i. ^Quinine
bisulph. £ss. Acid sulph. dil, Aq. ad. jviiim. ?ss.
stat. et rept. omni seer, hora, directing that if anything
unusual occurred to send for me at once, but that I’d see her
early the next morning. I did so, and to my astonishment,
for I thought the amount of relief I might have afforded
the old lady, never would have satisfied her. She expressed
herself very thankful to me, and I saw at a glance that she
was much better. Questioning her regarding any sensation
she might feel, she complained of numbness and tingling in
her fingers and toes ; she had had a few hours sleep in the
night after four or five doses of the mixture, and it was
after the sleep she awoke so much relieved. She apolo¬
gised for being, as she said, so like a mad woman on the
previous evening. I now ordered the mixture to be given
only every third hour, and seeing her the same evening so
much better, I discontinued the use of the aconite, and
reduced the dose of the quinine. She then recovered
completely, and I have not since seen her. I tried the
strength of the tincture. I used it in this instance, as
follows :—I selected a fine buck-rabbit, and having kept it
some hours previously without food, gave it ten drops of
the tinct.—
1st. Ten drops—no effect.
2nd. Ten drops, ono hour after : spasms about the throat
and twitchings about its mouth set in. 4
3rd. Ten drops, one hour after last: more spasms, limited
to the mouth and throat.
4th. Ten drops, one hour after last: more spasms, limited
to the mouth and throat
5th. Twenty drops, half-an-hour after ; great difficulty
of breathing, and spasms of jaws.
6th. Half-an-hour after, twenty drops ; same result, in¬
creased in energy.
7th. Twenty drops, half an hour after : violent con¬
vulsions of all the body, jerkings of head and hind
limbs, the latter thrown alternately out, and gaspings;
death in about half a minute after the dose, so that less
than 7>ii of this tincture produced death, divided over a
period of more than four nours. We may notice, in this
case I have quoted a few points :—1st. The effeote of
severe cold in developing a disorder latent for so many
years, as also that the thumb had recovered the effect# of
the injury, it was the part to originate the general disorder
of the nerves of the arm, shoulder, and face. 2nd. The
rapid subsidence of such severe pain under the combined
influence of aconite and quinine.
Now, before answering the question as far as pathology
and physiology will allow us : How do aconite and quinine
combined, or aconite alone, effect an neuralgic patient?
We must first decide what is neuralgia? and liere is the
first difficulty; without entering into varied discussions we
may take as the results of the researches of those in¬
terested in this curious affection, that it is due td some
morbid change in the nerves of parts often not recognis¬
able after death, as slight thickening, vascularity, or pres¬
sure from tumours in their immediate neighbourhood, these
changes being the active causes which are set in motion by
external or internal agencies, as atmosphere in the first
case, or stomach and intestinal disorders in the second,
both alike giving rise to intense suffering traceable often
to no cause, but this external or internal agency which
produces, in some unknown manner, a state of increased
•sensibility of the nerves of sensation of certain regions
not even evidenced by any visible changes in these parts,
or again to some low state of vitality of certain peri¬
pheral nerves, consequent on a disordered condition of
surrounding structures, or the direct result of any injury .
Looking, now, practically as to the manner in which
aconite given internally can be a remedy for any of those
morbid states :—1st. As a contro-stimulant, either by a
direct action conveyed to parts bv the blood, as evidenced
by the numbness and diminishea sensibility, this influence
being felt by parts preternaturally excited before acting
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6 The Medical Ptm* and Circular.
HOSPITAL REPORTS.
July 1,1*8.
on the system generally (Fleming). 2nd. By a direct
sedative action on the circulation as shown by its action
on the heart’s pulse. 3rd. By diminished power of sensi¬
bility of the brain—it being, as Bouchardat states, a stupi-
fying agent, less powerful than belladonna or opium. We
may thus make a two-fold division of its mode of action
on a neuralgic part.
1st Reducing any increased vascularity and excitability.
2nd. Exercising a healing influence on the nerves of the
part, and deadening sensibility in the nerves of the affected
region, both effects being increased in proportion as it in¬
fluences the nervous system generally through the brain ;
and, as Dr. Fleming remarks, “if an organic lesion, resulting
from an injury, be not present, our cure may be permanent,
if it is only temporary, the physician, always remembering
the physiological action of aconite, must seek for those
states of the system which contro-indicate its use, and not
stigmatise a drag as noxious and dangerous, which, if given
in congested states of organs, lungs, or otherwise, will de¬
cidedly verify his worst anticipations; or if in anaemic
states of the system we give this powerful drag, we must
only blame our own rashness, if its indiscriminate use
leads us into trouble.
To enter into the vexed question of the exact
way in which quinine acts, whether it is a tonic, act¬
ing simply by catalysis (Headland) on the blood, or by
giving to it some essential ingredient in which it is defi¬
cient. For my part, I must confess myself an advocate of
the logical conclusions drawn by Dr. Headland on this
matter in his recent able edition on the “Action of Medicines,”
believing quinine to be a restorative medicine, not directly
neurotic, and adducing in evidence the discovery of Duprk
and Jones by means of the fluorescent test, which estab¬
lishes the presence of a substance in the blood similarly
constituted to quinine. Certain it is that quinine is not
excreted in any quantity, and it requires very large doses
to detect its presence in the urine. To satisfy myself of
this fact, I obtained some pure quinia from the Apothe¬
caries’ Hall, Dublin, and gave, at intervals, to a healthy
man (a pensioner) 33 grains in the 24 hours. He suffered
from pains in the loins, head, and back. I got him to pass
urine immediately before the first dose, and obtained, then,
all he passed in the 24 hours, amounting to 54 fluid
ounces. It was quite clear and healthy. I first took two
ounces and rendered it slightly acid with tartaric acid,
evaporated to dryness, dissolved in absolute alcohol, and
evaporated in a water-bath, filtered, and extracted the
Residue, and repeated this process three times. I then ex¬
tracted the residue with more alcohol, to which remainder,
by this time very minute and colourless, I added solution
of carbonate of potash, and got a white precipitate , perfectly
soluble in aether, but failed to get the chlorine and ammonia
test on the evaporation of the ether. On again re¬
peating the same process with four ounces of this urine, I
got the green with chlorine and ammonia, but from
the quantity I obtained altogether from the six ounces, I
should say that not more than a few grains passed entirely
through the urine. We may thus look on quinine as pro¬
ducing a permanent change in the blood, either filling up
some deficiency, or producing some change in its integral
constituents, and so altering the existing state, and con¬
clude that quinine acts through the blood, and that its
effects in nervine disorders are due to this blood-action,
which is restorative in character. So that it is indicated
in any deranged state of the system which clinical experi¬
ence shows to be the result of certain morbid states of the
blood, originating in a deficiency or change in its ingre¬
dients, as evidenced by a certain class of affections that
follow those particular changes.
Is not, then, neuralgia often the result of such changed
conditions of the blood ? Pathology, in many instances,
can assign no cause for it! Morbid anatomyjlooks in vain
fbr any state to account for the life symptoms, and though
we may have palpable causes during life, and apparent
after death, still, in many instances, we can,assign no rea¬
son for suffering but some debilitated state of the blood,
anaemic or otherwise, no practical physician having failed
to observe the relation that exists between neuralgia,
debility, and hysteria; often do we find all three co-existing
in the same individual, and as surely as chlorosis and hys<*
teria are allied, so is neuralgia and other debilitated states.
The question arises, then, does not quinine, by altering this
morbid state, relieve the condition that it has induced?
and this I believe to be its true action. And so we may
use it as a valuable adjunct to aconite-—1st. In neuralgia
occurring in anaemic or debilitated patients, without any
apparent nerve-lesion or exciting cause. 2nd. In old cases
of neuralgia, where the primary disease has induced a state
of the circulation at the part affected not in accordance
with health. 3rd. In all cases where, to a temporary relief*
we would add permanency of cure.
I trust the society will pardon the time I have taken up
on this apparently trivial subject; but I offer my excuse
in the words of Dr. Headland, when he says that “ it must
be confessed that in the action of medicines and their
agency in curing disease, we do not so much excel our
ancestors,*” and he rightly attributes it to the want of
united medical testimony on the action of drugs, “ so that
the doubts and difficulties which are now clearing aftay
before the efforts of a few, may be finally dissipated by the
energies of all.”
-♦-
Hispid QtyttxU.
CITY OF DUBLIN HOSPITAL.
REMARKABLE AND VERT RARE OA8E OP 8PREADINO GAN¬
GRENE OF THE LEFT UPPER EXTREMITY, RESULTING
FROM DISLOCATION OF THE HEAD OF THE HUMERUd
INTO THE AXILLA—FATALTERMINATION—POST-MORTEM
APPEARANCES.
Under the care of Mr. CROLY.
J. S., aged 73 years, a bricklayer, a powerfully muscular
man, and unusually active for his time of life, residing^
few miles from the city, was admitted into the Hospital
under Mr. Crol/s care, on the evening of the 29th of May 1 ,
on the recommendation of a medical gentleman:—
History .—He was working at a gentleman’s house on
the 26th of May, and accidentally fell from a ladder ; he
struck his left arm in the fall, and immediately lost all
power of the limb, which swelled rapidly; he felt a cold¬
ness and tingling in his fingers. He was visited in twb
hours by a practitioner of long experience, who at once
cognized a luxation of the left shoulder-joint* and wat
forcibly impressed by the unusual amount of swelling, not
only of the hand and forearm, but of the entire upper ex¬
tremity. The patient was placed on the floor, the sur¬
geon (having taken off his boot) put his heel into the
axilla, and grasped the wrist; with the utmost facility the
head of the bone was returned into its natural position,
and the arm was bandaged to the side.
May 27 th.—On visiting the patient he observed that the
swelling had not diminished since the reduction, and on
examining the shoulder-joint he felt a depression beneath
the acromion process, as if the head of the bone had again
left the glenoid cavity.
29th.—The patient complained of coldness and total loss
of sensation m the fingers. He was then removed tb
hospital.
Condition of Patient and appearance of limb on admis¬
sion.—Countenance cheerful and natural; pulse (at right
wrist) 80 in the minute ; tongue clean ; left hand cold and
very much swollen ; nails blue ; no sensation in the fingers;
forearm swollen and congested, upper arm at least twice
the size of the sound limb ; no pulse con be felt at the
wrist or in the brachial artery. The shoulder-joint (when
the elbow is kept in to the side) presents a naturally
rounded appearance, but on abducting the arm a depression
is observed (beneath the acromion), into which the fingers
sink upon pressure.
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tbt Ifrdiad Pre* a&d Cfawltf.
HOSPltAL REPORTS.
inly 1,1868. 7
There is a large soft tumour filling the entire axillary
esrity, not diminished in size by compressing the axillary
artery in its first stage, and an enormous ecchymosis ex-
tendmgfrora the superior costa of the scapula to the gluteal
region posteriorly, and laterally from within two inches
of the dorsal vertebra to the nipple of the breast.
TtsmhnenL —Hand and forearm enveloped in wadding
Cotton and supported on a pillow. A liberal supply of
nourishment was ordered, and opium with quinine pre¬
scribed.
May 30th.—Patient slept well; does not complain of
pain; tongue clean; poise strong and natural in sound arm.
There is mat tension and infiltration of all the affected
lanb. There are dark-coloured bullse on the back of the
hand, which presents a bluish appearance.
Mr. Croly consulted with his colleague on duty (Profes¬
sor Hargrave), who agreed with him as to the propriety of
making superficial incisions into the forearm and arm, to
rsheve tension. This was accordingly done; serous fluid
escaped, and the angles of each wound were plugged with
•hips of lint steeped in turpentine, to prevent haemorrhage.
Immediately after the incisions were made the axillary
femora* disappeared.
; One of the incisions was made over the sourse of the
brachial artery, and the fasoia was opened; but neither
Professor Hargrave nor Mr. Croly could feel any pulsation
in the vessel.
31st.—Patient in the same cheerful spirits, and appa¬
rently not suffering from any constitutional disturbance.
Hand of a bluish-black colour; the discoloration has ex¬
tended as far as the dorsal aspect of the forearm above the
wrist. The integuments above the gangrene present a
pnypliah-red appearance on the dorsal aspect, and a mottled
look on the anterior part of the forearm, extending
pbliquely upwards and inwards nearly as high as the elbow-
June 1st—Patient passed a good night, and has taken
eggs beaten up with whiskey, a chop, strong beef-tea, and
a liberal supply of wine each day since admission. His
Mvontenasiee is natural, and he is, as usual, very cheerful
and hopefuL Pulse full and strong. He passes urine freely,
wash is not discoloured. A number of flaccid bull® con¬
taining gas and dark fluid have formed ou the forearm,
and there is a gangrenous odour from the limb,
i Me. Croly drew a line with ink around the forearm,
for the purpose of observing the extension of the gan-
' 2ikL —Patient was restless during sleep last night, yet
Ms countenance is not indicative of any distress. Pulse
88, and full. He was ordered a turpentine enema, with
tuBcture of assafoetida, as the bowels were not freed for
two dftJB* No tympanites. Continues to enjoy his food,
and passes water freely. The gangrene has not extended
above the ink-line on the dorsal aspect of the limb, but
there are dark streaks above the line marked on the ante¬
rior surface. Much of the extravasated blood in the scapu¬
lar region has been absorbed* Phlyctenae on limb larger.
Temperature of hand and forearm, 75°
* ' „ upper arm, 95°
i ML —Patient passed a tolerably good night. Counte-
iigiwe not so bright or cheerful; face sallow; pulse not so
st*qa$ and more frequent The gangrene has spread about
three inches above the ink-line. He could not pass water
Ibis morning. Mr. Croly introduced the catheter, and
drew off healthy-looking urine.
A consultation was held at twelve o’clock noon, and it
vie decided that amputation at the shoulder-joint should
be peifbnned at half-past three o’clock, which proposal the
patient and his friends agreed to.
At half-past three o’clock Mr. Croly visited the patient
{who was most anxious that something should be done to
me him a chance of his life), but found a marked change
for the worse in the short time which elapsed since the
oonsuftation at . noon. The countenance became anxious,
accelerated, with dyspnoea; the pulse was rapid,
raq patient seemed partly unconscious.
Mr. Croly at once abandoned the idea operation. The
patient expired at eight o’clock p.m.
AUTOPSY SIXTEEN HOURS AFTER DEATH.
Mr. Croly (assisted by his colleagues Professor Har*
grave, Mr. Tufnell, and Dr. Hewitt, and in tbe presence of
the class), made a careful dissection of the shoulder-joint
and axillary region in the following manner:—
An incision was made, commencing at the centre of the
clavicle, and carried in a curved direction to the insertion
of the deltoid muscle, and from that point upwards and
backwards to tbe spine of the scapula. On dissecting np
the integuments a large quantity of dark-coloured mood
was observed infiltrating the subcutaneous tissue. The
deltoid muscle, which was largely developed, was reflected
upwards so as to expose the joint; large black clots of
blood were seen beneath the muscle ; the dissection was
carefully continued so as to expose the axillary artery and
vein. On abducting the arm, an enormous quantity of
dark clotted blood was observed, filling the axillary cavity
between the subscapular muscle and the ribs. The dots
were removed in handfuls, and when the parts were
sponged, the axillary artery, at the termination of the third
stage of its course, was opened, and a gum-elastic catheter
passed through the vessel up to the clavicle, to ascertain
if it was wounded. A catheter was also passed through
the vein with the same object. The axillary artery and
vein were thus carefully examined throughout their three
stages, and no lesion of either vessel could be discovered,
nor was there any atheromatous deposit in the artery.
The subscapular vein (a very fcrge trunk) was found
lacerated at its junction with the axillary vein, thus ac¬
counting for the haemorrhage and gangrene. There was
not any lesion of the brachial plexus.
On examining the shoulder-joint, the capsular ligament
was found divided at its inferior part so folly, that on ab¬
ducting tbe arm the head of the numerus could be luxated
into the axilla with the greatest facility, the portion of
the head of the bone corresponding to the laceration of
the capsnlar ligament, and subscapular vein, presented a
well-marked appearance of chronic rheumatic arthritis.
A chisel-shaped osseous stalactite of about an inch in length*
was developed on the bone at the internal part of the ana¬
tomical neck. The upper arm was infiltrated with serum and
blood. There was not any rupture of the muscles dis¬
covered, and no trace of the long tendon of the biceps could
be found in the joint.
Remarks .—The post-mortem examination in this inte¬
resting case explained the remarkable facility with which
the dislocation was reduced, the joint having exhibited the
morbid appearances characteristic of chronic rheumatic
arthritis. The chisel-shaped osseous stalactite (an adven*
titious growth found on the anatomical neck of the hume^
rus) caused the extensive laceration of the capsular liga- .
ment.
This peculiar condition of the joint, and the destruction of
the articular portion of the long tendon of the bicepsusual in
this affection, allowed of unnatural mobility of the head of
tbe bone.
The subject has been recently brought under the notice
of the profession in an able article by Dr. Adams in the
pages of this Journal.
The sudden and enormous swelling and tension of
the entire upper extremity, and the subsequent ex¬
tensive ecchymosis of the scapular region and the
side, were found to be the result of laceration of the
subscapular vein (a vessel of considerable size), evi¬
dently produced by the sharp ridge on the neck of the
bone. The gangrene which soon followed was caused by tfe
venous extravasation, which intercepted the circulation
through the limb (venous haemorrhage being probably a
more frequent cause of gangrene than arterial lesion).
Being an example of spreading gangrene, in which not any
appearance of a line of demarcation .was observable, the
question of amputation was discussed (a procedure reoom-
mended in such cases by Larrey, Guthrie, and the lat
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8 Medical Press and Circular.
HOSPITAL REPOMS.
iolrii itta
Professor Porter, the highest surgical authorities), and
although an unpromising case for operation (in consequence
of the advanced age of the patient and the extensive ecchy-
mosis of the trunk), it was decided, upon consultation, to
afford the sufferer a chance of preserving his life, by ampu¬
tation at the shoulder-joint (and thus reach the source of
the lesion which caused the gangrene), as no constitutional
toms to contra-indicate the operation had appeared,
e consultation was held at twelve o’clock noon, the
operation decided upon, and the hour fixed for half-past
three p.m. ; but during that brief interval very unfavour¬
able symptoms set in. The operation was accordingly aban¬
doned, and the reasons were fully explained by Mr. Croly
to the class which had assembled in the operation theatre.
As far as can be ascertained, the foregoing is not only a
very rare, but probably an unique case, and will doubtless
be read with interest by the practical surgeon.
The post-mortem examination is very interesting—
firstly, in fully explaining the cause of the lesion which
produced the fatal gangrene; and secondly, in show¬
ing how unsuccessful amputation would have proved, and
consequently how hopeless in some cases' are the resources
of our art.
RICHMOND SURGICAL HOSPITAL.
Cases under the care op Mb. WILLIAM STOKES.
(Reported by Mr. James Ross.)
formed by M. Arlt, the eminent Professor of Ophthalmo¬
logy in the Vienna University. The different steps of
this ingenious operation were then carefully explained to
the class. The patient having been brought full under the
influence of chloroform the tumour was encircled by three
incisions in the form of a triangle (a e 6), the apex of the
triangle (e) being above the tumour, and the base (a b)
below. The tumour and the portion of the integument to
which it was attached were then carefully excised. The
incision (a b) was then carried outwards until its entire
length (a b') was three times that of the base of the. tri¬
angle (a e b). The different steps of this operation will
probably be best understood by reference to the annexed
woodcut:—
EPITHELIOMA OP FOURTEEN YEARS’ DURATION SITUATED
ON LEFT CHEEK OVER Tift MALAR EMINENCE: RECENT
Rapid increase of the warty growth: excision
OF THE TUMOUR, AND SUBSEQUENT PERFORMANCE OF
burow’s Elastic operation: successful result.
As this case is one in which the plastic operation of M.
Burow, a Polish surgeon of considerable eminence, was
fierfbnned, a brief record of the case to its successful ter¬
mination cannot be considered devoid of surgical import¬
ance:—
Phinter D., ret. 60, was admitted into Mr. Stokes’ wards
in the Richmond Hospital on the 20th of last May. The
patient stated that about fourteen years ago he received
the prick of a needle in the cheek, in the situation of the
tumour, for the removal of which he had come into hospital.
Shortly after getting this apparently trivial injury he per¬
ceived a small wart about the size of a grain of rice to form
exactly in the situation where he got the prick of the
needle. This wart remained stationary for a very con¬
siderable length of time, after which it seemed to get
loosened, and the patient then picked it off with one of his
nails. Another then formed m the same situation, and
ran precisely the same course. Things remained in this
way for several years, the disease being apparently quite
localized, and the general health of the patient remaining
. iu every respect perfectly unimpaired. About six months
previous to the patient’s admission into the Richmond
Hospital the warty growth began to increase in size, and
when be came under Mr. Stokes’ care the tumour was
fully half-an-inch in length, and a quarter of an inch in
breadth. There was no evidence of any similar disease
elsewhere.
After some clinical remarks to the class on the nature
of this peculiar form of malignant disease, Mr. Stokes ob¬
served that when it occurred in the situation in which it
was in the case under observation—viz., on the face, it was
of the last importance to the patient that no permanent
disfiguring cicatrix should be left in the situation when
the tumour was removed. Mr. Stokes proposed to obviate
the chance of this occurring by performing a plastic opera¬
tion after removing the tumour, which would have the
much' to be desired effect of not leaving any marked
cicatricial deformity. The operation alluded to, was one
designed originally by a Polish surgeon named Burow, of
considerable oontmeutal celebrity, the particulars of which
Mr. Stbkfcs had Iehm^dfrom seteihg the Operation p#r-
BnroVs Plastic Operation.
The next step consisted in making the outer third of this
horizontal incision (of b') the base of a second triangle
(a 1 K' b') in every respect equal to the original one (aeo) t
where the tumour was removed. The integument within
the incisions, constituting the second triangle (a? 6'K'),
was then carefully dissected off. There were then two
raw triangular spaces to be covered in by sound integument,
one which had been the seat of the epithelial cancer, and
the other in which the integument was perfectly healthy.
This was easily effected by dissecting off with great care
the triangular flaps (a a' K') and (e b V) from the adjacent
structures. This having been done, no difficulty whatever
was experienced in bringing the points (a b) together by
one interrupted suture, ana the points (a' b') together by
another. In this way the triangular spaces were com¬
pletely filled up, without any chance of a broad cicatrix,
which would necessarily have been left had either of thorn
been left to fill up by granulations.
Tbe sutures were left undisturbed for three days, after
which they were removed; the greater portion of the wound
had united by first intention—indeed, all, except the points
corresponding to the apices of the two triangles. In order'
to promote union at these points, Mr. Stokes inserted two
of the finest of the so-called “ entomologist” pins, and by a
figure of eight suture brought the ununited edges of the
wound into close apposition. After two days the pins were
removed, when it was found that all the wound had united
perfectly. Nothing could have been more entirely satis¬
factory than the result of this admirably conceived and ex*
tremely ingenious plastic operation. This case, as fur as
Mr. Stokes is aware, is the first in which this operation
has been performed in this country, and the particulars of
it to its successful termination cannot but prove interesting
to those who take an interest in this aU-important and
thoroughly practical department of operative surgeiy.
Several of the old students of St. Thomas’s Hos¬
pital met at Mr. Whitfield's on the 18th, to consider how, on the
rebuilding of the hospital, they might, by some special gift,
best testify their attachment to their old school. Drs. Barker,
Carpenter, Clapton, Saunders, Messrs. South, Solly, Le Groe
Clark, Whitfield, and Stone, with Dr. Sedgwick, 2 Gloucester-
terrace, as honorary treasurer and secretary (who will be glad
to hear from old students), were appointed a sub-committee to
remit on the matter to a general meeting to he shortly con-
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The lMtal Bra. and Cticntar.
DR. BURROW'S ADDRBSS.
July 1, I860. 9
DELIVERED AT THE OPENING OF THE
GENERAL MEDICAL COUNCIL.
Session 18Q8.
By Db. BURROWS, F.R.S., President.
Gentlemen, —Ten eventful yean have transpired since the
Legislature created this Council for the performance of most
important duties towards the medical profession and the
public. For nine of those years I have had the honour of
being associated with you in your labours, and for nearly five
years by your favour I have occupied the distinguished poet of
President. The vessel on which we have embarked, when
first constructed, excited the scrutiny and criticism of many.
When first launched she had to steer her course through un¬
known or untraversed seas, often through tempestuous waters,
with quicksands around us and breakers ahead. She visited
ports where her presence was hardly welcome. The original
crew, unaccustomed to work together, laboured under serious
disadvantages; the crew has sustained many great losses.
Some of our foremost men have been taken from us ; but still
nearly one half survive to recount the dangers of the past, and
to assist by their experience those more recently enlisted into
an arduous and responsible service. Our craft is still sound,
and our crew more disciplined. We have learnt to esteem or
Mipredateour companions, and let us hope that the venture of
the present year may, by our earnest denial of self, by our
prudence and circumspection, and close application to our
work, bring profit to those whose interests are consigned to our
keeping as well as credit to ourselves.
In former years, I have in my opening address ventured to
retraoe suocinctly the proceedings of the previous session, and
to indicate some of the questions which you would be called
upon to investigate and discuss during the current session;
but in consequence of the additional duties assigned to our
enlarged Executive Committee, it would be presumptuous on
my part to arrogate to myself a duty which must necessarily
be more ably performed through the joint labour and wisdom
of the members of that Committee.
It is, however, incumbent on me, as your President, to ren¬
der to you some account how I have performed certain public
duties which have devolved upon me personally, as such
knowledge may to a certain extent influence you in the course
von may think proper to take in the future conduct of the
busmeas of the Council. By a resolution of the General
Council oil June 6,1867, and also by one passed by the Exe¬
cutive Committee on November 12, 1867, recorded in the
Minutes of the Medical Council, vol. v., p. 273, your President
became charged with the duty of conferring with the Govern¬
ment respecting the Bill for the Amendment of the Medical
Acts.
THE MEDICAL ACTS AMENDMENT ACT.
During the past winter I had various communications with
the Government, and more particularly a lengthened interview
with the Home Secretary on February 7 last, and on that oc¬
casion I again pressed upon Mr. Gsthorne Hardy the necessity
of Amendments in the Medical Act of 1858, and requested
him to give his assistance to the General Medical Council in
bringing a Bill into the House of Commons. After a patient
hearing of my statement, Mr. Gathorne Hardy frankly said
that m the early part of the impending session of Parliament
he had so many Government Bills on his hands, that he could
hold out no promise of assisting the Medical Council before
Easter ; but that if the state of public business would permit,
at a later period of the session, he would give his attention to
the subject. Mr. Hardy at the same time requested me to
prep a re a short memorandum for him, embracing in a succinct
form the points most urgently requiring his attention. With
the able assistance of the Registrar (Dr. F. Hawkins), I was
pr e pa ri ng this document immediately before the Easter recess,
when, as you. know, a thunderbolt was thrown on the floor of
the House of Commons which startled and amazed the un¬
initiated, disconcerted all the Government plans, and practi¬
cally put an end to all legislation for the session. And then
commenced what is facetiously termed 41 the slaughter of the
innocents.” Bill after Bill was sacrificed, and it was hopeless
and usdes* to press upon the Home Secretary the promise he
had beM^otec atelatmg the Medical Council to bring in a Bill
this AH p wipe ot of medical legislation* haring
nMm&fjt M u m tmnocotearf to itunmtta ytta fibm ytfur
respective public and private duties until this more than custo¬
mary advanced period of the year. The Medical Council will
therefore be relieved from any pressing necessity of discussing
this question, which has often occupied so much of our time.
Although the question of the amendment of the Medical Acts
will not be necessarily before you, still, as this in all probability
will be the only opportunity I shall have of addressing you
from the presidential chair, I would wish to make a few sug¬
gestions for the consideration of those who may be called upon
hereafter to carry on the negotiations with the government
upon the amendment of the Medical Acts.
First, let me recall to the remembrance of the members of
this Council that one of the great obstacles to the introduction
of a bill into the House of Commons to amend the Medical
Act, 1858, was the discordance of opinion between the late
Secretary of State for the Home Department (Mr. Walpole)
and this Council upon the terms of a clause enabling thin
Council to admit colonial and foreign graduates on to the
British Register. Part of this question is likely to be brought
before the Council again this year, in consequence of an appli¬
cation from the University of Melbourne, addressed to the Im¬
perial Government, to have their medical graduates admitted
to registration in Great Britain ; and also because this Council
have already committed themselves by a resolution (June 3rd,
1867), moved by Sir D. Corrigan, and seconded by Mr. Csssar
Hawkins. See Minutes of Council, vol. v., p. 187.
Considering the difficulty that has been experienced in draw¬
ing up a clause to effect the registration of colonial and foreign
graduates, I would suggest whether the difficulty may not be
surmounted without attempting to frame a new clause, but
simply by a verbal amendment of the Clause 46 of the
Medical Act—the clause which enabled this Council to make
special provision for the registration of persons practising
medicine and surgery within the United Kingdom on colonial
or foreign diplomas and degrees before the passing of the Act.
The operation of Clause 46 was simply retrospective ; and
the amendment of it that I would suggest would be to make
its operation prospective as well as retrospective. Under the
powers granted to the Medical Council by that clause, no less
than 204 colonial and foreign graduates were admitted on to
the British Medical Register, and there is no reason for the
Legislature to suspect that this Council would act with less
liberality for the future than it has done in the past; and this
Council may feel assured that any committee appointed to in¬
vestigate the claims of colonial and foreign graduates to regis¬
tration would devote the same patient and careful consideration
to the subject as the former committee did, and which was so
ably presided over by the distinguished representative of the
College of Physicians of Edinburgh, Dr. Alexander Wood. I
commend the foregoing suggestion to the impartial considera¬
tion of members of Council as a means of evading the difficulty
attendant upon drawing up a new clause which shall be equally
acceptable to the Government and to this Council.
A second suggestion I would venture to offer for future
occasions is that any future application to the Government to
assist the Council in Parliament should be made in a different
quarter to that hitherto selected. The Home Secretary has
always been requested to introduce into the House of Commons
our Bill to amend the Medical Acts. The uniform reply that
we have received from that Minister has been that the pres¬
sure of public business has prevented him from acceding to our
wishes, and it ever will be so unless powerful Parliamentary and
external pressure is exerted to influence the Home Secretary.
It was suggested by Sir George Grey when in office that this
measure should be first introduced into the House of Lords.
Now, after much experience and reflection on this subject, I
am inclined to think that the suggestion that our Bill should
be introduced into the House of Lords is not only the course
which is most likely to be attended with success, but that it is
the course which ought rightly to have been adopted from the
first. My reasons for thinking so are as follows. According
to the enactments of the Medical Act, 1868, this Council has
not properly any relations with the Secretary of State for the
Home Department, although the Act happened to be intro¬
duced and carried through parliament by a former Home Sec¬
retary (Mr. Walpole). On the other hand, this Council partly
emanates from and may have most important relations with
the Privy Council. In the constitution of the Privy Council
you must bear in mind that six of our number—a fourth of the
whole—ate nominated by her Majesty with the advice of her
Privy Council.
Also by danse* 20 and 21 of the Acts Ware directed under
Certainte mufe to bWrMaJetiy’i
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tfORTITER IN RE.
J«lyi,lS&.
16 The Medical Press an 4 Circular.
Most Honourable Privy Council, and not to the Home Secre¬
tary. The Privy Council is called upon, if it shall think fit
to enforce any representations or regulations emanating from
this Council.
Again, by clause 23, it is the Privy Council which is
directed to prohibit attempts on our part to impose restrictions
upon the practice of medicine and surgery, and the Vice-Presi¬
dent of the Committee of the Privy Council on Education is
especially directed to take part in any orders Connected with
carrying out the regulations of this Medical Council.
It appears then from all that I have just advanced, that, as
we are a Council of Medical Education, and have much to
connect us with her Majesty’s Privy Council, it would hence¬
forth be more expedient and proper that we should seek the
assistance of the Lord President of the Privy Council to intro¬
duce any Bill into the House of Lords, rather than again fruit¬
lessly seek the assistance of the overworked Secretary of State
for the Home Department in the House of Commons.
THE COLONIAL PRACTITIONERS’ ACT.
I must next say a few words upon an Act of Parliament
recently passed termed “ An Act to amend the law relating to
Medical Practitioners in the Colonies.” Prior to the introduc¬
tion of this Bill into the House of Lords by the Duke of
Buckingham, there was forwarded to me by direction of Mr.
Hardy various documents relating to it, and I was requested
to peruse them, and return them with my opinion upon them.
Having read them, I fortunately had the opportunity of con¬
ferring with the Executive Committee before I wrotemy reply
to the Home Secretary’s communication. I made various sug¬
gestions in reference to the proposed legislation in my letters,
which I now place on the table, because it has not before been
brought under your notice.
When the Duke of Buckingham proceeded with his Bill, I
found that all my suggestions contained in the letter to the
Home Office had been entirely ignored. I therefore imme¬
diately applied for an interview With the Colonial Secretary,
and this being granted, Dr. Sharpey and Mr. Hawkins kindly
accompanied me to the Colonial Office. When offering our
objections to the Medical Practitioners (Colonial) Bill, I ad¬
verted to my letter, as President of this Council, on the sub¬
ject, when his Grace informed us that he had never seen nor
heard of any such letter from the President of the Medical
Council; in truth, it had never been transmitted to his Grace
from tiie Home Office. Fortunately, I was provided with a
copy of the letter, which I then read to the Duke, and left it
with him. The result was the objectionable parts of the ori¬
ginal Bill were amended, and the measure has now passed in
a form to which little objection can be made.'
THE REPRESENTATION OP THE PRACTITIONER ON THE COUNCIL.
There is one other topic to which I may briefly allude before
I sit down, and that is the prospect there is of your being in¬
vited to look into your own constitution, and decide whether
you think that constitution would be improved by an increase
of your number and by the introduction of members who are
to represent interests, which it is alleged by some persons are
not duly represented in the Council. It could hardly be ex¬
pected in this era of radical reforms and organic change
in the Legislature, that this Council, which has hitherto been
regarded as fairly representing the profession for those pur¬
poses for which it was constituted, should remain undisturbed
and that attempts would not be made to alter its constitution
and character. I am sure I am expressing the sentiments of
all when I say, that whenever this question is properly brought
before us, we shall be prepared to give a patient, careful, can¬
did, and temperate consideration to the argument and reasons
by which such a proposal is supported.
Lastly, it is a duty which I owe to the members of the
Council to remind them of a circumstance to which I have
already alluded, that my term of office as President will pro¬
bably have expired before the next annual session of the
Council. Now it is all essential to the future harmony and
credit and good working of the Council that this question of
the election of my successor to the honourable and distin¬
guished office of President should not take you by surprise.
You will during the present session have frequent opportuni¬
ties of personal intercourse, and I trust you will make that one
of the topics of private, friendly discourse—it can hardly be
discussed in public. Then as to the precise date when I should
vacate my office ? Whatever course may most contribute to
the convenience of the Council, and be most conducive to up¬
hold the dignity and honour of the office, will be the most
acceptable to Xaj feelings.
Registered for Transmission Abroad.
The Medical Press and Circular is published
simultaneously in London , Edinburgh , and Dublin ,
every Wednesday morning. Price 5 d. Stamped 6d.
By Post to Annual Subscribers , £12 6
„ If paid in advance , 118
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Charles Cooper, 3, Lincoln-place, Dublin.
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A. A. Tindall, 20, King William-street, Strand, London*
Jjptal fjms mtir fewfar.
1 *8ALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY 1, 1868.
FORTITER IN RE.
The profession will scarcely be reassured, albeit their faith
in the Medical Council needs strengthening, by the piti¬
able exhibition of timidity and irresolution with which the
exercise of their very simple power of removing a person
from the Register for “ infamous conduct in a professional
respect” was attended last week. The desire to suppress
public discussion of their act by obstructing the record of
their prooeedings in the public journals, was worthy of the
subsequent proceedings, and indicated a very reasonable
apprehension that the proceedings of some members
would not be read to the credit of the Council at large, or
inspire confidence in its energy or boldness of action. We
can hardly imagine the circumstances which should render
a debate after investigation as to the truth of the charges
at all necessary, much less can we understand what the
peculiarities of the discussion might be which require that
the thing should be “ done in a comer.” But the sequel
explains all.
On the question, which to an earnest reformer would ap¬
pear to admit of only one solution, whether a person, who
under the false pretence of a special commission engaged in
the sale of fraudulent diplomas, was deserving of being ex¬
pelled from the profession, nine members of the Council
supported the policy of pusillanimity, and four, scarcely
less timid, declined to vote at all.
Our Special Reporter describes the scene as follows :—
“ Upon this case opinion seemed to be equally divided*
for when the motion of bis expulsion from the profession
was put to the vote, nine voted for and the same number
against, the President giving the casting vote for his ex¬
pulsion, whilst a few cautious members abstained from
speaking or voting upon the question altogether, it being
suggested by one or two speakers that the Council might
find itself embroiled in some very serious legal difficulties,
if they attempted to deal summarily with the accused.
Some very plain-speaking followed as a necessary conse¬
quence, and for two hours the changes were very merrily
rung on both sides. As, however, we have not space for
the whole, and had we, some members who, as we have said,
spoke in no very guarded language, might possibly object
to their remarks appearing in print, jye purposely omit
further reference to the subject.”
We cannot conceive a duty more plain or u function
more secure than that of purging the profession of such
gross practices. In its discharge the Council would re¬
ceive the support and approbation of the entire profession,
Digitized by
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The Medical Fre« and Circular.
NOTES ON CURRENT TOTICS. wum*.' il
and the attempt to escape from the courageous performance
of their functions by the suppression of publicity is a
melancholy forecast for the future of professional reform.
Why did not the Council crown the absurdity by issuing
a u recommendation V*
NOTES ON THE ABYSSINIANS.
No. III.
There is much that is peculiar and interesting in the Deaths
and Funerals of the Abyssinians, whose religious tenets are
so remarkable that Pontius Pilate figures as a Saint in their
Kalendar.
When a sick person is not expected to live a priest is sent
for, and he, among other duties, has to remind the dying man
to declare his last wishes respecting the disposal of his pro¬
perty. These are not written, but, being simply declared in
the presence of the priest and other witnesses, are taken for
and esteemed his “ last Will and Testament.”
The funeral takes place on the day of death, and is thus de¬
scribed by Mr. Parkyns :—
* All the priests from the neighbouring church assemble,
and the relations of the deceased call from the house-tops and
send messengers to the neighbouring villages, where, standing
on eminences, they summon the neighbours by crying aloud,
* Such a one, Bon or daughter, of such a one, is dead. Come ye
to the funeral, and bring the crosses and the incense bowls.’
The priests on their arrival commence chanting the prayers,
while the spectators weep and wail. The body, having been
properly washed and laid out, is wrapped in a cotton shroud,
with the face covered. It is then placed on a couch, upon
which it is to he carried to the burial-place ; but before the pro¬
cession is formed the body is removed to the outside of the
door, and, on being again raised on the shoulders of the
bearers, every one present who has a gun discharges it as a
salute. The funeral train then sets out, the friends of the
deceased who accompany it wailing and violently rubbing their
foreheads and faces with the borders of their garments held in
both hands. On its way to the church the procession makes
seven halts, at each of which incense is burned over the body,
and the priests mid scribes read and pray. The service com¬
prises the whole of the Psalms, which are read very quickly, a
great number of the scribes as well as priests being present; to
each of these is allotted a psalm or two, and they all read their
respective parts at the same time. In Abyssinia they have a
hundred and fifty-one psalms, the extra one being merely a
private history of David’s youth, which it would appear we do
not allow to be authentic. Besides the Psalms they read certain
portions of the New Testament. The seventh halt is made at
the church gate. Should, however, the dead person’s house
be near the church, five of the services are read previously to
starting, and only the remaining two on the road. The
mourners usually take care to have among their party some
friend learned in such matters, to prevent their being cheated
out: of any part of the reading. The corpse is carried by the
friends in torn. On entering the church another long service
for the dead is performed, at the conclusion of which the
priests wrap the body in a mat, made of the leaves of the date-
palm, as symbolical of the branches of the palm which were
spread before our Saviour on his entering into Jerusalem—
death being considered as the entry of the Christian to the
spiritual Jerusalem.”
In Abyssinia there are no professional grave-diggers; but
while the funeral proceeds, as already described, any one pre¬
sent lends a hand, and helps to inter the deceased, in pursu¬
ant of the popular opinion that it is a meritorious and chari¬
table act to bury the dead. When the grave is prepared, the
priest descends into it and perfumes it with incense, after
which the body is lowered to its last earthly resting-place. At
various intervals of days masses are said for the deceased, and
are accompanied by some extraordinary proceedings on the
part of the near relatives. On the day of the chief or high
moaning, the third after death, the relatives, both male and
frainln, prrirtirlj signify their sorrow by shaving their heads;
and they mb themselves so severely on the forehead and
temples as to abrade the skin completely, and produce a sore
which takes a long time to cure ; and even when healed, the
part remains for some time as white as a European’s skin. By
degrees, however, it assumes a darker colour, and at last be¬
comes even blacker than the rest of the face ; but iu all cases
a mark is apparent for several years, and frequently for life.
The custom of crying or singing (ffibemici “ keening ”) is also
common at funerals ; and there are paid professional women,
“ keeners ” as in Ireland, who act as a choir, and improvise
verses in praise of the deceased, who, we presume, is lauded
whether he deserved it or not, according to the charitable
maxim, nil de mortuis nisi bonum.
Owing to the extreme ignorance of the natives about medi¬
cine, and to the custom of burying within a few hours of the
presumed death, it often happens that people are buried alive
in Abyssinia. Mr. Parkyns. relates that during a funeral it is
not rare to hear noises emanating from the freshly filled tomb.
These are often attributed to the “ Booda,” or Evil Spirit
making off with the body, and no one would think of re-open,
ing the grave to examine into such cases, which are caused
generally by burial during life.
Another custom of which this people are ignorantly guilty
is that of howling at the bedside of a sick relative. A case in
point is thus related by Mr. Parkyns :—
u A servant of mine was once dangerously ill, of which,
however, I was not aware, no one having intimated to me the
extent of his complaint; and as they seemed to prefer doctor¬
ing him themselves, I had only inquired after him casually
when passing his hut, thinking that little was the matter,
till one day I was astounded on hearing the death-wail raised
where he was lying. On immediately hastening to see what
was the matter, I found that though he was seriously ill he
was neither dead nor dying. The effects of a violent fever had
rendered his head shaky ; and, though not delirious, he was
wandering, and when I spoke to him he muttered something,
of which the only intelligible word was ‘ death.* To afford
him momentary relief I had him sponged ail over, and gave
him some medicine ; after which he became a little more sen¬
sible, but still continued to speak of his death. I expostulated
with his father about tbe wailing, and on his ordering the
women off I went and sat with the lad, and by keeping him
cool and easy by sponging, and continuing to talk to him
cheerfully, I at last persuaded him that there was nothing
seriously the matter. The result was, that he gradually got
better; though I firmly believe, that, had the women been
allowed to have their way, they would literally have howled
him to death.”
We must uot omit to notice that intoxication is a frequent,
even a general, accompaniment of Abyssinian funerals; which
in this, as in other particulars, are strangely like the typical
festive funeral gatherings of the Irish peasantry, who often
eat, drink, cry, sing, pray, and are merry, when sorrowing for
the loss of people whom they never saw once when alive.
-♦-
0ii faxeirf ®0jjics.
The Carmichael Prizes.
I We understand that the Council of the Royal College of
Surgeons of Ireland, inasmuch as the bequest of the late
Mr. Carmichael for the purposes of the prizes was, under
certain contingencies, to pass to the Royal Medical Bene¬
volent Fund Society of Ireland, has taken the opinion of
the Right Hon. J. A. Lawson as to the legality of the acts
of the Council in respect of the adjudication of the prizes.
The reply of the learned gentleman was lately laid before
counsel, and, as we learn, completely justifies the action of
the Council in the matter. Mr. Lawson is of opinion that
Dr. Mapother, though a councillor, was perfectly eligible
to seek and receive the prize; that it was competent for
the Council to appoint a committee from themselves to
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12 The Medial prea and Circular.
GENERAL MEDICAL COUNCIL.
July 1, 1866.
adjudicate, and to vote any reasonable remuneration to the
members of that committee for their services. Mr. Lawson
advises that the Council, having advertised prizes of £200
and £100, and the candidates having sent in their essays
on the faith of such advertisement, the Council ought not
on this occasion to avail themselves of their powers to in¬
crease the grant to £400 and £|00.
The Next Army Examination.
We are enabled to state that the number of vacancies for
assistant-surgeoncies in her Majesty’s army for the examina¬
tion next August, will be smaller than usual. It is ex¬
pected that they will not exceed twenty-two.
Public Prosecutors.
A good deal has been written in 'favour of appointing
such officers in England. Yet in Scotland they do not
give universal satisfaction, if we may judge from a remark
of Dr. Alexander Wood’s in the Medical Council last week.
He observed that a certain person had not been prosecuted,
because in Scotland it was necessary to apply to the Public
Official, who could refuse to do anything, whereas, in
England any one so disposed could commence a prose¬
cution.
Convenient Indispositions.
For the credit of our profession, we most earnestly trust
that our brethren will be warned by the contemptuous re¬
jection of Sir W. Ferguason’s certificate of the illness of
Madame Rachel by the sitting magistrate.
We certainly do not believe that any greater fault is at¬
tributable to the learned baronet than haste and thought¬
lessness in acting inadvisedly on false representation; but
we Would have our brethren more cautious than they appear
to be in guarding against such indiscriminate certifying.
The New Anaesthetic.
The use of the cumbersome apparatus for the manufacture
and storage of nitrons oxide, which we described in our
last as in use at the metropolitan hospitals, has been obvi¬
ated as regards the employment of the anaesthetic in pri¬
vate practice by Mr. Barth, of London, who sells the gas
compressed into bottles, with a suitable valve, by means of
which it can be made available in all cases to which its
employment is suitable.
The New Penny Paper on the Publio Health.
We are glad to observe that the Daily News , the en¬
lightened organ of the more thoughtful advanced Liberals,
which always evinced considerable interest in matters of
this kind, does not seem disposed to neglect them, now
that it has reduced its price. A high-class Liberal paper,
that would devote fair space to matters medical and be
above all partiality, would secure the support of the pro¬
fession. We give an extract from the Daily News of
Thursday last:—
“ Nothing tries the health of great cities like hot and
dry weather. It is in the most brilliant sunshine that epi¬
demics fester. The great year of the plague was a year of
blazing summer, ana the cholera seasons of the present
century were all hot, and in their worst weeks dry. It is
therefore satisfactory to know that the hot dry weather
which has just been broken by these summer showers has
left the health of London remarkably good. The deaths
from zymotic diseases are under the average, and even
were e^pajative^ew. Bat we owe tSiTfrmaiable con¬
dition of the public health almost entirely to the sanitary
improvements of late years, and we can only maintain it
by watchfulness. Hot weather will always bring choleraic
diarrhoea, and the number of persons attacked will rise as
the thermometer rises. This, therefore, is a most inop¬
portune time for reducing the sanitary staff of any metro¬
politan parish, much more of an East-end parish.
For the next three months sanitary inspection is
more useful and more needful than at any other
period of the year. Let this sweet summer air be
poisoned by bad smells from choked-up drains and it be¬
comes all the deadlier from its very warmth and softness.
Yet the registrar tells us that the parish of Whitechapel
has just reduced its staff of inspectors of nuisances. Is this
an indication of any diminution of inspection, or any re¬
laxation in the watchfulness of the parochial authorities
over the public health ? If so, its results are certain to be
bad, and may possibly be disastrous. But here is only
another illustration of the divided and cumbrous nature of
our metropolitan administration. The health of any and
every parish in this vast city is not merely its own concern,
but is the concern of all the rest. Disease seizes on the
least protected part, but getting a vantage ground there it
assails the whole. Our present system puts on the parishes
which because they are the poorest, need the most inspec¬
tion, all the cost of a carefulness which is of immense im¬
portance to us all. The inspectors of nuisances in the
East-end should be borne equally by West and East, for
they are needful for the protection of both. Happily, in the
present season, there is no epidemic in the air, and no poi¬
son in the water. We have got thus far into a sultry
summer with unusual healthfulness, and with even ordi¬
nary care against defilement of the vital air, or of the al¬
most equally vital water, we may hope that 1868 will not
only be a year of plenty but a year of health.”
The delays of the law have operated in the adjournment of
the case of Eastlake t\ Edmunds to the next term.
GENERAL COUNCIL OF MEDICAL EDUCATION
AND REGISTRATION.
Royal College or Physicians, London.
Wednesday, June 24, 1668.
Dr. Burrows, President, in the chair.
Present .— Dr. Bennett, Mr. Hawkins, Mr. Cooper, Dr.
Acland, Dr. Paget, Dr. Embleton, Dr. Storrar, Dr. Alexander
Wood, Dr. Andrew Wood, Dr. Fleming, Dr. Syme, Dr. Thom¬
son, Dr. Smith, Mr. Hargrave, Dr. Leet, Dr. Apjobn, Sir D.
Corrigan, Bart.; Dr. Sharpey, Dr. Parkes, Dr. Quain, Dr.
Rumsey, Dr. Francis Hawkins, Registrar.
The President then delivered his Address, which will be
found at page 9.
A letter was read from the Secretary of British Medical
Association to the effect that—
“ The Committee of Council of the British Medical Associa¬
tion had appointed a deputation to wait upon the Medical
Council in reference to the further representation of the pro¬
fession in the Council, and requesting an audience.”
Tuesday (yesterday) was fixed.
The following motions were then passed with but little dis¬
cussion
“ That the reference from the Scottish Branch Council on
the subject of Lunacy Certificates be referred to a Committee
who shall consider the subject, in concert with Mr. Ouvry, the
Council’s solicitor, and report to the Council.”
“ That the letter from the Medical Department of the Privy
Council of November 28, 1867, together with the letters from
the various Licensing Bodies connected with the subject of
Vaccination, be referred to a Committee, to draw up for the
approval of the General Council an answer to the Privy
Council.”
“ That the observations of the Licensing Bodies upon the
Report of the Committee of the Medical Council on the Visi*
tations of Examinations be received and entered on tho
minute*.”
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fee Medio! Prea tad Circular.
GENERAL MEDICAL COUNCIL.
July 1,1668. 13
“ That the Report* of Visitations since the last meeting of
the Medical Council be received and entered on the minutes.’*
44 That a Committee be appointed to consider the observa¬
tions and the reports of visitations of examinations, referred to
in the two last resolutions, and to report thereon to the
Council.”
44 That the Returns from the Army and Navy Medical De¬
partments, and from the India Office, relative to the Examina¬
tion of Candidates for Commissions in the respective services,
be received and entered on the minutes.”
We are compelled to postpone the publication of the impor¬
tant returns from the Army Medical Department.
NAVAL MEDICAL SERVICE.
“Admiralty, Somerset House, April 24, 1863.
14 Sir —We have the honour to acquaint you for the informa¬
tion of the General Council of Medical Education and Kegis-
tration, that, during the year 18G7, thirty-five candidates pre¬
sented themselves for examination for medical commissions
in her Majesty’s naval service ; but that of these, three, who
were rejected on their first examination, presented themselves
a second time, so that thirty-eight examinations altogether
were held.
44 2. The result of these examinations was that in twenty-
seven instances the answers given were of a more or less satis¬
factory character, and the candidates were admitted into the
service ; in ten they were unsatisfactory, and the candidates
were accordingly rejected ; and one candidate was found to be
physically unfit for the service.
44 3. In three of the twenty-seven successful examinations
the answers were very good in all branches ; in thirteen, good ;
In nine, fair only; and in two, indifferent.
44 4. Two candidates who passed good examinations, and one
a fair examination, had been previously rejected during the
; and one who passed a very good examination in all
ches, and one a fair examination, had been rejected during
the preceding year.
44 5. Appended hereto (for which we have not sp&Sfe this
week) are lists of the subjects upon which the candidates were
orally examined ; the questions forming the subjects for their
written examinations ; and a tabular statement showing the
qualifications of the different candidates, according to Schedule
(A) of the Medical Act; the results of the examinations in each
case I and the subjects on which the candidates were most
deficient.
44 6. In consequence of the preliminary examinations now
instituted by all licensing bodies in accordance with the recom¬
mendation of the General Medical Council, their lordships were
pleased to direct that, in future, the examination in Latin by
candidates for naval medical commissions should not be
compulsory. This regulation came into force on the 7 th of May,
1867.
tL 7. We are of opinion that the examinations on the profes¬
sional subjects have not evinced any marked superiority over
those of the preceding year ; and we find in the candidates an
increasiz^g disinclination to be examined in Latin, and that few
of them possess a useful knowledge of that language.—We
have the honour to be, sir, your most obedient servants,
44 J 48 . Salmon, Deputy Inspector-General, R.N.
44 Wm. R. E. Smart, M.D., Dep. Inspector-Gen., R.N.
44 Alex. E. Mackay, M.D., Dep. Inspector-Gen., R.N.
44 J. D. Macdonald, M.D., F.R.S., Staff Surgeon, R.N.
44 Dr. Bryson, C.B., F.R.S., &c.,
Director-General, Ac. ’ ”
registration of colonial degrees.
A letter from the Chancellor of the University of Melbourne
to the Home Secretary, preceded by one from the Colonial
and one from the Home Office, drawing the attention of the
Council thereto, was then read, from which we extract the
following
44 There is doubtless much force in the suggestion that those
charged with the grave responsibility of admitting to registra¬
tion applicants who arrive in England from distant countries,
should be allowed full opportunity to satisfy themselves as to
the respectability and social standing of such applicants.
Nevertheless, I may be allowed to submit, with great deference,
the compulsory residence in England, for the period of one
year, previous to the application, is not required ; for it is quite
possible to make provision that such persons may apply to be
registered in England, on producing to the General Council a
certificate or certificates of the nature deemed necessary, signed
bytitelfenreiMt
*n» C&ftf Justice,
44 The head of the religious body to which the applicant be-
longs,
“The principal medical officer of the colony, or any of the
chief officers of State, together with the like certificate or let¬
ters discuaaory or recommendatory signed by the Chancellor,
Vice-Chancellor, Warden, or Principal, or the representatives
of those officers, and six members, at the least, of the Univer¬
sity in which he has taken a degree.
“ Thus, should a medical man possessing a degree confirmed
by the University of Melbourne, present himself for registration
in London without the prescribed Certificates, or should it be
neffessary to refer to the proper authorities in this country to
complete any portion of the evidence requisite, a period of
six months would amply suffice to procure all required, while
any further delay could form no grounds for just complaint,
as it would be attributed in all likelihood to Borne inattention
on the part of the applicant, whose duty it would be to furnish
all the testimony required by the Act.
44 1 trust you will permit me therefore to impress upon yon,
that you be pleased not to insist on any compulsory residence
in England before registration by any of the Medical Gra¬
duates who may arrive in the United Kingdom furnished with
the Certificates or other testimony mentioned above.
It was then moved by Dr. Syme; seconded by Dr. Rumsky,
and agreed to:—
44 That the communication be entered on the minutes.”
Sir Dominic Corrigan suggesting that a copy of the Duke
of Buckingham’s Colonial Degrees Bill, now before Parliament,
should if possible be laid before the Council at the same time.
COMMITTEES ON THE 44 HOW, WHEN, AND WHERE” OF MEDICAL
EDUCATION.
On rising to move the following motion, which was seconded
by Dr. Andrew Wood:—
44 That a committee be appointed to consider and report how
the various subjects of medical education which have been
deemed requisite by the Council may be taught with most
advantage; in what order they should be studied; and how the
examinations on them ought to be arranged,”
Professor Syme, whose remarks were very inaudible, was under¬
stood to say that he felt greatly impressed with the importance
of the subject with which be bad to deal, and was almost con¬
strained to apologise that it was not in abler hands. As a
teacher and examiner for forty years he could, however, speak
with some degree of certainty. He knew great diversity of
opinion existed both in the Council and beyond the pale of its
constitution, as to the best means to be employed in educating
the youth for the profession; hence his proposition shaped
itself into three distinct clauses. Bow it could best be done; in
what order it should be pursued, and when the examination
should take place. There were two great errors prevalent
with regard to teaching. One was that teaching implied
learning, and that learning was the same as committing to
memory. The act of learning, or acquiring new ideas, was an
act of the mind, no less essential for the purpose than the acts
of digestion and assimilation were for the adaptation of nutri¬
ment to the body ; and they could no more make a man learn
by the mere enunciation of facts and opinions than they could
make a man strong by distending his stomach with food.
Nevertheless, many teachers, forgetful of this, believed that
they discharged their duty by pouring forth volumes of details,
no sooner received than forgotten. A man might be a profound
scholar and yet a bad teacher. He considered the system adopted
in Scotland superior to that in any other part of the kingdom.
There they had but three medical schools; but in London and
Dublin almost every hospital had its school, as well as nearly
all the large provincial towns, and this he conceived was in
some measure the cause of the present unsatisfactory state of
things. With so many schools, it caused the number of
students to be distributed over a large area; and from his ex¬
perience it was much easier aud much more satisfactory to the
teacher, to have a large class than a small one. He thought
teachers now looked upon their appointment to one of these
schools as a something that suited their present purpose— a
stepping-stone to a future appointment that would bring them
in a much heavier emolument. He would abolish all these
minor schools and limit the number to a few of the larger ones,
as in Scotland, and he then believed we should get more com¬
petent professors and teachers—men who would look upon
teaching as an honour worth seeking, and when obtained to be
held for the best of their life.
Dr. Andrew Wood had great, pleasure m.setehd&g this
mtfcftar, as he anticipated seme gbtfl must rWait freftfi s' frto
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14 the Medical Press end Circular. GENERAL MEDICAL COtJNCIL July 4, lift.
discussion thereon. If Professor Syme was right, Dr. Parkes’s
scheme of education must be wrong; there were points in
both he was not prepared to endorse, he hoped after due con¬
sideration they would be able to reconcile the two seemingly
opposite schemes, and draw therefrom one which would be
generally acceptable. He would suggest that they should
have all the medical teachers in the kingdom before them, and
endeavour to arrive at the right and wrong sides of the ques¬
tion ; with such evidence before them, he thought such a
system might be adopted, as would redound to the credit of
the proposer and the Council also.
Sir Dominic Corrigan begged to propose the following
amendment, seconded by Dr. Storrar :—
“ That a Committee be appointed to consider and report in
what order the various subjects of Medical Education which
have been deemed requisite by the Council may be taught
with most advantage, and how the examinations on them
ought to be arranged.”
Sir Dominic argued against the concentration of schools
proposed by Professor Syme, and said he considered the compe¬
tition by the many was productive of great good, both as re¬
garded the status of the teachers, and the anxiety of students
to be at the top of the tree. Competition was the order of
the day, if we did away with it, the standard of education
would be lowered, and emulation, which was the basis of all
knowledge, would soon cease to exist. Students under the
present code, went where it was most convenient, and where
they could get best value for their money, but if the proposed
concentration took effect they would be compelled to go to
these one or two schools, because they could not obtain the
necessary instruction elsewhere. He also disagreed with Pro¬
fessor Syme that large classes were easier to teach than small
ones. He had never found it possible to teach, clinical medi¬
cine and surgery, properly to large numbers; he thought
teaching would be more successful if each subject were
brought under the individual attention of students—take them
to the bedside, and let them see facts for themselves ; a mere
knowledge of words, from ever so good a teacher, when a
large number were arranged round a class-room, added to all
the cramming a professional grinder could impart, would not
be nearly so satisfactory. He would make the examination
what it ought to be—thoroughly practicable. He was also op¬
posed to the suggestion thrown out by Dr. Andrew Wood—
“ That all the medical teachers in the kingdom should be sum¬
moned before the Council; ” he did not think that possible, in
fact, with such a multitude of councillors and their evidence
to deal with, the members of that board would soon be non
e$t”
Thursday, June 24.
The debate on Professor Syme's resolution was resumed by
Dr. Pabkes, who regretted that some portions of his recent
pamphlet on Education had been misinterpreted. He was,
however, pleased to find that the scheme as propounded by
Professor Syme, and that contained in his pamphlet, though
at first sight they appeared to dash, on dose examination the
difference was very slight. He said the term of “ wet nurse”
had been applied to his proposition, and he would accept the
definition as a compliment, because he held that when students
came from school they were, as far as science was concerned,
but children, and what better mental food could be given
them than that which should minister to the growth and vigour
of the mind. Even Professor Syme, like every other practical
teacher, must of necessity proceed from particulars to genera¬
lities'. He entirely disagreed with the amendment of, and the
doctrine as put forth by Sir Dominic Corrigan on the previous
day; it appeared to him that if the amendment were adopted
the pith and marrow of all that was good in the original pro¬
position would be left out, and he would rather do away with
the whole question than vote for the amendment. He entirely
coincided with Professor Syme, that a committee should be
appointed to take the whole matter into consideration; let them
at least try what could be done, let them court the opinions of
those teachers most competent to give them, let objections
come whence they might, and he did not despair that the
committee would be able to bring up a report, upon which the
council could base all future legislation.
Dr. Allen Thomson thought the time was come when a
revision of the existing clauses was absolutely necessary ; it
was a fact that the profession and the public at large looked
anxiously to the Council for deliverance from the e xis tin g
anon^aHes. Several branches oould be improved, others oould
be eaKrd? wnodeBed, wtttet tbow which bad prowl wwIm*
could be left out altogether. He instanced chemistry in the
preparatory branch, in the form now taught it was very un¬
desirable; in fact, in its application to medicine, was perfectly
valueless.
Dr. Sharpey feared it was scarcely possible that the Council
could arrive at a very congruous conclusion on the subject before
them, still he hoped they might, by careful deliberation, im¬
prove the existing educational code, so as to make it more
generally acceptable.
Dr. Aquilla Smith would support the resolution of Pro¬
cessor Syme, as it was less restrictive than the amendment; he
considered it impossible that any fixed rules could be laid down
for teachers, because (what would be applicable in one case
would not be in another.
CASE Or DR. MACDONALD.
It being three o’clock, the time appointed to consider the
case of Dr. William Macdonald, who was summoned to ap¬
pear before the Council at this hour, the debate on Mr. Syme’s
resolution was adjourned.
The President then rose to suggest that, as the ease More
them was of a very serious nature, and the character of one
of their professional brethren was at stake; and as, moreover,
matters of private import would necessarily be introduced into
the discussion, he deemed it advisable that the reporters be
requested to withdraw.
Whereupon a long discussion arose, in which almost
every member took part, the majority contending that,
as that was ’ essentially a court of justice, and as, in such
courts, there Was no precedent of the press being excluded,
exception should not be taken in this instance, unless,
their legal adviser, who was present, should show them that
there was any illegality in discussing the subject in public.
Mr. Ouvry then read the sections bearing on the point, and
considered that it was within the province of the Council to
deliberate on any one point of the evidence either in public or
private.
A motion was then put by Mr. Hargrave, seconded by Dr.
Rumsey—
“ That the reporters be requested to withdraw.’*
This motion was lost by a very large majority.
A letter from the Registrar to Dr. William Macdonald, was
then read, to the effect that a statement had been made that
he had been guilty of infamous conduct in a professional
respect:— ;
“ First.—In offering to procure for fee or reward, the De*'
gree of Doctor of Medicine from Pennsylvania College.
“ Second.—In offering to procure for fee or reward the
Degree of Doctor of Medicine from the University of Giessen.
“ Third.—In falsely pretending to hold a Commission from
the said University oi Giessen, for inviting young persons^
aspirants for the Degree of Doctor of Medicine, to Giessen.’*
Dr. Macdonald not being in attendance, and having de¬
clined to appear before the Council, Mr. Ouvry then read at
full length the evidence in support of the charges, and also
the answers to them which Dr. Macdonald had. addressed to
the Council as his defence. . < r
Upon this case opinion seemed to be equally divided, for when
the motion of his expulsion from the profession was put to the
vote, nine voted for and the same number against; the President
giving the casting vote for his expulsion, whilst a few cautious
members abstained from speaking or voting upon the question
altogether, it being suggested by one or two speakers, that the
Council might find itself embroiled in some very serious legal
difficulties, if they attempted to deal summarily with thfe
accused. Some very plain speaking followed as a necessary
consequence, and for two hours the changes were very merrily
rung on both sides. As, however, we have not space for the
whole, and had we, some members who, as we have said, spoke
in no very guarded language, might possibly object to their;
remarks appearing in print, we purposely omit further refer 4 "
ence to the subject.
It was ultimately moved by Mr. Syme, seconded by Dr?
Fleming—
“ That William Macdonald, of Ewing-place, 859, Argyie-
street, Glasgow, M.D. Univ. Edin., 1880; FeL Fac. Pnys.
Surg. Glasgow, 1882, is judged by this Council, after
due inquiry, to have been guilty of infamous conduct in a pro¬
fessional respect.”
Amendment moved by Sir Dominic Corrigan, and seconded
by Dr. Apjqhn :
“ That the General Medical Council, however disapproving
of Dr. Maodopald’s conduct, is of opinion thatthOcAee befott
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The Medical Prow tad Circular.
GENERAL MEDICAL COUNCIL.
them is one in which it is the province of the Universities
which deny that Dr. Macdonald was authorized to act for
them, to proceed against him, should they see fit, and not for
the judgment or intervention of this Council.”
The amendment was negatived.
The original motion was then put to the vote and carried.
Sir Domikic Corrigan required that the names and num¬
bers of those who voted for and against the motion, and of
these who declined to vote, should be taken down.
Majority, 10—The President, Dr Bennett; Mr Hawkins,
Mr Cooper, Dr Paget, Dr Alexander Wood, Dr Andrew
Wood, Dr Fleming, Mr Syme, Dr Parkes.
Minority, 9—Dr Embleton, Dr Storrar, Dr Thomson, Dr
A Smith, Mr Hargrave, Dr Leet, Dr Apjohn, Sir D. Corri¬
gan, Dr Sharpey.
Declined to vote—Dr A eland, Dr Quain, Dr Rumsey, Dr
Stokes.
Moved by Mr Syme, seconded by Dr Fleming, and agreed
to:
“ That WHKam Macdonald, M.D., having been judged by
tide General Council, after due inquiry, to have been guilty of
infamous conduct in a professional respect, the General Council
do hereby adjudge that the name of the said William Mac¬
donald be erased from the register; and do by this order direct
the registrar to erase his name from the register accordingly.”
Dr. Andrew Wood required that the names and numbers of
those who voted for and against the motion, and of those who
declined to vote, should be taken down.
Majority, 12—The Prendent, Dr Bennett, Mr Cooper, Dr
Adand, Dr Paget, Dr Alexander Wood, Dr Andrew Wood,
Dr Fleming, Mr Syme, Dr Parkes, Dr Quain, Dr Stokes.
Minority, 7—Dr Embleton, Dr Storrar, Dr A Smith, Mr
Hargrave, Dr Leet, Sir D. Corrigan, Dr Sharpey.
Declined to vote—Dr Thomson, Dr Apjohn, Dr Rumsey.
Moved by Mr Syme, seconded by Dr Fleming, and agreed
to:
-" That a copy of these orders, signed by the President in the
chair, and countersigned by the registrar, be transmitted to the
said William Macdonald, M.D.”
, MR. SYME’S MOTION.
Jhe adjourned debate upon Mr. Syme’s motion was then
summed by Dr. Storrar, who wished to state briefly why he
had seconded the amendment of Sir Dominic Corrigan. In the
first place he doubted if it was within the province of the
Council to issue any prescribed rules, and to say to teachers
that such and such should be the order, and that certain
ey a ses must be taught, whether their discretion told them
ii was right or wrong. That he considered to be a com¬
plete system of tyranny, and the sooner abolished the bet¬
tor. He would take his stand on the ground of liberty of
teaching and liberty of learning. He conceived it to be mon-
strong that a student should be required to attend a certain
number of lectures in the course of each term, and as it often
happened, on subjects that were perfectly useless in the de¬
partment of practice they intended to shape their course, and,
at waa frequently the case, the lecturer was thoroughly incom¬
petent to the task, and indulged his class with readings—some¬
times inaudible—from books that were useless in the present
g yge. And he could not help saying that students could spend
tjus hour—the torture of which they compelled them to
ergo—much more profitably by study at their own firesides,
course proposed to the Council would in effect tie up the
Whole system of medical education. He would get rid of the
intolerable system of lectures, and adopt one of drill, and of
tfytrbooks— io that the raw student going in at one end of the
tflgflhjne should come out an educated one at the other. A very
gfmnent authority—Mr. Simon—recommended that they should
of regulations altogether, so that if a man who presented
q fon s elf was found fit, he should be passed whether be had
gone through the prescribed formula or not. He considered
the scheme before them of the wildest conception; if they
chose to give a young man just a skeleton outline of the order
of study well and good; but to fix a precise mode for every
flher to impart to his class the knowledge he possessed was
tidy absurd. He would recommend that the question be
with by the Examining Boards, or still better, by the
Schools—the governing bodies of which would, if a certain
of elasticity were allowed them for existing differences,
* l out men much better prepared to enter upon the career
^had chosen, than if the council adopted the restrictive
t the proposed resolution. In the cause of freedom of
dor®, he would support the amendment.
July 1,1861. 15
Dr. Acland said although he would support the motion of Pro¬
fessor Syme, confessed his entire concurrence in some of the re¬
marks that had fallen from Dr. Storrar; although he did not
believe with that gentleman, that the existing educational fabric
was likely to tumble, he nevertheless maintained that much might
be done to improve it; one of the first steps towards which would
be, that they should dictate only such a course as was abso¬
lutely necessary ; that students should not be compelled to
attend certain lectures, or have their brains crammed with
subjects that would never be of use to them in practice. He
was therefore pleased that the subject which he had brought
before the Council some four years since, and which then
seemed distasteful to the majority, was now likely to go before
a committee, from whom he anticipated a solution of the
difficulty which, in the present condition of opinion on the
matter of education, cried for reform. It being six o’clock the
debate was again adjourned.
Friday, June 26.
After the minutes of the previous day had been read.
Dr. Risdon Bennett proceeded in a lengthy speech to
criticise the arguments adduced on both sides during the two
previous days’ debate, on the motion brought forward by Pro¬
fessor Syme. Although it was desirable to get through the
business of the session as speedily as possible, still on so impor¬
tant a question as that before them, every member should have the
opportunity of speaking, before giving a silent vote. Nothing
in his mind w*s more important than they should give out
what was necessary for the student to learn, and should see that
the licensing bodies taught the various subjects in accordance
with their recommendation. Opinions had been expressed that
the Council were either incompetent to deal with the subject,
or were reluctant to interfere with existing arrangements, or
that the difficulties surrounding it were insuperable, and that
therefore it was left without an attempt being made to alter
it. There might be some truth in the remarks that were con¬
stantly made use of out of doors ; for undoubtedly a grave
responsibility hung around the subject, but the time had now
arrived that they should face the difficulties ; so that no
grounds of complaint should be left as to their inability, or
incompetence to interfere. He agreed with several speakers
that there were great differences of opinion, but if it were
grappled with, he doubted not that the committee, if.ap¬
pointed, would receive ready assistance from all quarters, from
those teachers most competent to give it. He regretted so much
time and attention had been given to the pamphlet by Dr.
Parkes—not because he did not consider it a very valuable
production, on the contrary, but because the minds of the
Council were thereby more or less prejudiced by a book, which
after all, was but the opinion of one man, although he wottld
readily admit from the eminent position occupied by Dr.
Parkes, no one was probably better able to give it than he. If
he understood the proposition aright, the question was simply
how the various subjects deemed necessary for the acquire¬
ment of professional skill and knowledge, oould best be taught.
The proposition was of great value, one which he hoped the
Council would consider of paramount importance, and while
admitting it to be impossible that one particular mode of
teaching could be adopted by every teacher under all circum¬
stances, yet if a distinct understanding were not at once come
to, he feared they would merit the blame that had been con¬
stantly heaped upon them out of doors.
Dr. Paget was of the same opinion, and thought that the
expressions of the Council should not go forth as regulations
to be devoutly observed, but in the form of recommendations,
or suggestions, or if they chose, merely as expressions of
opinion to serve as a guide to those engaged in medical tuition.
Mr. Caesar Hawkins would support the amendment of Sir
Dominic Corrigan, and suggested that a oertain amount of
levity should be allowed to teachers, as they had to consider
not only the abilities of these, but the minds of the pupils
also. He agreed with one or two speakers that if they
attempted to enforce tuition by certain rules, they would
certainly be unsuccessful.
Dr. Embleton opined that if a committee were appointed,
it would at once become a nucleus round which to gather some
very valuable information ; he hoped the scheme w*uld be at
onoe broad and comprehensive, that it should be neither too
much English, Irish, or Scotch, but thoroughly British in all
its bearings. He would further suggest that a time be speci¬
fied when the report of this committee should be ready, and
that every member of the Council should, .be furnish* with ad*
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16 The Medical Press and Circutar. MEETING OP MEDICAL OFFICERS.
July 1,18*8.
copy thereof, before their next meeting, so as to be fully pre¬
pared to deal with the whole subject.
Dr. Stokes considered that the speeches at the present
juncture, might be taken as an evidence of what was passing
m the minds of the Council generally. He agreed with Dr.
Storrar that a line should be indicated but not enforced. Coer¬
cion might be necessary in subjects that could only be taught
by demonstration, because the student could not possibly have
the various apparatus—such as the dead body, &c., in Ins own
rooms ; but coercion should be entirely limited to such subjects
which must of necessity be demonstrative. He thought Mr.
Syme had spoken very severely of the tutorial system. The
tutorial system and the system of grinding or craming was
essentially different. The former sought to instil into the
pupil's mind, that it was not so necessary to learn a prescribed
number of subjects for a particular end ; but it endeavoured
to impress upon his mind how he could teach himself ; whereas
the latter endeavoured to fill his mind with a smattering of
facta, which although upon the surface only, would enable him
to answer the questions put in the regular examination.
Dr. Quain feared there was no probability of the Council
being able to come to any definite resolution, or to agree to any
particular course, if even they sought for information from the
various licensing bodies ; with so many diverse opinions he
thought there was little chance of agreement, and could not
therefore support the resolution before them. He was in favour
of examination being the test of merit. If a student should
acquit himself creditably of an examination which should be
eminently practical, he would pass that man, no matter how
or where he obtained the necessary knowledge, without re¬
quiring that he should produce a certificate of having attended
this or that course of instruction or lectures.
Dr. Fleming argued that if they oould find a committee in
the Council who were willing to undertake so arduous a task
as that proposed in Professor Syme’s resolution, they were bound
to accept it. It could at least do no harm, and might be pro¬
ductive of great good.
Mr. Syme replied to the criticisms his motion • had pro¬
voked.
The amendment of Sir Dominic Corrigan was put to the
vote, and lost by a majority of 13 to 7. Mr. Syme’s original
motion was then agreed to, and a committee appointed of
the following members :—
The President, Dr. Parkes, Dr. Stokes, Mr. Hawkins, Dr.
Sharpey, Dr Acland, Dr. Andrew Wood, Dr. Thomson, Dr.
Smith, Dr. Christison, Dr. Apjohn, Mr. Syme, Mr. Hargrave.
The consideration of the communications to the Council
from the Colonial Office, Home Office, and Chancellor of the
University of Melbourne, were next taken into consideration.
Sir Dominic Corbigan, in ririug to move “ That the General
Medical Council see no objection to the introduction of a clause
in any amended Medical Act that may be introduced, provid¬
ing that graduates in medicine of the University of Melbourne
shall be entitled to register as medical practitioners in the
United Kingdom on the production of the necessary proof of |
their having graduated in medicine in the University of Mel¬
bourne, and paying the fees payable on registration in the
United Kingdom,' saw no difficulty in granting so simple
and so just a request. They all knew that the University of
Melbourne stood very high in the estimation of men who were
most competent to judge. Some of the most creditable gra¬
duates he had seen had taken their diplomas from this Uni¬
versity, and he thought as the requirement that a graduate
from the colonies should first reside in Great Britain for one
year before he could be placed on the register emanated from
the Home Office and not from the Council, the time had now
passed when this should be a condition of his being allowed to
g ractise his profession here, provided he could produce a corti¬
cate authoritatively signed and sealed by the governing body
of the University in question. He was not afraid if the Council
adopted this course, that any laxity would be shown in the
granting of these certificates.
Dr. Andrew Wood would second this motion because he
considered a great injustice had hitherto been done to the
colonies, the graduates from many of the universities, of
which had proved themselves in every way worthy the privi¬
leges enjoyed by British subjects at home. He hoped the
council would take advantage of the present application, to
show the colonies that it was not only desirous of removing
the injustice which had so long existed, but also of dealing
liberally with them. Their was a great distinction between
foreign and colonial universities, he would certainly not grant
the same privileges to the former, and it was on these grounds
he hoped the motion would be passed, as they were bound in
justice to all the subjects of the British empire to remove any
line of demarcation that might exist.
Dr. Alexander Wood, Dr. Paget, Mr. Hawkins, Dr. Ac l an d,
and other speakers, agreed that the graduates from the Uni¬
versity of Melbourne reflected great credit upon its licensing
body, but feared that if the condition of a year's residence in
this country were removed in one case, a precedent would
thereby be established, and the council would be immediately
deluged with similar applications from every university in ex¬
istence; and as there were some whose method of granting
diplomas,was bo objectional that they could not possibly con¬
cede this privilege, complaints of injustice would be freely in¬
dulged in. Whilst, therefore, fully admitting the cla im s of the
University of Melbourne worthy the most serious attention of
the Council, they conceived it would be advisable to postpone
immediate action to some more favourable occasion.
The following amendments were then put to the vote :*—
Moved by Dr. Sharpey, and seconded by Mr. Syme :
“ That in any provision which may be introduced into an
amended Medical Act, for admitting to Registration persons
holding Degrees or Licenses from the University of Mel¬
bourne, previous residence in England be not required as a
condition of admission to such registration.”
The amendment was carried, and then put as a Substantive
Motion.
Moved by Mr. CjESab Hawkins, and seconded by Mr. Har¬
grave :
“ That in any provision which may be introduced into an
Amended Medical Act, by which power would be given to
Register Graduates of the University of Melbourne in the
British Register, previous residence be not required as a condi¬
tion of admission to such registration.”
The amendment was then put as a Substantive Motion, and
carried.
Moved by Dr. Sharpey ; seconded by Mr. Hawkins ; and
agreed to :
“ That the above resolution be communicated to the Secre¬
tary of State for the Home Department in reply to the letter
of the Chancellor of the University of Melbourne."
Moved by Dr. Alexander Wood :
“ That a Committee be appointed to consider the List of
Bodies whose Testamurs are considered sufficient evidence of
the student having received a competent Preliminary Educa¬
tion. That the Committee do also consider and report whether
any plan could be devised, by which the Council could better
supervise the Preliminary Examinations, or dispense with the
necessity for frequent supervision, or in any other way promote
the improvement of the General (preliminary) Education of the
Medical Student.”
This motion having been agreed to nent con, the Committee
was appointed by the mover as follows :—Dr. Alexander
Wood, Chairman; Dr. Fleming, Dr. Acland, Dr. Embleton,
Dr. Rumsey, Dr. Leet, Dr. Storrar, Dr. Sharpey, and the
meeting adjourned.
THE MEETING OF LONDON AND
PROVINCIAL POOR-LAW MEDICAL OFFICERS.
The aggregate meeting of London and Provincial Poor-law
Medical Officers took place on the 24th inst., under the presi¬
dency of Mr. Clements, F.R.C.S., and M.P. for Shrewsbury.
The following resolutions were adopted :—
“That this meeting is of opinion that it would be conducive
to tbe best interests of the State that the Poor-lew Board
should consist of a definite nnmber of responsible members ;
and, as the present arrangements for the treatment of the sick
poor are unsatisfactory, that the control of all medical ar¬
rangements, including the fixing of the salaries of the medical
officers, should be immediately subject to a special medical
department.”
(< That this meeting is of opinion it is desirable that in the
second article of the general order of the Poor-law Board,
dated May 25th, 1857, the words referring to residence within
the district be omitted ; and that since the words * or be re¬
moved by the said board' give unlimited, or at least too large
a measure of arbitrary power to the said board, these Words
either be expunged or be altered to * or be removed by the said
board after a public inquiry, of which due notice shall be
given.' And that some means be adopted to ensure the uni¬
form carrying out of the general order so altered throughout
the whole country.”
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fbs Vetted Pina and Circular.
CORRESPONDENCE.
July 1, 1888. 17
“ That it ia desirable to insert clauses in the Poor Belief
Bill now before Parliament—
**(a) To give effect to the opinion of the Poor-law Board
that the providing of medicines by guardians is an expedient
course.
“ (b) To make Clause 38 of the Metropolitan Poor Act,
1867, compulsory on the Poor-law Board.
u (c) To enable the Poor-law Board to direct the formation
of dispensary districts in the larger provincial towns, &c., as
and when they shall think fit.”
In the present crowded state of our columns, it is impossible
to give a lengthy report of the proceedings, and postponement
would be of little avail, as the General Medical Council is sit¬
ting, and its meetings must occupy much of our space. We,
therefore, content ourselves with an abstract of the speeches of
Mr. Clement, M.P., who, as chairman, lent valuable aid to the
movement, and of Dr. Rogers, who laboured to get up the
meeting, and himself took the first resolution.
The Chairman said that although the opposition of guardians
and the indifference of the Central Board might be as great as
ever, yet there was growing up a healthy public opinion which
in time would work out good results both for themselves and
the sick poor. Regarding a better treatment of the Bick poor
as a question above party, men of all shades of political
opinion had united in pressing upon the legislature the neces¬
sity for extensive reforms. They would soon be solicited by
candidates for votes and influence. Before pledging them¬
selves he strongly advised medical men to ask candidates that
in the event of their being returned they would promise to re¬
member the onerous obligations of the profession, their miser¬
ably insufficient payment, the total absence of any approach to
uniformity even in the same unions, the risks they ran of con¬
tracting mortal disease, and the various forms of illness that
might affect them and their families, and to support any mea¬
sure that might be brought forward with the view of doing
them justice. It was very desirable that there should be a
central board consisting of responsible members, not dummies
—men well-known to the public, and who should consult upon
all important questions as they arose, and establish uniformity
in all suitable matters. No, public department was in such
continued bad odour with the public as the Poor-law Board,
and this, he believed, was due to its unsatisfactory and unre¬
presentative character. One thing was very certain, it was
absolutely essential that a larger medical element should
be introduced into the discussions of the central body.
Up to a very recent period there was no medical staff
at all, and this arose because the new poor law of
1834 started with the assumption that there were no sick
at all ; and he remembered that at the time the bill was passed j
it was prophesied that at no distant date there would be no j
poor at all. As regarded the supply of medicine as part of the I
contract of the medical officers, it was derogatory to the
character of an educated and liberal profession that the medical
officers should be called upon to supply the medicines. In all
large towns, and in all possible places, drugs and appliances
should be found by the guardians. There might be difficulties
in certain localities where the population was thin and widely
scattered, but this should prove the exception to the rule.
Permanence of appointment he considered to be absolutely
requisite if Poor-law medical officers were faithfully and
honestly to perform their duty. Without it the medical
officer’s position was unbearable, and there was no security for
the proper treatment of the sick poor. No Poor-law medical
officer should be removed without grave reasons for it, and
after open public inquiry into his alleged shortcomings. In
conclusion, he trusted that they would be united, and that
they would show to their opponents that the supposed bAne of
the profession—intestinal division—would not operate to their
disadvantage on this occasion.
Dr. Rogers said that the question was, how could the
1,250,000 persons who annually became the patients of Poor-
law medical officers be best dealt with ? Should their atten¬
dants be provided with proper means to secure a more ready
restoration to health, or was the present faulty system to be
perpetuated, which perpetrated grievous wrong-doing, not
alone on the poor, who were the first sufferers, but also on the
good and conscientious of their own class, who faithfully fulfilled
their obligations. There was now a very wide-spread opinion
that what was popularly known as the “ Poor-law Board’*
Was not a distinctive corporate entity, but a mythical body.
Thera was certainly a president and a parliamentary secretary
who Were known, but generally it was for a very brief period only.
TfoW it was currently believed that because there was a presi¬
dent, a parliamentary secretary, and a “ board,” that, there¬
fore, there was a deliberative body that met and consulted
upon the various questions that constantly came up from the
provinces for settlement; but, having had leisure for investi¬
gating this subject, he was in a position to assert positively
that no such board existed. He would ask who was the board
when Lord Devon was away for weeks in the south of France
during the terrible distress in the East of London last winter ?
He very much wished that some independent member would
move for the production of the minutes of the “ board M meet¬
ings—who attended and how often, and generally that they
might learn something as to the mode in which the business of
an office costing some £60,000 a-year was conducted. If his
information was correct, the contradictory policy of the board
could be understood, and it could be explained why decisions
arrived at at one time should be reversed at another. With
regard to the inspectoral system, many of the inspectors were
by previous education and pursuits, utterly unfit to carry out
the duties for which they were appointed. That was now
officially admitted, for the Poor-law Board had recently, by a
general order, directed that the workhouse surgeons should do
these gentlemen’s duty for them. He would ask that there
should be a distinct medical department of the Poor-law
Board, to which all matters relating to the sick and medical
and hygienic arrangements should be referred. Seeing that
sickness amongst the poor was so enormous, and their atten¬
dants were between 3000 and 4000, this was not an unreason¬
able request. As an illustration of the glaring inequality of
salaries, he instanced the workhouse of St. Marylebone, with
its 1700 inmates, where the medical service cost £780 an¬
nually, and the workhouse of St. Pancras, with its 2300 in¬
mates, where the salaries amounted to £400 only ; and yet
both these arrangements had been sanctioned by the Poor-law
Board, though they knew that the money was paid from a
common fund equally levied on the whole metropolis.
-♦-
€oxxn$0n'i!tMt.
THE DISTINCTION OF GENERAL PRACTITIONERS,
SURGEONS, AND PHYSICIANS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —In the course of my medical career I have often had discus¬
sions with my fraternity regarding the above questions, and how
the public can distinguish which is which when required on an
emergency. It is acknowledged there is a difficulty about it,
and, though I do not consider one man a wit less respectable
than another, I think the subject ought to be made clear,
many medical men agree with my suggestions, as follows:—
A professional man in general practice should have engraven
on his plate, below his name, whatever diploma he may hold,
the words “ general practitioner a pure surgeon, that of
surgeon; and a pure physician, that of physician. The public
would easily discern the particular class of practice in each
case, and the fees customary to be paid, according to ancient
custom. Another suggestion I would make is, the professional
dress. All black should be adopted, similar to the clergy,
who have no further claim to it, solely except habit; but that
the general practitioner should wear a black neck-tie; the
operalinp-surgeon all red, and the physician all white, with
cambric edge ; the neck-doth to be made either of cambric or
satin. Lastly, what is the correct court dress, I am asked t
as I see several of the profession at court occasionally, but no
two alike. The correct one for a physician is black velvet;
for a surgeon I leave you to define that question, I know not.—
I am, sir, yours obediently,
A Member of the Profession.
London, June 18, 1868.
TREATMENT OF THE APPARENTLY DROWNED.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —I beg to transmit to you a paper of queries just issued
by the National Life-boat Institution regarding the treatment
adopted in cases of apparently drowned persons.
We are of opinion that the cause of science would be much
benefited if answers to these queries were accurately and
promptly reported to this Institution by medical men and
others; and, in order to elicit this valuable information, we
calculate on your kind co-operation by conceding to this Insti¬
tution the favour of publishing the queries in the columns of
Digitized by
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18 The Medical Press and Circular.
CORRESPONDENCE.
July 1,1868
The Medical Press and Circular.—I am, Bir, yours faith¬
fully, Richard Lewis, Secretary.
Royal National Life-boat Institution,
John-street, Adelphi, June 24, 1868.
“ As the cause of science would be greatly benefited if the
result of the treatment in cases of apparently drowned persons,
were reported, it is requested that answers to the following
questions on the subject may be immediately forwarded to
the Royal National Life-boat Institution :—
“ Queries. —1. Date and place of occurrence? 2. Sex,
name, and age of person ? 3. Length of time immersed ? 4.
Time from rescue to first sign of life ? 5. Time from
rescue to recovery ? 6. State of the weather, if warm or cold ?
7. State of the water ? 8. What mode of treatment adopted,
whether the rules of the National Life-boat Institution or those
of others—if the former, whether the “ Marshall Hall” system
or the “ Silvester” was adopted, or a combination of both ?
9. If treatment successful or not ? 10. Length of time perse¬
vered with ? 11. How long were the efforts to restore respira¬
tion continued ? 12. Was much fluid discharged from the
mouth, and at what intervals ? 13. Was a medical man in
attendance ? 14. Remarks, if any ? ”
LIEBIG’S FOOD FOR INFANTS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —Allow me to thank you for the article in your valuable
journal of June 10, and your correspondent “ M. A. B.,”
for drawing the attention of your readers in the follow¬
ing week, to the necessity of an inquiry into the respec¬
tive value of infants food in general, by one of the Medical
Societies. As manufacturer of the food in question, and hav¬
ing such perfect confidence in the result of the most rigid tests
it can be subjected to, nothing will give me greater pleasure
than the proposal of your correspondent. At the same time,
I hope that similar tests may be applied not alone to Liebig’s
preparation, but to all other kinds of farinaceous food, with or
without Liebig’s name. This, indeed, would be a great boon
to the profession and to society, for at present there exists
much confusion and doubt upon this important subject.
I agree with “ M. A. B.” that it would be well for the
medical profession to suspend judgment upon food which is
not compatible with physiology, and in that respect I venture
to assert that those lands which, freed fronh husks, show the
most complete reduction of starch into dextrine and grape
sugar are comparatively the best. In the meantime, that the
children may not starve, I can supply sceptics with an “ autho¬
ritative verdict” respecting Liebig’s Food as follows :—
“ We have been requested to express ouropinionon a project for
supplying to the infants of poor persons, either gratuitously or
at a reduced charge, the preparation of milk introduced by
' Baron Von Liebig. We have to state that every facility that
is given for the purchase and distribution of so good a food as
this, will, in our judgment, be instrumental in reducing the
intolerable amount of siclmess and mortality among infants
that we know to exist at present ; and we are satisfied that
hospital and dispensary work will become more hopeful from
the time that we are enabled to assist poor infants with
appropriate food:—
(signed)
Edwin Lankester, M.D. Herman Weber, M.D.
Thomas Hillier, M.D. W. R. Rogers, M.D.
C. H. F. Routh, M.D. E. Symes Thompson, M.D.
George Buchanan, M.D. John Wbstmacott, M.D.
John Charles Steele, M.D. F. Barozzi de Vignole, M.D.
R. Druitt, M.D. Graily Hewitt, M.D.
J. Braxton Hicks, M.D. F. Edmund Anstie, M.D.
J. Cooper Foster. Henry Smith, Asst.-Surg.
Henry Gervis, M.D. B. Curgenven, M.R.C.S.”
A verdict pronounced by a society of such talented men,
surely ought to be an “ authoritative one” in the eyes of the
profession, as it is in that of your obedient servant,
16, Tichborne-street, London, W. G. Mellin.
MEDICAL WITNESSES’ FEES.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sib,—A n answer to under-mentioned case in your next publi¬
cation will greatly oblige,—Yours, <&c.,
R. Brown M‘Clelland.
Banbridge, June 26, 18C8.
A station-master on the Dublin and Belfast Junction Rail¬
way was found dead with a pistol wound in the middle of the
frontal bone. To see the exact character of the wound it was
necessary to make an incision and dissect back the ocoipito
frontalis muscle, and prove that the bullet entered the brain,
at an inquest held on the body by two Magistrates.
Query. —Does this constitute a post-mortem under the
Coroner’s Act, and entitle the medical witness to a fee of
£2, 2s. or not.
P.8. —I ask this, as one of the Magistrates has refused
giving his name for any amount beyond one guinea.
R. B. M‘C.
[Our correspondent is clearly entitled to £2, 2s., the fee
for post-mortem examination, without which it would have
been impossible to swear to the fact that the bullet had entered
the brain and caused death.]
THE TURKISH BATH IN ACUTE BRONCHITIS.
TO THE EDITOR OP THE MEDICAL PRES8 AND CIRCULAR.
Sir, —As the following cases may interest your readers,Y beg
the favour of their insertion in your valuable journal:—
I was sent for the other night at about 12 o’clock to see the
child of a poor woman, said to be dying of suffocation of the
chest. On reaching the house, or rather cabin, I found a fine
little boy, aged three and a-half years, almost suffocating from
an attack of acute bronchitis. The face was nearly livid and
much congested ; skin hot and dry; pulse rapid ; and the
wheezing so hard and loud that I could hear it distinctly before
I had entered the house. I at once ordered it a full warm
bath for 15 minutes, to be followed by a linseed meal poultice
over the chest and back, the limbs to be wrapped up in flannel
wrung out of hot water, and covered with a dry blanket. In
the morning the child was certainly better, and had perspired
very freely in the night, but still the symptomB were very
severe and urgent. I at once ordered it to be taken to the
Turkish Bath, on its return from which the mother reported to
me that it was wonderfully better, that the bath had acted
like a charm, and after it had been ten minutes in it perspiration
set in freely, and the wheezing seemed to have nearly entirely
disappeared. I ordered another Turkish bath to be administered
in the evening, and the following morning the mother reported
to me the child was all but well, and keeping it quiet in bed
was utterly impossible; two baths were again administered
the foliowring day, and the next the child was perfectly well,
and breathing quite natural.
The second case I would mention, is that of an infant of my
own which, in December last, at the age of eighteen days, con¬
tracted an acute attack of bronchitis through carelessness of
the nurse. I found it almost moribund. I had it well
wrapped up and carried at once into the Turkish Bath, where
its symptoms in a few minutes became greatly mitigated, and
at the end of a quarter of an hour a papular eruption made its
appearance over the chest and back, greatly relieving the
distress of breathing. After the bath, I had a compress of
cotton-wadding covered writh oil-silk applied over the chest and
back, ordered a Turkish bath to be given the next and follow¬
ing day, when the child became quite convalescent, and rapidly
recovering. The paroxysms of dyspnoea in this case were very
severe, and several times the nurse sent for me to say tlje
child was dying, and that nothing but squills and tartar emetic
could save it.
Case 3.—W. G., aged 52, was attacked writh pleurisy and
inflammation of the lungs. I found him in great pain writh
great difficulty of breathing, rapid pulse, hot skin, foul tongue,
hackingcough, and the characteristic “ prunejuice” expectora¬
tion. There was much pain in breathing on the left side, and
the stethescope gave unmistakable signs of attrition between
the pleural surfaces. As it was inconvenient to have the
patient wet packed, I ordered a hot stupe to be applied over
the chest for twenty minutes, followed by a linseed meal poul¬
tice for four hours, after which a wet chest compress was to be
applied, refreshing it every two or three*hours when very hot
or dry. A wet stomach compress was also ordered, and a
tepid wash-down at 92° morning and evening. Diet to consist
of oranges or stewed apples, and cold water. Suffice it to
say that the case made steady and rapid progress to recovery,
and in seven or eight days he was up and about his business.
I need not say that in none of the above cases was a par¬
ticle of medicine or stimulants administered in any shape
or form, nor was any drink allowed but milk or cold water,
alone or mixed. In the last case, when the appetite improved,
gruel or stirabout, with potatoes and cabbage, or other vege¬
tables for dinner, alone were allowed.—Yours faithfully,
R. Griffith, Ch. M.
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hs Medial Press end Circular.
MEDICAL NEWS.
July 1,1868. 10
D&. PROSSER JAMES’ PLAN OF REFORMING THE
MEDICAL COUNCIL.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—I t gives me great pleasure to see that Dr. Prosser James,
in his admirable address to the enlightened constituents of
the Edinburgh and St. Andrews Universities, expresses him¬
self as in favour of the granting of one State degree in medi¬
cine in various parts of the kingdom, by means of ambulatory
examiner*. I am glad to say that in a recent conversation with
Dr. Sharpey, that illustrious gentleman also expressed to the
writer an opinion favourable to such a change being made. As
to tiie machinery of examination, there seems to me to be but
little necessity in looking about for a fresh staff of examiners
when we have such an admirable body of men already in com¬
bination in our Medical Council.
It appears to me that these gentlemen might easily obtain a
charter from Government enabling them to grant a degree for
a small sum—say £10—obligatory, as Dr. Prosser James says,
on all before any other degrees were taken, but after which
any other fancy degree might be added, and which degree
(which, I hold, ought to be called Doctor of Medicine) should
alone admit to all public appointments, whether in the army,
navy, or poor-law services.—I remain, sir, yours obediently,
Charles R. Drysdale, M.D.
99, Southampton-row, W.C., London,
July, 1868.
-♦-
GENERAL MEDICAL COUNCIL.
The Council, while these pages are being printed, are engaged
on the discussion of the representation of the Medical Practi¬
tioner- The programme for yesterday (Tuesday) contained a
notice of a motion by Dr. Andrew Wood :—
“ That the Medical Council take into consideration its pre¬
sent constitution, with the view of determining whether it be
not advisable that it shoidd be placed on a more popular basis,
by the addition of a certain proportion of members to be chosen
directly by the suffrages of Registered Practitioners.”
This proposition will probably lead to a prolonged debate,
and it is therefore unlikely that Mr. Paget’s motiou—
“ That in future every person whose name shall be entered
for the first time on the Medical Register shall be entitled to
receive, on application, a copy of the Register for the year in
which his name has been entered”—
will come on.
The following communications are also before the Council
for consideration:—
6. Communication from the Royal College of Surgeons of
England, relative to some of the educational recommendations
of tiie Medical Council.
7. Resolution passed by the King and Queen's College of
Physicians in Ireland, relative to the age at which candidates
for its licence may be admitted to examination.
9. Application from Dr. Frederick Milford to be registered
as M.D. (by examination) Heidelberg, 27th June, 1856.
10. Communications from the Medical Teachers’ Associa¬
tion respecting the registration of students.
11. Letter from Dr. James Mason, relative to the Medical
Acts Amendment Bill.
12. Letter from Dr. Edwards Crisp, relative to the adjudica¬
tion of the Carmichael Prize.
. 13. Memorial from the North of Scotland Medical Associa¬
tion, relative to the position of Parochial Medical Officers.
-♦-
gpbical ito.
University or Cambridge.—S cholarships at Syd-
ney Sussex College. There will be an Examination at this
College, on Wednesday, October 7, 1868, open to all students
who have not begun to reside in the University, when (provided
fit Candidates present themselves) the following Scholarships
will be filled up :—two for Classics only, £40 ; two for Mathe¬
matics only, £40 ; two for Natural Science, Heat, Electricity,
Chwnistry, Geology, Anatomy, or Mathematics, £40 ; one or
more Johnson Exhibitions, £32, per annum each; Two Scholar-
be held by the same person, and each will be tenable
f^Hfcfoeyears it least, or until promotion to another of greater
virfue. &2?.~A1I Candidates will be expected to show a fair
tanrfedgeof the** subjects in Classics, and also of Arithmetic,
the early part of Algebra, and first three Books of Euclid. Books
recommended by the Examiners for the Natural Science
Scholarships:—Heat and Electricity, Ganot’s Physics ; Chemis¬
try, Fownes, Church and North cote’s Chemical Analysis ;
Geology, Lyell’s Principles and Manual; Anatomy (Human
Osteology and General Anatomy), Gray’s Anatomy, and
Holden on the Bones. The names of Candidates must be
entered on the College boards on or before October 1st. Any
further information may be obtained of the Tutor (the Rev.
J. C. Williams Ellis). Candidates must present themselves in
the College Hall, on Wednesday morning, October 7th, 1868,
at nine o’clock.
London Medical Benevolent Fund.— Election of
Annuitants.—At a special meeting of Committee two vacant
annuities of £20 were filled up as follows :—No. 66 . A widow,
aged 67, Edinburgh, maintained herself for many years ; now
suffers from rheumatism and dropsy ; on the list of candidates
since 1862. No. 67. A widow, aged 70, Sussex, has passed
through many misfortunes, suffers greatly from rheumatism,
recommended by several eminent members of the Profession ;
on the list since 1866. The fund has already distributed in
the course of the year, in addition to the annuities, £420 among
fifty cases of extreme distress.
The Health of London.— It appears from the re¬
turn issued by authority of the Registrar-General, that in the
week ending on Saturday, 4546 births and 2754 deaths were
registered in London and in thirteen other large towns of the
United Kingdom. The annual rate of mortality was 22 per
1000 persons living. The annual rate of mortality last week
was 20 per 1000 in London, 21 in Edinburgh, and 17 in
Dublin ; 26 in Bristol, 21 in Birmingham, 26 in Liverpool, 80
in Manchester, 23 in Salford, 27 in Sheffield, 20 in Bradford,
22 in Leeds, 16 in Hull, 24 in Newcastle-upon-Tyne, and 28 in
Glasgow. In London the births of 1024 boys and 1001 girls,
in all 2025 children, were registered in the week. In the cor¬
responding weeks of ten yean (1858-67) the average*number,
corrected for increase of population, is 2054. The deaths re¬
gistered in London during the week were 1228. It was the
twenty-fifth week of the year; and the average number of
deaths for that week is, with a correction for increase of popu¬
lation, 1250. The deaths in the present return are less by 22
than the estimated number. The annual rate of mortality
was 21 per 1000 in West London, 20 in North London, 21 in
Central London, 21 in East London, and 20 in South London.
The deaths from zymotic diseases were 328, the corrected
average number being 335. Five deaths from small-pox, 59
from measles, 32 from scarlatina, 2 from diphtheria, 58 from
whooping-cough, 35 from fever, 66 from diarrhoea, and 8 from
choleraic diarrhoea were registered. The prevailing high tem¬
perature has caused an increase in the mortality from diarrhoea,
and has also occasioned some deaths from choleraic diarrhoea.
It is of great importance that the utmost vigilance should be
exercised by inspectors of nuisances at the present time. The
application of disinfectants to drains, and an abundant supply
of pure water to every house* are essential. It would be false
economy to imitate the Whitechapel board, which has recently
reduced its staff of inspectors of nuisances. The deaths from
fever were at the annual rate on 10,000 living of 4 in West
London, 4 in North London, 6 in Central London, 13 in East
London, and 3 in South London. In calculating these results
the deaths in the London Fever Hospital have been referred
to the districts from which the patients were brought. The
deaths of 7 'infants and 1 adult from syphilis, of 6 persons
from drowning, of 9 infants from suffocation, of 4 persons who
committed suicide, and of 6 persons who were killed by homes
or vehicles in the streets, were registered. A builder aged 65
years died on 14th June, at 82, Howland-street, St. Fancras,
from “ coup de soleil, 8 days, effusion, 2 days.”
Mortality by Enthetic-Disease.— In the ten
years 1857-66 no less than 12,786 lives have been destroyed
in England and Wales by enthetic disease (syphilis) alone.
The number of deaths registered in each of the ten years was
957, 1006, 1089,1067, 1177, 1245, 1386, 1550, 1647, and 1662.
Allowing for increase of population the results show that the
mortality by this disease is steadily increasing ; thus, to
1,000,000 persons living in each of the years 1857-66 the pro¬
portional number of deaths was 50, 52, 56, 54, 59, 62, 68 , 75,
79, and 79 respectively. The results published by the Regis¬
trar-General show the lamentable amount of suffering
death which this disease entails upon infant life. Out of 1$)9L4-
deaths from enthetic disease registered in England and Wales
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20 The Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
July 1,1868-
in the 12 years 1854*65, no less than 9512, or 69 per cent.,
were those of infants under one year of age ; in 1854, out of
964 deaths, 577, or 60 per cent., were those of infants under
one year of age ; and in 1865, out of 1647 deaths, 1155, or 70
per cent., were those of infants who had not completed their
first year of life. In London, in the 12 years 1854-65 3370
deaths were registered from enthetic disease ; in 1854 the
deaths numbered 206 ; in 1865 they were 392. Of the 3370
deaths the large number of 2587, or 77 per cent., were those of
infants under one year of age. In 1854, the proportion of
deaths of infants to total deaths was 43 per cent., in 1865 it
was 76 per cent. The deaths registered from enthetic disease
represent only a small proportion of the cases, and the syphiline
sets up actions which affect various organs, and gives rise to
diseases referred to other causes of death.
Association for Promoting the Extension of
the Contagious Diseases Act. —A general meeting of the
members of this association was held on Friday, at St. James's
Hall; Sir Thomas Watson, Bart., in the chair. A report
going at length into the objects of the association, and giving
statistical evidence of the great prevalence of the disease which
the association sought to grapple with, was presented to the
members. The Chairman, in the course of his remarks, stated
that such were the ravages of this disease that in one of the
largest hospitals of the metropolis, amongst the surgical out¬
patients half were found to be suffering from it, and in the
children's hospital there were 174 children treated for this
alone. The Act of 1866 was already in operation amongst
soldiers and sailors, and it was the object of the society to ex¬
tend its benefits to the civil population, but denied that any
member of the society, in pressing this matter, had any idea of
licensing prostitution. The meeting was further addressed by
several members of the profession and others, and resolutions
were passed adopting the report, authorizing the carrying out.
of the objects of the association, expressing an opinion that the
“ Contagious Diseases Act*’ should be extended to the civil
populatioil of the country, and that petitions upon the subject
should be presented to both Houses of Parliament.
At a meeting of the Metropolitan Board of
Works on Friday last, some magnificent samples of wheat,
opts, Ac., were shown, as results of the utilization of London
sewage, on land hitherto comparatively barren.
It has been determined to proceed with the new
Fever and Small-pox Hospital in the neighbourhood of Brixton,
notwithstanding the strenuous opposition of the inhabitants ;
the <Poor-law Board holding out no hopes that they can inter-
fere.
-♦-
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in England on or before Friday morning are
expected to be returned to the Editor, at the office, 90, Ki ng
William-street, 8trand, W.C., before five p.m., on Friday afternoon.
Proofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two p.m. on Saturday, which is
an early dosing day. Duplicate proofs are sent to authors, in
order that they may correct and return one copy, and keep the
other for private use. Contributions should be lxoibly written, on
one side of the paper only.
8axitas.— Owing to unusual pressure on our space, your com¬
munication is unavoidably postponed.
Dr. C. Dbysdalk.— The One Portal 8ystem—see previous reply.
“FLUID EXTRACT BELLADONNA.”
TO THX EDITOR OF TUB MEDICAL PRESS AMD CIRCULAR.
Sir,— In reply to your correspondent Mr. Johnston, there is no accre¬
dited preparation called fluid extract of belladonna. Other fluid extracts
in the Pharmacopoeia are made simply by stopping the process whilst in
a state of fluidity, such as sarsaparilla. I therefore apprehend that
extract of belladonna, which itself is a soft solid , if made semi-fluid by
water, would answer the purpose.—Yours, &c.,
A Member of thb Pharmaceutical Society.
MOLLEB’8 COD-LIVER OIL.
The Norwegian Medical Sodety having received an application relative
to the medicinal use of pale cod-liver oil prepared by Peter MoUer*s
process, the subject was duly discussed at the meeting of the society
held on 16th January last. Professors Chr. Boeck, Heiberg, Voss, Zoch-
mann, the President of the 8odety, and several other members, took
part in the discussion. From the information supplied and authenti¬
cated on that occasion, it may be laid down as a fully-substantiated fact
that the physicians to the hospital and the profession generally in this
city rarely, if ever, prescribe the brown oils, and when they do so, from
economical reasons alone, having a decided preference for the pale oil
obtained by Mr. Peter Muller’s mode of preparation, the latter having
been proved by experience to be equally powerful in its therapeutic
action, for less nauseous, and much easier of digestion. Several officially
appointed practitioners who attended the meeting gave evidence to th*
effect that this variety of pale oil, though more expensive, is adminis¬
tered even to pauper patients, on account of its singularly beneficial
and salutary properties. Otto Zumd, President.
A. Holst, Secretary.
Christiania, January 80th, 1868.
COMMUNICATIONS RECEIVED.
Notes on some peculiar cases of Syphilis. By A. M. Porter, M.O.
On some points connected with the Operation Hare-lip and Excision
of the Lip for Cancer. By R. Kinkead, A.B., Ac.
Urea and Urio—Their relation to Health and Dise as e. By B.
Kelly, M.D.
Lecture.—The Use and Abuse of Stimulants. By W. J. Cummins,
M.D.
The Progress of Sanitary Improvements in existing Hospitals. By
F. Oppert, M.D.
Letter from E. Crisp, M.D.
-♦-
BOOKS, PAMPHLETS, &c., RECEIVED.
Diseases of Children. By Thomas Hillier, M.D. London: Jamas
Walton, Oower-street.
On the Action, Uses and Value of Oxygen. By 8. B. Birch, M.D.,
M.R.C.P.,* &c. London: John Churchill and Sons.
Testimonials in favour of Dr. A. R. Simpson, Candidate for the
Chair of Midwifery. Glasgow University. 1st, 2nd, and 8rd series.
The Causes and Treatment of Lateral Curvature of the Spine. By
R. Barwell, F.R.C.S. London: Robert Hardwicke.
Hoarseness, Loss of Voice and Stridulous Breathing. By Morell
Mackenzie, M.D..M.R.C.P. London: John Churchill and 8ons.
Principles of Forensic Medicine. By W. A. Guy, MJi.Gsnteb.
London: Henry Renshaw.
Dr. Addison's Works, published by the New Sydenham 8odety. 1888.
Schlangenbad, its Medical Importance. By Rudolph Wolf, 1LD.
London: Asher and Co.
The Pathology and Treatment of Ulcers, and Cutaneous Diseases of
the Lower Limbs. By J. Kent Spender, M.B. London: John
Churchill and 8ons.
The Journal de Mededne.—The Pacific Medical Journal, Ac.
APPOINTMENT.
Hayward, Sid yet, M.D., has been appointed a Physician for out¬
patients to the Samaritan Free Hospital for Women and Children.
DEATH.
Buber— At Scariff, June 90, Thomas Burke, M.D., of KfUaloe.
NOTICE TO ADVERTISERS.
t gpirfcal §r m auto €)irntlar
OFFERS UNUSUAL ADVANTAGES ~
F OB the Insertion of announcements from its extensive
and largely increasing circulation in each of the three
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supplied to the Hospital Libraries, Ac., it will be found a moat
valuable medium for Advertisements of Books, Vacancies and
Appointments, 8ale§, and Transfers of Practices, Surgical Instruments,
Chemicals, ana Trades generally.
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The average of words per line is twelve.
When advertisements are given for a series of insertions, a very con¬
siderable reduction from the above scale is made.
KBTAdvertisements for Insertion in this Journal must be at the
Office, on Saturday, by Thbrb o’Clock.
EASY chairs, couches, and sofas,
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800 different shapes eonstantly on view for selection and immediate
delivery. Easy Chairs made to any shape on approval.
FILMEB AND SON,
UPHOLSTERERS,
81 A 89, Bemers-street, Oxford-street, London, W.
Factory—34 A 86, Charles-street.
An Illustrated Catalogue post free. ._
WEAKNESS.—The finest TONIC is WATERS’
it QUININE WINE, unrivalled as a stomachic stimu¬
lant. Sold by grocers, oilmen, oonfectioners, Ac., at 80s. per dozen*
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Cannon-street, London.
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44 SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, JULY 8, 1868.
CONTENTS.
ORIGINAL COMMUNICATIONS.
The r rogree e of Sanitary Improremente
in Existing Hospitals. By F. Oppert,
M.D. fade SI
Notes on some Peculiar Cases of Syphilis.
By Angos M. Porter, H.D. 85
HOSPITAL REPORTS.
Ricqcovp Sumioal Hospital—
Snonnona Inearoecated and Snbse-
Spentl? St r an gu l at ed Iogtrfno-Scrot&l
Hernia,probably Congenital: Difficulty
of Diagnosis: Operation: Violent Peri¬
tonitis: Recovery. Under the care of
Ifr. WnUam Stokes. 26
CjTT or Dmu Hospital—
Cues of Onychia, with Operation for
PAOS
Removal of the Diseased Nail. Under
the care of Mr. Croly. 38
FOREIGN MEDICAL LITERA¬
TURE.
Transactions of the Swedish Society of
Physicians. Translated by W. D.
Moore, M.D. Dub. et Cantab.,
L.K.Q.C.P.I., M.R.I.A.. 28
LEADING ARTICLES.
The Constitution or ths Medical
Council . 84
NOTES OB THB OeBAT DbBATE IN TBB
Medical Council . 35
NOTES ON CURRENT TOPICS.
The Future President of the Medical
Council.—The Royal College of Phy¬
sicians of London.—Royal College of
nu
Surgeons of England.—Medioal Par¬
liamentary Representation. —Medical
Statistics of the Abyssinian Expedition.
—First-Fruits of Sanitary Reform in
Liverpool.—What should we Drink!—
Poor-law Salaries in England.88-7
CORRESPONDENCE.
S*n ita s on Dining. 46
MISCELLANEA.
General Council of Medical Education
and Registration. 80
Dr. Charles Drysdale on Prostitution. 48
Royal Medical Benevolent Fund Society
of Ireland. 47
Copy of “ Medical Practitioners’ (Colonies)
Bill”. 48
Medical News, Notices to Correspon¬
dents, Ac.47-8
THE PROGRESS OF SANITARY
IMPROVEMENTS IN EXISTING HOSPITALS.
^ By F. OPPERT, M.D.
(Read before the Medical Society of London.)
Btibt subject connected with public hygiene finds a
deferred attention in this country, and great care is at
present bestowed on all measures for the prevention and
treatment of diseases'.
hospitals are capable of being improved in many ways,
and it is useful to take notice of every recent improve-
Taent introduced with advantage, and to direct public at-
Uation constantly to these important matters.
r. hospitals not capable of improvement.
There are of course some hospitals in existence which
eatt^ot be improved at all, their construction being radi¬
cally faulty, and they are better pulled down to give place
to others, than wasting money on their improvement.
The old H6tel Dieu in Paris belongs to this order, and
though still in use, will shortly come down. The new
building, which I saw in course of construction at a recent
viaik stands close to the old one, and is being built on the
E ivilion plan. The Circular Asylum in Vienna, the
ying-in Hospital in St. Petersburg, some military hospitals
Pwjia* the old Fever Hospital in Glasgow, and other
institutions, have been found utterly unfit for improve¬
ment and arc now replaced by others. In many estab¬
lishments the process of improvement goes on without
remittance. Many hospitals in London, Paris, Munich,
Bejrttg, and Vienna are already materially improved, others
Hul be gradually ameliorated.
PREVENTION OF OVERCROWDING.
There is one mode of improving the healthiness of even
• veiy defective building, viz.: by diminishing the num¬
ber of inmates, and by occasionally emptying the wards.
It is a-pity that,in many instances, this is riot done be-
wrfc Atonal diseases, such as erysipelas, pyaemia, fever,
their appearance. As regards London hospi-
workhouse infirmaries and the foundation of
hospitals are likely to diminish the press
y to Wop and overcrowding. It has been found in
7*™% that the healthiness of the General Hospital was
ttynma by the foundation of the new hospitals, Wieden
and Rudolphstiftung, which receive a portion of the sick
population.
A hospital should never be too full. But I actually
found last year, additional beds placed in the wards in
excess of the number originally intended, and I also saw
two patients placed in one bed in an infirmary. I should
consider it far more expedient to construct temporary
sheds or tents in the gaiden or yard than to overcrowd
the wards.
CLASSIFICATION OF PATIENT8.
Another means of improving the arrangements and
furthering the cure of disease is by proper classification and
distribution of the patients in the building. It is well-
known that the pavilion plan offers great facilities in this
respect, but also in corridor hospitals much more can be
done than is done at present.
First, as to separation of sexes, we find sometimes men's
and women's wards adjoining on the same floor as in the
Manchester Infirmary, the proposed cottage hospitals offer
the same objection ; at other times both sexes use the same
yard or garden for exercise, or they sit together in the
convalescent or waiting-rooms. This might easily be
better arranged. In many Paris hospitals there are separ¬
ate gardens for men and women, for instance in the*
Charity ; in many German hospitals the men occupy one
side of the building and court-yard, which by-the-bve
may be tastefully laid out with shrubs, and females the
opposite ones.
Next, as to age, children are often found in the wards
of adults (St. Bartholomew’s Hospital). But this is unde¬
sirable, as children ought to have specially trained nurses,
and they require special utensils. It is also for the sake
of decency necessary that they should be separated.
Therefore special wards or blocks and special play-grounds
should be given to them, if they must be admitted into
the establishment.
Thirdly, medical and surgical cases should not be in the
same wards as in the Royal Free Hospital, though no eviT
consequences, I was told, are observed there. It has, how¬
ever, been noticed in military hospitals that where fever and
surgical cases were close together, the wounds often became
sloughing. In some cities surgical cases are exclusively ad¬
mitted into surgical hospitals: in Rome two buildings of this
description exist. It is well-known that the London genet&l,
hospitals admit surgical cases in excess to medical ones,
ana place more beds at their disposal, and that they oontai*
apecial accident wwda.
*nly 8 , 180 &
$2 The Medical Press and Circular. OPPERT ON SANITARY IMPROVEMENTS.
It has scarcely to be mentioned that women in their
confinement must be kept as separate as possible from
fever as well as surgical cases.
Again, certain medical cases should be separate from
others. In hospitals which serve for clinical instruction,
we generally find the more important cases removed to
special wards, which are arranged with special care, and
the lighter cases are in other rooms. This is better than
a clinical teacher having his cases distributed through the
wards. We often find a female department, especially
one for cancer (Middlesex Hospital, Berlin Charite, and
some Paris hospitals), and this seems a satisfactory
arrangement. It is rare that patients with lung diseases
are congregated in the same wards (as in Traube’s wards
in Berlin), but this is convenient for clinical instruction in
auscultation. Contagious diseases, such as small-pox,
measles, scarlatina, &c., should always be treated in
separate rooms. Also, noisy patients should have separate
accommodation. A more doubtful question is whether
patients attacked with typhoid, or typhus, fever should be
excluded from the medical wards of a general hospital or
not. To discuss this point alone might occupy a whole
evening. State hospitals are conducted on different prin¬
ciples, m this respect, to private ones, the former being
liberal in their admission, the others act on restricted
principles. We find, however, in this country hospitals
supported by voluntary contributions, which admit fever
patients into the general wards, for instance Leicester, and
this without detriment to the others. In Germany, where
typhoid fever, the less contagious form of fever, is more
common than typhus, fever patients are constantly with
the others. It seems to me that the contagiosity of the
fever varies in different countries and places, and at certain
times, and that the question how to accommodate fever
patients must often be decided on local grounds.
As for surgical cases, they should be on the lower floors,
accidents especially; eye cases should be separate, as noth¬
ing is more dangerous to the results of eye-operations than
a traumatic atmosphere. Special eye wards are generally
found in Continental hospitals—Berlin, Vienna, &c., but it is
only lately that attention has been paid to this arrangement
in this country. So I read lately that certain London hos¬
pitals have adopted this plan, and it can easily be instituted
in many country hospitals. A dark room, for ophthalmo¬
scopic researches, has to be added where needed.
Special departments for other patients—viz., ear, laryn-
goscopic, female cases,' may, in many instances, be advis¬
able, not only for the purposes of medical education, but
to prevent the starting of too many special hospitals.
Lock wards may be added the more easily to general
hospitals, as the syphilitic patients can very well be accom¬
modated in the attics, and new attics can be built for
them if necessary.
ACCOMMODATION OF THE OFFICIALS.
The officials should be properly accommodated. It is
veiy rare that any one takes the trouble to visit the ser¬
vants 1 rooms. I believe that Continental hospitals are
more defective in this respect than those of Great Britain,
as it is not rare to find these people living underground in
the former establishments. If I remember rightly, some¬
thing of this sort may be found in Hamburg and Berlin.
In some French hospitals I found too many beds for night
nurses (vieilleuses) placed in one room, and so it is in some
English hospitals. Recently the servants of St. Mary’s
Hospital have received better accommodation, and the
nurses of University College Hospital are about to enjoy
more spacious sleeping-rooms.
VENTILATION.
I come now to a most important question which never
should be lost sight of by hospital authorities, this is how
to improve the ventilation. The cubic space is easily in¬
creased by diminishing the number of bedsteads, but to
improve the circulation of air in the wards is more difficult.
You have often to remove partition-walls, form apertures
in the walls and ceilings, place louvres over the doors,
put in hopper-mouthed window panes, oy institute ventilat¬
ing fires, &c. There are some managers of hospitals on
the Continent, and I had the honour to confer with them
on the subject, who make light of such improvements as I
just mentioned; they aver that it is quite sufficient to
open the windows occasionally, and pay the greatest atten¬
tion to cleanliness by removing everything immediately
which might cause bad smells, keeping the bed-linen in the
best state, &c. But in this country we think different,
and much has been done in this direction. The Royal
Manchester Infirmary, a corridor hospital for about 250
patients, which is cut up into a great number of small
wards, may serve as an example. Fine end wards have been
formed with windows on more than one side by taking
down partition-walls, and other wards have had square
apertures placed opposite the windows, and louvres have
been formed over the doors. The old infirmary of Leeds
has been improved similarly, even some ceilings which
were too low have been raised.
The new (Hunt’s) block in Guy’s Hospital has been im¬
proved by cutting apertures in the wall for the admission
of air. The Charity Hospital in Paris has been greatly
changed. New wings built on improved principles are
added, some of the old wards are much improved. For
instance, the ward St. Charles, which contains twenty-five
beds, had a low arched ceiling, as usual in hospitals which
were formerly convents. This ceiling is now pierced in
four places, and skylights placed there to admit light and
air. This ward is warmed by caloriftres, but a conva¬
lescent-room, which has been cut off from it by a glass
partition, contains a chimney-place with marble slab.
Ventilation can be much improved by paying attention
to the construction of windows. They are generally sash-
windows in this country. I may mention that the Lock Hos¬
pital in Harrow-road has some French crois&s, and in
the Kensington Workhouse Infirmary I found the same. I
have not seen sash-windows in Germany and Italy, I observed
a few in the Incurables Femmes in Paris, an old building
which is to be vacated. Windows inclining inwards, revolv¬
ing on their lower border, have been introduced with ad¬
vantage in many English, French, and German hospitals.
They are sometimes fixed by small boards against which
they incline when open, at other times by ropes and piilleys.
They are found in tne hospital Rudolphstiftung in Vienna,
and will be in the new Hotel Dieu. The windows of the New
Leeds Infirmary are partly on the French crois^e principle.
In some hospitals (Whitworth, Arbroath, Manchester),
perforated zinc plates are placed before the upper sash.
When this is lowered the air percolates through the per¬
forations. I wonder why we do not more often find
similar arrangements, as in railway carriages, for instance.
I would place double zinc plates the whole width of the
upper part of a window, say five inches high, sliding on
each other to regulate the draught. I mention in another
place that in the justly praised Chorlton Union Hospital,
the draught from the ventilating apertures is too strong,
this leads to plastering up the apertures as in Leicester.
Much more difficult than to admit fresh air it is to insti¬
tute the means for extracting vitiated air in an old build¬
ing. There are, however, instances where chimney shafts
have been formed with this object.
WARMING.
The means for warming can be improved in different
ways. The Paris administration has lately introduced open
fire-grates in some hospitals, the Charity les Cliniques,
Hospital Cochin, St. Louis. In the latter hospitals the
chinmeyB have gone through singular transformations. In
the middle age the large ohimney-places of the square
wards were heated with wood-blocks, later they were re¬
placed by caloriferes and blocked up, but I was surprised at
my last visit to Paris to find them again prepared for use.
If the warmth is deficient we can place Gurney’s stoves
into the wards (German hospital), but I should not think
it so difficult to form water-pipes into coils to be heated
from the basement. Quite recently objections have been
raised against cast-ironstoves byBr. Garret The artificial
Digitized by vji vJvJW LV~
iMieai ptm «nd cizvokr. OPPERT ON SANITARY IMPROVEMENTS.
July 8,1888. 93
means for warming and ventilation have not always
answered, and open fire-grates had to be built in their
stead. Smoky chimneys or sto^ es must not, of course, be
tolerated.
FLOORS.
I have not much to say about the floors, walls, and ceil¬
ings of hospitals. In Paris, where some hospitals had
stone-floors, these have been replaced by parquet ones, lea
Clinique?, Charity, St. Louis. In English hospitals, some
deal noon are now oiled and lacquered—King’s College
Hospital, Newcastle. In bath-rooms tiled floors are in
their right place (Cambridge, Lock Hospital, Harrow-road).
In France, every grocer sells the material which is used to
lacouer the floors; walls, and ceilings, which are not coated
with cement, want repairing or whitewashing about once
a-year.
FURNITURE.
The furniture, which the wards contain, can easily be
improved where necessary. The Paris Administration has
nearly all other bedsteads replaced by such as are provided
with spring-mattresses. They are more easily kept clean
and free from vermin, the quantity of horse-hair contained
in the mattress is only 18 kilogrammes, or 40 lbs. I saw
some very useful hospital furniture in the Paris Exhibition
—night-tables, contrivances to raise the patient, &c. All
the London hospitals should gradually replace their beds
by better ones.
WATER-CLOSETS AND LAVATORIES.
That the salubrity of a hospital is endangered by badly
placed water-closets or latrines and drains is well-known,
and it is therefore desirable where they are faulty to re¬
move the nuisance. These things are better arranged in
England than elsewhere. I have, however, pointed out in
another place that we are not altogether free from blame.
At the Oxford Ratcliffe Infirmary a nnrse’s-roora is, or was
till recently, squeezed between two water-closets. The Paris
Administration is gradually replacing the latrines by water-
closets. The new ones of Lariboisi&re are quite on a level with
English ones. La Charity, les Cliniques, the new part of
Cochin, Beaujon, la Salp6triere,are provided with new water-
closets. It will not be long before we will have to search
diligently for the ancient latrines which everyone who sees
them for the first time contemplates with amazement. Low
seats of stone with a small round opening, not fit to sit but to
stand upon, as constructed more than 100 years ago, are still
visible at the Charity and Salpetrifcre. Earth closets T did
not see in hospitals, but I noticed them in the Exhibition.
They seem to me the next best thing to water-closets,
especially in hot climates. Lavabos are not difficult to place
where they do not exist. In France, they have generally
marble-slabs, whereas the English are content with slate.
Water-closets and the place where the lavatories are, are
rarely warmed, it should become in future the object of
architects not to overlook this. In Guildford Hospital,
Herbert, New Leeds Infirmary, and the Brompton Hos¬
pital, the means for warming are found. In consumption
hospitals especially they should not be overlooked. The
best means are small chimneys or warm air, which has
passed over hot pipes.
OPERATING-ROOMS AND LECTURE-ROOMS.
They are not always what they should be. Where they
are not light enough, windows may be formed at the proper
place. Some hospitals have had new ones added lately at
a considerable outlay—viz., Guy’s Hospital. The most
ancient amphitheatre I saw recently is that of Bouillaud
in the Charity Hospital. It is of a round form, the chair
in the centre, the seats rising steeply, the light sparingly
filling through a round skylight above the chair. 300
*ndauls may be seated.
THE POST-MORTEM ROOMS
ffqJba&y arranged in many of the old buildings, and might
% replaced by separate detached deadhouses 9 care being
wen that the patients cannot see the funerals.
THE BATH8
are capable of much improvement in English hospitals.
The more recent establishments are somewhat more satis¬
factorily arranged, but the older ones contain neither a
sufficient number, nor are the baths of the proper material.
Enamelled earthenware I consider the best material for
the fixed baths. In Paris, a great many newly instituted
baths are of enamelled cast-iron, and they look beautiful,
but they are less durable than the former. Zinc-baths
are not rare with us or on the Continent ; copper-baths are
much valued in Germany (Berlin). The finest baths are
those of one piece of marble, as exhibited last year in the
Italian gallery of the Exhibition, blit they are very expen¬
sive.
Hot air or Roman or Russian baths are rarely met with
in British hospitals. I may mention they are to oe found in
Cambridge, Colney-hatch, and Herbert Hospitals; they will
of course not be missing in the New St. Thomas's Hospital,
French physicians are much struck with the deficiency in
this respect, great value is attached to them in France. In
Germany, the larger establishments (Charite, Rudolphstif-
tung, and others) usually contain these baths ; and so they
do in St. Petersburg. Occasionally a voice hiis been lifted
in their favour in England, but as yet with little success.
The same must be said of sulphur baths. Almost all
hospitals in Paris, where skin diseases are common, have
plenty of these. The famous baths of Bar&ges in the
Pyrenees are much valued, and produced artificially in
French hospitals. In the same manner the “ Mother of
Lye” baths are used in Germany. Soda and sea-salt baths
find some favour with English Hospital Physicians. A
number of other artificial baths used in Paris, as seen from
the report of the administration, are almost unknown in
London. The atomized baths of Mathieu de la Drdme
seem not to find much favour with our French colleagues,
as they are only instituted in St Louis and another
hospital.
Appliances for fumigations for theenre of syphilis and skin
diseases should be added to the baths in English hospitals.
The hydro-therapeutic apparatus are brought to great perfec¬
tion and used in Paris, but there is some caution necessary
regarding their use, especially ns respects the Douche. A
plan of treating habitnal constipation by shower-baths is
not much known in England. There is some danger of
falling into the error of treating too many diseases hydro-
therapeutically where the apparatuses exist.
Portable hot air and vapour-baths may, of course, bo
easily acquired for an hospital, and I have reason to re¬
commend them. There is some caution necessary to pre¬
vent accidents with them. A new appliance, the bidet,
which I found in several French Hospitals, may be intro¬
duced in English ones. I was pleased to see it in the
female lock-hospital.
The warming of bath-rooms is often considered super¬
fluous. As an instance, I refer to the new Alexandra
wing of the London Hospital, opened only two years ago.
Some of the bath-rooms are partitioned off the ward by an
opaque glass partition, and are rather dark, but there is a
gas-burner. No means of warming nor for the escape of
steam are provided for, so the steam enters the ward. Such
arrangements should be ameliorated. An apparatus for
warming the linen must not be over-looked
As it seems very difficult, and in some cases not possible,
to provide London hospitals with the desirable Russian
baths, appliances for fumigation, sulphur baths, &c., I
suggest that a central establishment for medicated and
other baths be founded ; hospitals, infirmaries, and dis¬
pensaries to support the institution by becoming subscribers
for tickets, the tickets to be distributed on an order from
a medical man connected with the hospital. I know cases
where patients with skin diseases have not been admitted
into the public baths. : An institution of the kind sup¬
ported by the profession and well managed, would be an
undertaking which might be taken in band by a public
company with the greatest success, and be an inestimable
boon to the poorer classes of the metropolis.
O
24 ThtMeOle^ Press and Cimil&r. OPPERT ON SANITARY IMPROVEMENTS. . . July 8,1S6§.
DINING-ROOMS OR HALLS
have found much favour with hospital authorities in this
country, and there is no doubt that they often prove a
desirable addition to many buildings. They ore more
necessary where the number of light cases is large, and
may therefore not be out of place in many country hospitals
where the privileged light cases are often largely admitted
to the detriment of the real sufferers from disease. Those
patients who cannot leave their bed enjoy a larger cubic
space by the others vacating the ward ; the attendants
are saved a great deal of trouble by serving a greater
number, at one time ’ the patients do not get their dishes
cold, and dine comfortably together. Therefore, notwith¬
standing some disadvantages which I know quite well, I
consider the addition of dining-rooms an improvement.
patients’ libraries
can be easily connected with the recreation rooms, and
when libraries do not exist, the chaplain of the hospital
should make it his business to form them. Such a library,
recently founded, I noticed with pleasure at my lust visit
to the Sheffield Intiriuarv.
LIFTS
hkve been lately added to some establishments, for in¬
stance, University College Hospital. They serve to carry
the dishes from the kitchen to the upper stories, and are
very useful. Also,
LINENSHOOTS
can .be formed ’where they do not exist, and it is well-
ksowff that earthenware tubes deserve the preference. I
need scarcely add that many other improvements are of
more importance, and should therefore first be attended to.
DISPENSARY.
The place where the medicines are made up is often too
dark, and in that event should be made lighter, or the dis¬
pensary removed to another part; for instance the dispensary
of th‘e Herbert Hospital is defective in this respect. A small
g a ca pparalus is very convenient for preparing infusions and
d*oections,and mighCbe added, a defective sink and lavatory
might be replaced by an improved one. Medicine vessels
should be provided with stoppers. The preservation of cod
liver oil, especially in large establishments and consump¬
tion hospitals, makes some precautions necessary. Tne
principal store is in * cool place in the cellar; A stone barrel
with' a tap should be kept for it in the dispensary. The
objection* is raised that such a barrel might be difficult to
dleqpae, their being only a small opening for filling it, but
I think this is not the ca>e. The next best things to be re¬
commended ape the glass vessels with double margin. For
larger stores-a slate tank, under which a current of air
passes, I s desirable. Poisonous drugs have to be kept
always separately ; distilled water kept in stone jars.
KITCHEN.
This is a much neglected department in English hospi¬
tals. Many kitchens are in the basement, and too low,
badly lighted, etc. The ceiling may be carried higher
(Sheffield), or the floors low^r Windsor), but it is pre¬
ferable, where possible, to build a new kitchen. The Berlin
Charity Hospital is an instance of this improvement. A
large kitchen was built attached to one of the wings of the
old hospital a few years ago. Almost all the kitchens of
the Paris hospitals, are lofty, airy, and have opposite win¬
dows- with vasistas for ventilation, the smoke flues are
carried under the floors which are of stone. For fuel they
. usp <?oke, formerly coals were used. A central range usually
baa four fires. Coke wants a little more time before it gets
t horOfigUybeated, but is cheaper than coals. - - Steam I
found employed for cooking, but in one-establishment—
viz* 4St.~ Anne-;, in Germany they generally cook by
steam; Gridirons for chops or steaks with side or down¬
draught can be instituted where not found. For storing
the provisions whioh are to be consumed,! noticed in Paris,
and recommend for imitation, airy meat rooms like the
new one in the Salpetriikre, stone floors, marble slabs, or
slate, tiled walls, opposite windows, etc., ice in summer.
Milk to be kept in enamelled slate tanks with air draugfil'
underneath (Brompton). Meat-safes, hot plates, tin boxes
for the lifts, and many modern improvements of minor im¬
portance may be added.
THE WASH-HOUSE.
The plan of haring the washing of several hospitals dona
at one of them is a good one, and, of course, easily acted'
upon, where a central administration exists as in Paris. 1-
have found the washing attended to at the smallest institn*
tion I visited—viz., at Windsor, an infirmary for twenty
patients—and, on the other hand, large hospitals do not
undertake it—for instance, the Brompton Hospital It
may not be feasible to act upon the principle of oo-opera-
tion in London, but there may be country towns more
favourable for it.
Only very small institutions should be without a steam-
engine, and no large amount of washing should be done
without steam-power. It is true that the liuen wears longer
if only subjected to hand-work, but this is so much more
expensive that it cannot be thought of. I am convinced
that a great amount of lalnrar and money might be saved
in this country by better managing these matters, and
adopting some of the continental principles. These mat¬
ters are too much left to the ingenuity of the female mind,
and time and labour is often wasted. I found washing by
hand done before the things were put in the machines; in
fact most things were washed twice over, which I should
think only necessary in a fever hospital. The French way
is far more expeditious, as hardly anything is washed
twice. It is very singular how the different countries ad*
here to their own ways, and that, for instance, the modus
operandi in France should be different from that of Ger¬
many, and both differ from the English one.
In all the large French wash-houses—say, of Lariboisiere,
of the Salp6trifere, or the Incurables Femmes—I was told
that the dirty linen, after being wrinsed in cold water, was
not washed bv hand, but at once thrust into the steam-
tubs, where the water was gradually raised to a high tem¬
perature. The water, mixed with hot ley, percolates the
linen for four hours, after which time it is ready for the
washerwoman. . .
The German procedure, as in the Berlin Charite, and
many other establishments, is a little more tedious. The
linen is wrinsed in cold water, subjected to the action'of
hot ley—the temperature being moderate—for twelve hours,
removed into the steam-tubs, where it is steamed for three
or four hours, washed in hot water, wrinsed, &c.
This system was partly adopted from a French model,
and the precepts of Bourgnon de Layre, but replaced in
France by that of M. Bouillon. The tube k arrosage are
not exactly a new invention, but they are an improvement
on previous apparatuses.
I cannot describe all the washing-wheels and machines*
the wringing ones and hydraulic presses; suffice it to say
that the French plan deserves a trial in this country, and a
good opportunity exists in the new St Thomas’s Hospital
THE OUT-PATIENTS’ DEPARTMENT.
It requires improvement in many English hospitals.
Many of them were built without architects paying rnnch
attention to the subject, and we find the defects the more
striking the more the number of out-patients hm in mused
The possibility of this department being nsed for purposes
of medical education did not, of course, occur to the boikb
ers. The waiting-rooms are almost as arule defective in
the country and in London dispensaries. Hour -often have
I seen the patients, male and female* sitting togetberin
the hall, blocking the way to the stairs or mnsullmg^ioomsi
exposed indraughts, &©.
The consulting-rooms have often insufficient li ghts i$fce
patients should have a separate entrance and-exit,'in wider
not to be in each othoFs wav. The rooms should be quiet*
and therefore separated by double doors or Iobbies, from
the waiting-room.
Digitized by
Google
The Medical Pres* and Cfreular.
PORTER ON SYPHILIS.
July 8» 1068. }J
Where the department is used for medical instruction,
several consulting and private examination-rooms should
be found near the principal entrance. The lecturer must
be enabled to detach some of his pupils for examining the
patients, and go on lecturing to the others. The names of
the patients must, of course, be inscribed in a book kept
for the purpose, and ease-books for interesting cases be
found besides; assistants and famuli, elected according to
seniority and merit, should be trained to attend to these
matters. The^dispensing department should be placed in
such a manner that the out-patients pass by it when they
leave.
NOTES ON SOME PECULIAR CASES OF
SYPHILIS.
Br. ANGUS M. PORTER, M.D.
(Bead before the Ulster Medical Society}.
Cam 1.—Mr. L., a young, unmarried Scotchman, of fair
complexion, and free living habits, contracted the disease
in Dublin about ten days before coming for advice. Had
never suffered from syphilis previously. Five days after
connexion he noticed an inflamed spot on the upper part
of bis foreskin.
On September 22, 1867 (the date of bis first visit), the
appearance of the sore was so indefinite, that it was im¬
possible to determine whether it was specific or not; a
dry elliptic chafe being the form it assumed. Recommended
rest, a mild purgative, and, locally, cold water dressing.
24th.—The dorsal part of the foreskin was considerably
inflamed. The* sore, on being exposed, presented a sup¬
purating surface. There was no constitutional disturbance
nor any enbirgement of the neighbouring glands.
26th.—The ulcer was covered by dark sanguineous matter,
the edge* raised and hard. The prepuce was much swollen,
but tire system remained perfectly tranquil. The strong
nitric arid was carefully applied, and then water dressing.
He xlid not come back till October 2, when, on examina¬
tion, the surface of the sore was found clean, the margin,
however, remaining high and indurated—there was com¬
plete absence of ppm or irritation. The healing prooess
aid not seem to have commenced as yet. For the first
tire* he appeared depressed, and had a bilious look. The
various glands still remained unaffected.
Prescribed one 5 gre. Plummer's pill, to be taken each
night for a week, and large doses of decoction of sarsapa¬
rilla daily, the topical remedy being altered to blackwasn.
Next day he returned much better, the ulcer looking
He continued to improve till October 9, when he com¬
plained of soreness and stiffness in his right groin, for
which a apica bandage was employed, and rest recom¬
mended. The chancre had begun to heal rapidly, but con¬
siderable hardness remained around the edges. Some red
oxyde of mercery was dusted freely over it.
164h^—The chancre had disappeared, leaving a fine
purplish skin behind it, surrounded by slight induration.
The patient still complained of tenderness in the groin.
He was continuing to take large quantities of the sarsapa¬
rilla decoction.
' He nowleft, promising to return as soon as convenient,
which he did on November 5, when he reported himself as
comp l e tel y cured. There was no hardness remaining to
* indi c ate; the situation of the chancre, and the abortive
hnbohad auite disappeared. Up to the present he has en¬
joyed excellent health.
' Ll this gentleman's ease, which, from its persistency and
difficulty of core, was undoubtedly one of a specific nature,
. afcJaast one-feature of interest occurred, and that was the
premnee of induration unsupplemented by any form of
■rfjndiiie* Thb hardness, as has been noticed, was not the
Niuftfc nf * cicatrix, nor incidental, but evidently charaoter-
Wa^theimmof nicer which it accompanied, inasmuch
d considerable time before the healing process
, and subsided on the disappearance of the sore.
Case 2.—Mr. A. G., of Belfast, occupied as a clerk, of
dark complexion, bilious temperament, regular habits,
young, ana unmarried.
On October 2, 1867, he first sought advice for three non-
indurated, fiat, round, ulcers, two of which were situated
on the mnoous surface of the right side of his foreskin,
and one on the left side. A large bubo had formed in the
left groin ; considerable constitutional disturbance was also
present. He stated that he bad not had connexion for
six weeks, and that it was two since be first noticed the
sores.
He had never been the subject of venereal disease prior
to this attack. On drawing back the foreskin he ex¬
perienced intense pain ; a good deal of smegma bad con¬
sequently been allowed to collect, and keep the chancres in
a foul condition. After the removal of all the secretions
by warm bathing, the strong nitric acid was freely applied,
followed by cold water dressing. Pressure, by means of a
pad and spica bandage, was put upon the bubo, and per¬
fect rest inculcated.
The following day (Oct 3) the chancres were looking
clean and not so sore, the bubo, however, was causing him
considerable inconvenience. He was now recommended
to use blackwash as the local remedy, and the following
internal medicines :—
IV Hyd. bichloridi, gr. ii.
Infus gentianse co., 3viii. M.
Ft. mist
Sg. A teaspoonful at each meal, aud 20 drops of the
tincture of perchloride of iron three times daily. His*
diet to be plain and nourishing, and bis mode of living
regular. His bowels being confined, two teapoonfhls of the
liquid extract of senna was prescribed to be taken at bed
t iine.
October 5th.—The aperient had acted freely, which
Xave him some relief. The chancres were looking better,
and not causing much annoyance. The bubo, however,*
wus intensely painful, and the system considerably die-
turbed.
His next visit was on October 11th, when the chancres
d id nob seem to be doing so well, this it appeared was
owing to his own dread of drawing back the foreskin to
dims them. Some red precipitate was now applied to
each of them.
14th.—The change, which bad taken place in the sores
was most satisfactory, and the patient now felt less diffi¬
culty in applying the dressings himself. The bubo, which
had pointed, was freely opened, and a large quantity of
thin pus allowed to escape. The general disturbance of
the system had greatly abated.
16th.—The chancres were almost healed, but the bubo
continued to discharge watery matter, and was still very
painful, especially when walking.
19th.—The chancres had quite disappeared, but the
affected groin continued to resist all attempts to bring
about a healthy condition. The diseased gland was re¬
opened, and covered with a linseed poultice. A consider¬
able quantity of thin serous matter subsequently drained
away.
25th.—The oozing had nearly ceased, so pressure was
substituted for the poultice, by means of a sponge pad and
close fitting truss. At this time his general health was
unimpaired.
November 3rd.—Mr. A. G. left to fill a situation in
England, and had apparently quite recovered from the
disease for which he was treated. He felt in excellent
health, and had ceased to take the prescribed medicines.
Scarcely any trace of the bubo remained.
26th.—A letter came from him, stating that the glands
of his neck were swollen, and his throat sore. The general
tone of his letter indicated despondency.
In reply, the following treatment was recommended—
R Pil Plummeri pi
Div in pil dnodecem
Sg. One 3 times'daily, with a wineglaasful of decoction
of sarsaparilla. Ten grains of chlorate of potass (in water)
Digitizec ~ * jOO gle
^6 It® Medical Proa juid Circular. HOSPITAL REPORTS.
July 8,1860.
night and morning; and twelve grains of Dover’s powder
every second night, also a gargle containing astringents.
. December 4th.—There was another communication from
Mr, A. G., to say that he was no better. In answer, I advised
him to take two teaspoonfuls of cod-liver oil three times
daily, and to persevere with the remedies already prescribed.
Subsequently, finding no improvement in his state of
health, he went under medical treatment in England.
; January 20 th, 1868.—He returned to Belfast, having
become impatient and discouraged by the obstinacy of his
maladies. His face was now covered with pustule, while
over his trunk and limbs a squamous eruption had become
thickly developed; some of the spots were bright red,
others purple, and the remainder copper-coloured. His
tonsils and the back of his throat were extensively ulcer -1
ated. He was greatly dejected in spirits, and suffering
from a severe cough which, on examination of the chest,
proved bronchitic. His bowels were pretty regular, his
tongue clean, skin moist, and pulse normal. Whilst in
England* his medicines had been altered, with the excep¬
tion of the Plummer’s pills. He objected to take any more
mercury although he had never been salivated, nor other¬
wise felt the unpleasant effects'of this drug. Owing to his
pertinacity on this point, I thought I would give the
terchloride of gold and sodium a fair trial. Accordingly,
he waa recommended to take one of Grotzner’s pills,* with
two teaspoonfuls of cod-liver oil three times daily; and, for
the cough, an anodyne pectoral mixture containing the
dilute mineral acids aud muriate of morphia, together with
expectorants. His throat was thoroughly cauterized with
nitrate of silver, and a strong astringent gargle prescribed
for frequent use.
Feb. 3rd.—He seemed in a somewhat better condition, as
regarded his general health. The cough had become easier
and less frequent. His appetite had improved, and he
rested more comfortably at night.
The pustular rash on his face had increased, especially
on the chin and forehead ; where any spots had died away,
a deep purple stain remained.
8 th.—He was almost free of the bronchitis, and in
better spirits, though he was somewhat alarmed at seeing
a new form of rash present itself—viz., roseola of a very
bright colour, principally situated on the chest and arms.
The appearance of his face was very disagreeable on ac¬
count of the confluent nature of the pustules, which in some
places were discharging a yellowish matter. He had now
taken 57 of the pills, or better than 2 grs. of the terchloride
of gold and sodium (which quantity of corrosive sublimate
I have seen remove equally severe cutaneous eruptions,
and in a shorter time). Not having noticed any marked
beneficial effects from this preparation, I deemed it judi¬
cious to adopt the following (without consulting my pat ient
on the subject) :—
- R Liq. hydriod hyd. et arsenici, §ss.
Syr. Simplicis, Jiss. M.
Sg. A teaspoonful in water with each principal meal.
The cod-liver oil being continued.
His hair had commenced to fall out in large quantities,
for which symptom Erasmus Wilson’s prescriptions were
hdOpted—viz.,
R Ung. hydr. nit. ox., 31 .
Adipls odoratae^iii.
Sg. To be rubbed well into tfye roots of the hair at bed¬
time :—
B 01 amygdalae dulcis,
Liq. Ammon, fort., JL
Spts. rosmarinae, Jii. -
Aq. Mellis, Jii.
;Sgi To. be sponged about the roots of the hair each
jBoming.
lflth.—A slight improvement was observable in the
general condition of the patient, yet the cutaneous erup¬
tions were very, perceptible. the ho pe of aiding their
♦ B; * «odii attfo terchl. *r. ir ; ex. Si.
Solve ia aq. dirt. q.a. 4^* *** 0*s*
Ext. aconlt. irr. X. »•
PiT.iapfliOO. Vt.&t.
removal, one part of citrine ointment, in two of simple
cerate, waa directed to be rubbed on them each night.
March i4th.—The patient’s general health had become
very good. The skiu affections were quickly disappearing,
leaving the surface of the body covered with scales and
crusts of various shades and sizes. The hair had ceased to
fall out.
29th.—A vast improvement had taken place in every
feature of the case. No ulceration of the throat re¬
mained, though on rising in the mornings a peculiar dry¬
ness was felt which a drink of cold water immediately
relieved. The medicines were still continued.
April 16th.—No trace of cutaneous disease remained
save some slight red marks on the face. The patient’s ap¬
petite and general health were good, and he appeared in
excellent spirits. All medicines were now omitted.
Mr. A. G. paid his last visit on April 20 th, on which
date every symptom of the disease had vanished.
In this case the plurality of the chancres, the absence of
induration, and the late development of the roseolar rash,
are points of some interest, as well as the absence of ptyal*
ism during a lengthened course of mercurial treatment. It
may be well to remember that cod-liver oil was adminis¬
tered throughout.
(To be continued.)
- 4 -
§rprffi.
RICHMOND SURGICAL HOSPITAL.
ENORMOUS INCARCERATED AND SUBSEQUENTLY STRANGU¬
LATED INGUJNO-SCROTAL HERNIA, PROBABLY CONGENI¬
TAL : DIFFICULTY OF DIAQNOS1S : OPERATION : VIOLENT
PERITONITIS : RECOVERY.
Under the care of Mr. WILLIAM STOKES.
(Reported by Mr. James Ross.)
From the very unusual and extraordinary symptoms and
physical signs in the following case of hernia, it must be
admitted that an accurate record of it is of considerable
value in a practical point of view.
Thomas F., act. 30, by occupation a cooper, was admitted
into Mr. Stokes’ wards in the Richmond Hospital on the
8th of last June. He stated that he had a hernia on the
right side as long as he remembers, and that he was always
able to reduce it until two weeks previous to his admission
into hospital. He stated that when it was reduced, there was
a great thickness of the scrotal coverings remaining which
was not so on the left side, and that the testicle was always
much smaller on the affected side. The symptoms of
strangulation, however, did not appear to supervene until
the day before his admission. There was frequent vomit¬
ing and hiccough, constipation, great pain ana tenderness
over the lower part of the abdomen, which were especially
acute in the situation of the external ring.
On examination a large scrotal tumour was found, of
great weight, the upper half of which was tympanitic on
percussion, the lower naif absolutely dull. There was great
tension of the skin over the tumour, which was somewhat
lobulated and irregular on the surface. There was little or
no impulse on coughing , and on moving the tumour sud¬
denly from side to side, or from before backwards a loud
splashing sound could be distinctly heard, like that of
hydro-thorax, indicating the admixture of air and water *
within the tumour. On examining it with reference to
transparency, none whatever could be found.
Shortly after his admission, he was put under the influ¬
ence of chloroform, and the taxis carefully tried, and though
Mr. Stokes failed to reduce the hernia, he thought be suc¬
ceeded in diminishing the size of it somewhat.' At all
events, some of the symptoms of etrailgulation—viz., the
vomiting and retching, and the violence of the abdominal
pain, subsided after the toons. In the evening, 8 p.ir., the
scrotum became again very much distended, causing much
pain from the tension. There was also retching and hio
cough. These symptoms, however, under the 0 f
Digitized by v joogle
Th« Medical Free* tad Circular.
HOSPITAL REPORTS.
Julj 6,186ft. 27
anodynes, enemata, hot fomentations, and the warm bath,
towards morning completely subsided. The same state of
things recurred next day.
June 12.—The bowels were moved slightly on the 11th.
Pulse quiet. Patient able to take light food, and very
little tenderness about the abdomen or scrotum.
13th.—The symptoms of strangulation recurred with
great violence. Mr. Stokes got the following message from
Mr. Ross, his resident clinical assistant:—“The patient with
hernia in No. 7 ward has been very ill during the night,
vomiting set in at two a.m., and has continued at fre-
ouent intervals since then. He is }>erspiring profusely.”
On Mr. Stokes' arrival, he found that the alarming symp¬
toms the patient had during the night and early morning,
had greatly subsided. He was in a state of great prostra¬
tion, perspiring profusely, but the vomitiug had stopped, the
constipation which had now lasted since the morning of
the 11th continuing. The tenderness and pain over the
abdomen and scrotum had also to a great extent subsided.
The pulse was 76, and very weak. At this juncture, Mr.
Adams kindly saw the case with Mr. Stokes, and was of
opinion that although the patient s symptoms were decidedly
alarming, and the prognosis unfavourable, yet, that under
existing circumstances, the symptoms of strangulation
having to a great extent subsided, immediate operation was
not called for. It was then determined that a consultation
should be held at 5.30 p.m., the patient to have in the
meantime a full enema, and morphia and hydrocyanic acid
internally. At 5.31) p.m., the patient was found consider¬
ably better. He had only had during the day two slight
attacks of retching. The tumour was not nearly so tense,
and the ten derness in the abdomen greatly better. He was
still in a ve-ry weak and exhausted condition. The enema
had come a way, but there was no feculent motion from the
bowels. Mr. Stokes then agreeing with his c< ’eagues,
considered it would be better again to defer any operative
interference until he saw what course things were going to
take, and accordingly it was agreed to meet again to see
the patient at 10.30 p.m. In consequence of this unusual,
and extremely interesting case, many other eminent sur¬
geons in a^ddStion to Mr. Stokes' colleagues, came to see
this case. Among them may be mentioned Mr. Porter,
President of the Royal College of Surgeons ; Mr. Fleming,
Mr. Collis, Dr. Wharton, Mr. Croly, Mr. O’Grady, 6vC.
The difficulty of diagnosis in this case as to whether
namely, it was one of simple strangulated congenital hernia,
or whether the case was one of a small hernia into a large
previously existing hydrocele of a hernial sac, arose from
the existence of the following symptoms and appearances:—
1. The absence of all impulse in the tumour on cough¬
ing.
2. The intermittent symptoms of strangulation.
3. The great weight of the tumour.
4. The loud succussion sounds.
5. The absence of translucency iiTany part of the tumour.
6. The comparative freedom from pain in the vicinity of
the ring.
7* Absence of all abdominal fulness.
Many of these symptoms and signs were characteristic of
the rare form of hernial complication, known as “Hydrocele
of the hernial sac,” which, as Dr. Fleming has remarked,
occurs generally in adults in early life, with large not
fully reducible scrotal hern iso, or the rarer variety named
u inguinal hernia.”
The chief difficulty, however, in determining the exact
natqre of the case, and, consequently, the line of treatment
to adopt, arose from the intermittency in the symptoms of
strangulation* and the loud succussion sounds.
At 10 # 30 p.m. the symptoms of strangulation having again
supervened, and with greater intensity than at any time pre¬
viously, Mr. Stokes decided upon performing the ordinary
gyration for strangulated hernia. On making the usual
“ ^over the external abdominal ring, and dividing
r layer of fascia down to the sac of the hernia,
i'Which was given, in the first instance, by Pro-
fotuid tc» be absolutely correct. .There
was no hydrocele of the hernial sac, and the great mass of
fluid and air which gave the succussion sounds, so unusual
in hernial tumours, were with in , not external to, theintestine,
and the enormous scrotal tumour was composed entirely of
a mass of intestines.
On arriving at the peritoneal sac, Mr. Stokes passed his
finger up to feel for the constriction which caused the •
strangulation, and found that it occurred at the external
abdominal ring, and that it was caused, not by a narrow
cord-like constriction, but, which is also unusual, by a
broad, flat, riband-like constriction.
Mr. Stokes was very anxious in this operation to reduce
the hernial tumour without opening the peritoneal sac, in
consequence of the large size of the tumour, and the re*
cent and intermittent strangulation of the intestine. How*
ever, in passing his finger up to the constriction he must
have pushed a portion of the sac before it, for a quantity
of fluid came welling up from the bottom of the wound, the
very moment the stricture was divided. After this a good
view was obtained of the intestines. They were found con*
siderably congested at the seat of the stricture, but every¬
where else they appeared quite normal and healthy. Fully
three feet, or perhaps more, of small intestines were in the
scrotal tumour, and the reduct ion of this vast coil of intes¬
tines was not accomplished without very great difficulty.
After the operation the patient got a powerful anodyne
draught, and one grain of opium every third hour during
the night Also, strong beef-tea iced.
14th.—He slept very well during the night, and at 8
p.m., this morning, his bowels were moved. He took
some milk and egg this morning. Pulse 112 . As the day
advanced the pulse became full and bounding, and rose to
120 in the evening. Very violent spasms in the abdomen
set in. When each spasm subsided, Mr. Ross could hear
a loud gurgling noise, after which the patient expressed
himself much relieved. There was great tenderness and
pain in abdomen, especially above the right groin. The
patient was put on calomel and opium, and twelve leeches
were applied to the right side of abdomen. After the
application of the leeches, the bleeding was encouraged
for some hours by hot fomentations.
15th.—Pulse 112 , compressible. There is persistent*
vomiting, but scarcely so much tenderness over the right
side of abdomen. The right testicle is highly inflamed.
The patient's countenance wears an anxious expression*
He is in a state of great prostration, and lies with his
legs stretched at full length. The abdomen is tympanitic
and very tender. He passes urine freely, it is high
coloured; bowels not moved since yesterday. Mr. Stokes
ordered the calomel to be stopped, but a grain of opium
to be given every third hour, and strong mercurial oint¬
ment to be rubbed into the axilhe and smeared on a large
linseed meal poultice to be applied to the abdomen.
Twelve more leeches to be applied to the abdomen.
16th.—The spasms have diminished in frequency and
intensity, and the patient slept pretty well during the
night.. The tenderness in the abdomen is somewhat
diminished, but it is distended to a great extent. He
frequently passes flatus, but bowels not moved since the
14th. There is great thirst, the tongue is now red, but
moist. Pulse 100 . The gums are slightly touched by the
mercury. Although he has taken a grain of opium every
third hour since the operation, it has not had any effect,
except making him drowsy and taking away liis appetite*
The pupils are not contracted.
17th.—Pulse 90. Patient had a slight attack of syn¬
cope at 7 o’clock this morning. The distension of the.
abdomen is considerably less than it was yesterday, but
there is a good deal of tenderness still. There is less
vomiting now, and his appetite is returning.. He took a
little calve's-foot jelly and iced brandy this R oomi ng.
Last night prussic acid was given to allay vomiting*,
and it proved very efficacious. The mercumlinunc tiou,wqa
ordered to be stopped. Opium reduced to. half agrra*
every third hour. Six leeches to be applied to
men, close to the wound. . n >
Digitized
28 The Medical Pres* sad Circular.
FOREIGN MEDICAL LITERATURE.
July 8, I860,
18th.—The anxious expression of the face is almost
gone, and he has had very few spasms during the night.
He is able to take light food to-day. His bowels still not
moved, but a great deal of flatus came away. There is
very little thirst. The testicle is not so painful, but is
still enlarged. Pulse 90.
19th.—Expression of face greatly improved. He has
lost all his anxious look. The abdomen is now very flat,
and there is very little tenderness about it. In the even¬
ing the bowels were moved four times, the evacuations
being partly solid. Pulse 86. Opium to be stopped.
20th.—Still progressing very favourably, but the en¬
largement of the right testicle is undiminished. Bowels
moved twice.
21st.—Improving rapidly. All medicine to be discon¬
tinued.
July 2nd.—Wound very nearly healed. Bowels per¬
fectly. regular. Appetite excellent. No trace of any
abdominal pain or tenderness.
CITY OF DUBLIN HOSPITAL.
CASES OF ONTCHIA, WITH OPERATION FOR REMOVAL OF '
THE DI8EASED NAIL.
Under the cabs or Mr. CBOLY.
Case I.—E. R., a healthy-looking boy, aged 12 years, was
admitted into the City of Dublin Hospital, suffering from
Onychia of the great toe of the right foot.
The disease commenced six months previously, and was
caused by an injury, a person having stood on her bare
f0ot.
Appearance of toe. —The ungual phalanx is clubbed; .the
nail is black and shrivelled; there is much foetor, and an
ichorous discharge from the region of the matrix, where a
fjpululoer is observed. The part is exquisitely painfuL
Various rsmsdies were adopted before the patient sought
for hospital relief.
* Gperirfum.—A freezing mixture consisting of ice and
salt was applied to the toe by means of a bladder, and
when the part was sufficiently frozen Mr. Croly seized the
nail in a dissecting forceps, and with a scalpel rapidly dis¬
sected out the entire nail, taking care to remove every
portion of it, to prevent a return of the disease. The freez¬
ing mixture caused considerable pain, but none was felt
during the operation.
-An iced lotion was applied to the part, and the subse¬
quent treatment consisted in touching the raw surface with
nitrate of silver, and circular strapping with soap plaster.
The ulcer healed, and the patient was discharged eared.
Case 2.—A. B., a boy, agea 6 years, had Onychia of the
itrdex-flnger of the right hand. The disease commenced a
month previously, ana was attributed to an injury—a win-
dow-saan having fallen on the Anger. The ungual phalanx
presented the characteristic clubbed appearance indicative
of Onychia. The nail was curved, black, and shrivelled;
t^e discharge was ichorous and foetid.
• The patient having been placed under the influence of
chloroform, the naif was dissected out, and the ulcer was
treated as in the preceding ease.
Recovery soon followed.
J Case 3.—P. C., a boy, aged ten years, had well-marked
Onychia in the great toe, of six months' duration. The dis¬
ease originated from a cut of a piece of glass.
‘ The toe was clnbbed, and there was a foul ulcer at the
matrix. Discharge foetid and thin ; patient suffers much'
pain. On measurement the diseased toe was found to bq
the sound toe measuring two and a-half inches rft the cor¬
responding part The diseased toe was two inches in length
-wthe sound toe one and a-half inch. The patient was
ftdly chloroformed, and the nail dissected out Carbolic
arid letion was used as shewing, and the parts soon assumed
40 years, suffering from Onychia
ef more than four months' duration, in the second finger of i
the right hand ; the patient had been treated by lotions and
other local applications without relief. The part having been
frozen with ether, by means of the spray-producer, the nail
was dissected out; the ulcerated part was subsequently
dressed with. “ Condy’s fluid," and the disease was cured.
Mr. Croly, in making clinical remarks on these cases, ob¬
served on the characteristic appearances of this very painful
and tedious disease, and on the successful result of the
removal of the entire nail from the matrix, as even the
smallest portion, if allowed to remain, is surely followed
by a return of the disease. Having tried in these several
__a?_a 1_£_;__ ii___J
application of intense cold on a highly inflamed part pro¬
duces excruciating pain. He, however, recommends iced
lotions, subsequently to operation, with a view of reducing
the inflammation.
In connection with this subject, Mr. Croly also referred to
Onychia maligna (described by Wardrop, Abraham Colles,
and other surgipal authorities) and the appropriate treat¬
ment for that special fonn of the disease.
TRANSACTIONS OF THE SWEDISH SOCIETY OF
PHYSICIANS.
Translated from the Hygiea for October, 18S7, by
W. D. MOORE, M.D.Dub. et Cant., L.K.Q.C.P.I., M.R.IA,
HONORARY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIANS.; OF
THE MOB W KOI AN MEDICAL SOCIETY; AND OF THE ROYAL MEDICAL
SOCIETY OP COPENHAGEN; SECRETARY FOR SWEDEN, NORWAT AND
DENMARK, TO THE EPIDEMIOLOGICAL SOCIETY O# LONDON. •
At a meeting held on the 10th September, 1867, Hr Bllx
communicated the following case of ulcerative endocarditis, of
the tricuspid valve:— ' - ;
Mrs. R. Q , aged 31, was admitted into the Seraphim Hospi¬
tal on the 20th June, 1867, and died on the 1st of August fotr
lowing. '
The patient had been delivered in the General Xyfrig-tfl
Hospital on the 13 th April. During pregnancy she had been
tolerably well until the 6th January, when hemorrhage took
place at night from the uterus, subsequently returned several
times, and increased in frequency towards the end of her termj
On admission she was extremely pale and ansemic. Delivery
was completed by operation, inconsequence of placenta previa
and cross presentation of the child. For the first few following
days her state was particularly unsatisfactory, but she after¬
wards improved, ana her confinement proceeded quite normally.
She was dismissed on the 26th of April “ at her own desire,
being then in a very anaemic state.’' The report of her case
will be found in the July number of the Hygiea^ Communicated
by Dr. Netzel in a paper “ On the origin and development of
placenta previa totalis.** During her subsequent stay at home
the patient was very languid ana weak, though not incapable
of lighter kinds of work. In the early part of May she observed
that her feet and the lower part of her legs began to swell;
the swelling, however, continued only Six days, was not con¬
siderable, And totally disappeared on rest, in the recumbent^
posture. In the course of a month her state was, with thy
exception of the languor and weakness, which continued almos$
unaltered, tolerably good; but on the 6th June she was quitJ
suddenly attacked With violent rigors, which, during the four-,
teen days she afterwards remained at home, were repeated
regularly four times daily, and were usually followed b£
copious pempirations. Her state of weakness meanwhile mere
extremely, on Which account she sought admission into the
Seraphim Hospital. On her admission, her strength was mu
depressed; she could scarcely raise henelf in bed; her eouri
nance presented a death-like paleness. The body was m
etnacyisd^.,There was no swelling of the extremities or othfS
parts. Tie* skin felt dry: its temperature varied so that bejtw ~
the attacks it was ujffi^te lJB‘8 0 , while during and ifnmediat
after them it was l ungs there was nothing
itetnark upon except*™®* ^
Digitized by
FOREIGN MEDICAL LITERATURE.
Tfc« Medical fireas end Circular.
Julya,lW.S9
mixed with some yellow lumps. The sound on percussion in
the cardiac region was normal. On auscultation there was
heard both over the apex and base of the heart, and also oyer
the intervening parts, a strong and particularly protracted sys¬
tolic bellows-murmur almost drowning the diastolic sound,
which was heard pure but weak, l^oud bruits dt diaUe were
apdible over the cervical vessels. The pulse was extremely
small and rapid. The liver was considerably enlarged, pro¬
jected a couple of inches below the margin of the ribs, where
it could be distinctly felt. The spleen was not enlarged. The
appetite was tolerably good; the bowels were regular; the
urine was free from abnormal constituents. In the uterus and
its appendices there was nothing to remark. With respect to
the intermittent attacks, it was observed that they occurred
regularly four times a-day; only two days were they wholly
absent, and during three days they were only two or three in
number. They occurred always during the day-time; at night
tbs patient for the most part slept well; they did not occur at
definite times, but varied—two sometimes taking place in the
forenoon, and two in the afternoon; while at other times one
or none was observed in the forenoon, and three or all four in the
afternoon. Their duration and intensity also varied from
fifteen minutes to two hours; they exhibited themselves at
times as slight chills, at others as severe rigors. During the
attacks the respiration was always very much hurried, while
the pulse was extremely small and quick. Between the attacks
—which w ere invariably followed by profuse perspiration—the
patient felt perfectly free from suffering, but was languid and
weak. Fourteen days after her admission she coughed up,
during a violent intermittent attack, some tablespoonfuls of
li'^ht coloured frothy blood, after which the expectoration had
for some days a sanguineous, admixture, which subsequently,
however, quite disappeared. Quinia seemed to have not the
slightest effect on the attacks; it was given repeatedly both in
full and in divided doses. She was at the same time treated
with.tonics and stimulants. Upon this plan her condition
somewhat improved, her strength having increased sq far that
she could occasionally remain up dressed between the attacks.
Without any further change having taken place on the preced¬
ing days in her state, she was quite suddenly attacked on the
looping of the 1st of August with severe dyspncea and palpi¬
tation of the heart; cold perspiration broke out over her face.
Which soon assumed a livid hue; tracheal rile began to be
audible, and she died after an hour’s agony.
Postmortem appearances ^—Body much emaciated. On open¬
ing the thorax Doth lungs were found perfectly free in their
Cavities; the left exhibited no changes except oedema in its
upper lobe, hypostatic sanguineous congestion in its inferior,
ana sjUght broncbial catarrli; the right was somewhat swollen
■Ad doughy to the touch. On dividing its parenchyma the
hitter grated slightly under the knife, and the cut surfaces,
which presented an uniformly reddish-grey appearance, rapidly
copied themselves with a thin fluid containing but little air,
sflflclvfcodld be abundantly pressed out from the parenchyma.
ItijSfce apex of the upper lobe were found Borne encysted and
qd^fied foci, around which the pulmonary parenchyma was
At the Same time more or less solid fibrinous plugs,
gertly WhitC or whitish-grey, partly reddish-grey, were visible
on the cut surfaces in the divided branches of the
r artcry> generally completely filling the calibres of
i. On Slitting up the pulmonary artery it was seen
l in its principal trunk and also in the majority of its
> fat as these could be traced—nearly, in fact, as
dface of the lung—the vessel was completely filled
, which in one part, and chiefly in the branches
Supper lobe, consisted of a whitish mass, in some
ing up, in others more solid, and attached to the
p»$uflc6ned .vascular wall; in others, were composed of
‘ iminated, fibrinoufl masses, completely filling the
„.. i vessels and loosely adherent to their walls. The
if Sp the principal trunk was of a bluish-red colour and
[Pfe|jet£tice, did not completely fill the vessel, and
ftaperfag manner immediately at the opening of
the auricle. The few branches of the pulmonary
: Were not obstructed were pretty considerably
tWot exhibit any change in their Walls* In the
1 “ ^tttrqmbi. The pulmonary pleurae of both
[ with some greyish-white tubercles
. The heart was of the usual size,
t The muscular substance, espe-
>,has lather more brittle than is nor-,
l a yeHowith discolouration. The
r valves were of healthy appear-
j ance; but the tricuspid exhibited the following changes:—The
right anterior lobe (Luschkai was in parts thickened, somewhat
rugged and uneven on its outer surface; on its inner it wA$
loaded with an irregular!v-shaped fibrinous lump, nearly the
size of a Spanish nut, adhering intimately to the thickened
part of the lobe of the valve from its free margin to one and a*
half lines from its attachment to the muscular Wall; the fibri¬
nous, mass was of a greyish-white colour, tolerably solid And
hard, but in spots, as it were, excavated, and there in a break¬
ing-up condition. Borne of the chordae tendineas going to thin
lobe were cut off and lay retracted and thickened towards their
papillary muscles; the ipfero-posterior lobe was in one half per¬
fectly normal, but the other half, lying against the right ante¬
rior lobe, exhibited a considerable loss of substance, as there
remained of it only a patchy ridge from one to one and a-half
lines in breadth, springing from the ventricular wall with thick,
uneven margins in a state of disintegration. The chords? ten-
dineie which are inserted on this part of the valve were also
cut off and lay retracted, with small swellings on their free
extremities. The left posterior lobe was normal.
The liver was considerably enlarged; its capsule was smooth
and shining. The surface of section was even, of a bluish-red
colour, quickly becoming covered with fluid blood, which, espe¬
cially when the parenchyma was pressed, ran out in great
quantity, both from the larger and smaller blood*vessels. The
acini were small, with bluish-red centres and greyish-yellow
peripheries. The spleen, kidneys, and intestinal canal pre¬
sented nothing remarkable. The uterus and its ligaments were
quite normal both in situation and size. In the uterine veins
were found thrombi, which could be traced into the hypogastric,
and further into the iliac and crural veins, and into the vena
cava inferior, though in all these vessels they exhibited very
different appearances. In the uterine veins, of which only two
or three at each side of the uterus contained tlirombi, the latter
were of a greyish-red colour, tolerably solid and loosely adhe¬
rent to the vascular walls, which in general'presented no
I change. The hypogastric and iliac veins were considerably
thickened as to their Walls, and were strongly contracted ; the
I iliac veins wenas thick as .a small lead pencil, and/embong
slit up were, found, to. be filled with greyish-white fibrinous
cords, which on‘microscopic examination appeared to be Com¬
posed of ordinary young connective tissue. At. the jua b tioft of
the iliac veins with the vena cava inferior, .which did not ex¬
hibit any alteration in its walls, the. tbrombous mass assumed
a reddish-grey colour, was of rather loose consistence, though
it nowhere seemed^ to be in a state of disintegration, anifiDed
the vessel only incompletely, being closely adherent to
the posterior wall * It extended for ten' centimetres (nearly
four inches)* up into the vena cava, and terminated quite
abruptly, sending off a fusiform lateral offshoot. In the crural
vein, and in several of the larger veins opening into it, were
greyish-white and greyish-red fibrinous masses, in general; in a
state of disintegration, and loosely attacked tathe th i c ken ed
vascular walla. • - '
This was therefore a case of ulcerative, endocarditis Of the
tricuspid valve, and it was the second instance, of the hind
whiph, within a comparatively short time, had occurred in the
hospital. The first is detailed in the September number of the
Hyyiea—x circumstance of great interest when it relates to 4
disease which is so extremely rarely met with.
In this, as in the formdr case, the diagnosis of cardiac
disease had not been made, the change in the talve beffig cjit-
oovered first at the post-mortem examination. A* appefcrs
from the history of the case, the patient presented: symptoms
of well-marked anaemia, and under such droumstaneesLonerwan
naturally quite satisfied to explain the Systolic acoeseocy «Ur-
mur perceived over the heart as accidental, the attention not
having been specially directed to the tricuspid valve, so as to
induce a closer investigation of the cardiac sound derived from
it. That, however, the great .fibrinous maw on onelobp off
the valve must have produced an accessory sound is quite
natural, and that the considerable'loss of substance found is
another lobe, must hare given rise to insufficiency, ift also a
matter of course. In addition to anaemia, pulmonary tubercu¬
losis was diagnosed for reasons which the physical mvSetiga-
tion, the course of the disease, and other- circumstances wig*
gested; and which were exceedingly strengthened -by the
expectoration of blood*: Tubercles. Were* .in fact? discovered hr
the lungs, but, aethe post-mortem ex amin a tio n showed csd&
some miliary eruptions on the pleura pulmonajia- / The* &§%
was, however,in many respects obecure^nd not the least aafjrqm
die frequent intermittent attodw; which could ap&ttftfed
for either by the anumia or the tuberculosis; tke examteatto
Jnlr 8, tttf.
30 The Hedlcal Press and Circular. GENERAL MEDICAL COUNCIL.
of the uterus did not furnish any standing points. It was only
the post-mortem investigation which yielded the necessary ex¬
planation of all. The formation of thrombi in the vessels of
the pelvis, as well as in the vena cava and the crural veins, is
of course connected with the accouchement, was a puerperal
process ; the appearance of the thrombi is by no means opposed
to this view, but it is very curious that this extensive thrombo¬
sis should take place without other symptoms thhn a slight
swelling of the feet and legs, which, after six days, completely
disappeared.
The intermittent attacks coincide with the occurrence of the
ulcerative endocarditis and the formation of thrombus in the
pulmonary artery ; nor is the fibrinous mass, nor the appear¬
ance of the valves, nor are the thrombi themselves opposed to
this view. The very sudden death of the patient was un¬
doubtedly connected with the fresh coagulation in the principal
trunk of the pulmonary artery, which, if it did not completely
cut off, yet considerably limited the supply of blood to the
few non-embolised and dilated branches of the artery.
In connection with this case, Hr Bruzelius spoke briefly of
the different diagnostic value of accessory sounds, accompany¬
ing the first and the second sound of the heart.
■■
GENERAL COUNCIL OF MEDICAL EDUCATION
AND REGISTRATION.
Royal College or Physicians, London.
Saturday, June 27, 1868.
Dr. Burrows, President, in the chair.
departmental business.
The President read a memorial from the clerks in the
office of Medical Council, Messrs. Bell and Koope, asking for
an increase of salary in consequence of their long years of
service, and the great increase of work now devolving upon
them The President handed the memorial to the Chairman
of the Finance Committee to report thereon.
Dr. A. Wood, as Chairman of the Business Committee,begged
to suggest that, in order to give the fullest attention to the sub¬
jects appointed for consideration by Committees, and to facilitate j
the business of the session, there should be no meetiog of the !
Council on Monday, but that the members should meet on that
day from twelve till six o’clock for sittings of the following
Committees:—The Visitations of Examinations, Vaccination,
Medical Education, Finance, Lunacy, Primary Education,
and the Pharmacopoeia.
Sir Dominic Corrigan seconded the resolution, agreeing
that it would greatly expedite the business before them if the
whole of that day were devoted to committees as suggested.
With this the Council entirely concurred.
diplomas in state medicine.
Dr. Acland, pursuant to notice, then rose to move—
u That a Committee be appointed to report on the steps
proper to be taken (if any) for granting Diplomas or Certifi¬
cates of Proficiency in State Medicine, and for recording
the same in the * Medical Register,' due regard being had to
the interests of existing Health Officers in the several parts
of the kingdom."
Ha said the subject had been introduced by him last year, but
he was induced to withdraw its consideration from press of
business, and for other reasons well-known to the Council.
Now that it was stripped of some of the objections by which
it was then surrounded, and the essence of the whole matter
left, in his mind it was one of the most important subjects that
could occupy the attention of the Council It was unnecessary
for him to enter into details 7 State medicine, or as it was
otherwise called, preventive medicine, some few years since had
no existence whatever; but now, thanks to Dr. Rumsey, whose
labour to make it recognised had been remarkably successful,
and ateo to the more extended study of the subject, it had now
become a most important and useful branch of knowledge. It
was generally supposed that if a person's name was on the
register, he was conversant with this subject, still he doubted
if it were so, and although he did not think the study of it
should be added to those already on the curriculum ; he,
nevertheless, held that it might be advantageously placed as
one of the optional subjects, so that medical practitioners
should have the opportunity afforded them of studying it, if
the^iwddsfred. He knew of cases where members of the pro-
fuikii - had vet about it manfully, and had even diminis hed
their income in consequence, because the public imagined they
were incapable of mastering the difficulties attendant on the
direct line of their professional sphere, and had stooped to an
indirect and an inferior course in their estimation. But was
this an inferior branch of knowledge, he argued that it was
far otherwise ; sanitary measures, medical jurisprudence, &o.,
were of the highest importance, and instead of being second to
the ordinary subjects of education, be looked upon them as
even superior, as everyone must admit that prevention is
better than cure." He should be glad to see medical men as
health officers in all parts of the United Kingdom, and that a
special certificate should be granted them as to their capabili¬
ties to advise on all matters connected with this department.
Daring the meeting of the British Medical Association in
Dublin last year, which was a great success, owing to the
kindness and urbanity of the President, Dr. Stokes, and the
genuine and hearty welcome with which their Irish brethren
received them—a successful attempt was made to give to the
meeting a national scientific air. Amongst others, the paper
on “ State Medicino ” by Dr. Rumsey, was read, whioh eventu¬
ally led to a committee being appointed in conjunction with the
Social Science Association, to wait upon the Government in
reference to this important subject. He therefore hoped that
a committee would be appointed to consider the claims of this
special branch of. education, and that they should report
thereon to the Council.
Dr. Stokes, in seconding the motion, held thatit behoved the
Council to watch narrowly the interests of the profession. Strict
supervision was necessary, as the subject of state or preventive
medicine in a medico-legal view was of the utmost importance.
Nothing was more common than the sneers and unchari¬
table remarks indulged in by clever lawyers and the public,
when a medical man was called upon to give evidence in a
case in court, because he was unable exactly to determine the
cause of death ; he was snubbed and had to retire, oonBciotts
of his inability to give any satisfactory answer to the cross-
questionings to which he was subjected. And why was this !
simply because this portion of his education had not been at¬
tended to. The time bad however now arrived, when this
branch must receive special legislation, and he hoped the time
was not far distant when—instead of the practitioner's ignor¬
ance of this subject being a cause of concealing crime—he
would be able at once to determine, when called upon, the
point under investigation.
After further remarks from one or two speakers, the motion
was carried nem con, the committee consisting of Dr. Smith,
Dr. Stokes, Dr. Christison, Dr. Rumsey, Dr. Parkes, Dr.
Acland, Dr. Thomson, and Dr. Paget. An instruction to the
committee by Mr. Hargrave, seconded by Dr. Alexander
Wood, was ultimately withdrawn by consent.
secondary school education.
The following was then moved by Dr. Storrar :
“ That, having regard to the importance of improving the
general education of persons entering on the study of Medi¬
cine, it is incumbent on the General Council to petition both
Houses of Parliament, praying for early legislation on the sub¬
ject of Secondary education in schools ; that it be referred to
the Executive Committee to prepare petitions to the Honsee
of Lords and Commons; and that the President be authorized
to sign and affix the seal of the Council to them, and take
measures for their presentation."
Dr. Storrar commenced by saying that if he were asked
what he meant by secondary education, he should define R
thus : primary education he underetood to mean reading,
writing, arithmetic, and the English language ; secondary'
education when a youth was taught the olassics, mathematics,
languages, &c. It was a conventional term, but he believed
one generally accepted. The principles of general education
had been so often discussed, that it was only necessary for him
to take a retrospective glance at what had been done, and
what could be devised to improve it. He would have the pre¬
sent standard raised, and see that it was honestly maintained.
He would rather youths were kept at their preliminary studies-
a year longer than was generally the case, so that their intel¬
lects might be better formed for the transition to the higher
attainments. He would shut out those men who were incap¬
able, from whatever cause, to come up to this standard, telling
them honestly the profession they were better fitted for than
that of medicine ; but, on the other hand, they would do well
to secure all young men who had received a good general edu¬
cation, with a capacity to enter on their professional studies,
and having attained this object, to steer them through the
Digitized \ ' )0^lC
Hie Medical Pres and Circular.
GENERAL MEDICAL COUNCIL.
July 8,1888. 31
higher branches required by the examining bodies. He had
the honour to be engaged on the recent Royal Commission,
appointed to inquire into the conduct of public schools, and
the impression upon his mind was, that endowed schools were
often, by their m is ma n agement, great obstructions to the well¬
being of the pupils. There were no less than 800 endowed
schools in the kingdom, with endowments varying from £5 to
■ P 61 " a np ^ Tn > the aggregate being considerably over
£200,000. fie might state that a grammar school was gene¬
rally understood to mean a clas s ical school, where the system
of secondary education on which he was speaking was taught.
Some of these schools he had found to be very good, others in¬
different, others downright bad, and a few, though it might
seem an anomaly, were not schools at all. On the subject of
general or secondary education in England, Ireland, and Scot¬
land, they all agreed that it was not in the satisfactory state
they could desire; he, therefore, proposed that the Council
by their actions, should endeavour to strengthen the hands of
tire Legislature who were endeavouring, and were willing, to
do all that was possible in this respect.
Dr. Alexander Wood had great pleasure in seconding this
motion. From* his own experience as an examiner in the Edin¬
burgh schools, he must confess that to improve the education
ef youths in the present constitution of schools was simply im¬
possible. It was deplorable to see so mnch seed wasted because
of the unprepared state of the ground on which it was sown.
He hoped the Council would raise their voice towards dragging
the present unsatisfactory condition of general education into a
new existence. There was one school which he might mention
as an exception in Scotland to the general rule—that was the
University of Aberdeen. It was so admirably managed, and
the most essential portions of their education were so thoroughly
impressed on the minds of the students, that he had no hesita-
tion in saying he could distinguish an Aberdeen graduate from
any other by the superior way his mind had been prepared. He
would extend this system throughout the country, and men
would be able to take their stand in life on a much higher
platform. J
Pr. Bennett considered the subject of great importance, but
sweated that it should be referred to the committee sitting
on Dr. Andrew Wood’s motion, to which the question be
longed.
Sir Dominic Corrigan could not give his adhesion to the
project of a petition to Parliament. If the subject was worthy
thtir attention, and action was to be taken on it, they should
legislate for themselves; because, from past experience of the
Council on Parliamentary petitions, little could be expected
from that quarter. He agreed that the present state of our
young men demanded their most serious attention, and for that
reason he objected to wait the result of a petition. His opinion
was that a committee be immediately appointed to inquire in
what way the.standard of general education could be raised;
apd he would extend the inquiry not to public schools alone,
but to private ones also. He begged to propose an amendment
to that effect.
Pr .Andrew Wood remarked that something must be un¬
questionably wrong in the system which produced such results
as came under his observation, instancing some very extraordi¬
nary answer? that had been given to the simplest questions by
pupils when under examination.
Dr. Apjohn would also vote against the motion, as he con-
■ideised that the Council had already done what they could for
cdueatipn, and this was a step out of their province.
Mr* Hawkins was of the same opinion, and suggested that
ssGovarmnent was taking the entire subject of education up,
it,would be unwise at-present to interfere.
After a few remarks from Dr. Storrar,
-The motion was put from the chair and agreed to by a ma¬
jority of one.
The Council then adjourned.
Monday, June 29.
Council were engaged the whole day in committees on
the subjects mentioned in Friday’s proceedings.
^ Tuesday, June 80.
* •’ REGISTRATION OF STUDENTS.
tfcQved—“ That a committee be appointed to
Mm returns of examinations from the licensing bodies,
“^-atfdn of students.”
objected to the motion, because the
found to be utterly useless in practice, and in
h regulations would be laughed at.
Dr. Andrew Wood hoped the Council would express them¬
selves m favour of the appointment of a committee, and not
be deterred therefrom because they were told they might be
laughed at. J 6
After a few remarks from Dr. Paget, Dr. Alex. Wood, and
Professor Stme, the motion was carried ncm, con.
PRESENTATION OF THE “ REGISTER.”
The following motion by Dr. Paget— “ That in future every
person whose name shall be entered for the first time in the
Medical Register’ shall be entitled to receive on application
the published copy of the ‘ Register’ for the year in which his
name has been entered,” was also agreed to with bnt little dis¬
cussion.
DEPUTATION FROM THE BRITISH MEDICAL ASSOCIATION.
The deputation from the British Medical Association—which
consisted of Dr. Sibson, president; Dr. Waters, Mr.Nunneley,
Mr. Southam, Dr. Hy. Simpson, and Mr. Watkin Williams,
secretary to the association—was then formally introduced to
the Council, the president stating that he should reserve to
himself the right, on behalf of the whole Council, to use what
interrogatories he deemed necessary, or should be suggested to
him m writing by any member of the Council, so as to elicit
anything that might be necessary for them to know, and what
importance they should attach to the memorial which was
brought for presentation.
The President then inquired whether it was the memorial
of the whole body of the Medical Association, or simply ema¬
nated from the council.
, ’P 1 ** replied that in spirit it emanated from the whole
body of the Association; and in answer to some other questions
°l if P^ e8 ^ en ^ & ave a brief account of the manner in which
the British Medical Association had come to the resolution to
present this memorial to the Medical Council. The resolution
was carried almost unanimously at a very large meeting in
Dublin, presided over by Dr. Stokes. Addressing the presi¬
dent, Dr. Sibson said—Let me now call your attention to the
spirit which animates the Association towards this Council. It
was, so to speak, in taking steps to give aid to this Council in
its work, and in token of our great approval of the work done
here by the Medical Council, that this proposal originated. Let
us look for one moment at the constitution of the Council as
it now stands. I may say there is no single member of it that
represents what may be termed the body of the profession.
There are most important members sent up from the various*
universities, who represent truly the education of the profes¬
sion; there are most important members sent up from the
various bodies who confer power to practise medicine; and
although some have said that it is possible those gentlemen
may be influenced by the bodies they represent, to the disad¬
vantage . of the true interest of the medical education, the
Association that I have the honour to represent do not enter¬
tain such views, but are satisfied that every gentleman oom-
posing this Council always has done his utmost to promote the
welfare of the profession, quite irrespective of the individual
body that he represents. We therefore take no exception
whatever to the elements that compose the existing Council'.
On the contrary, they are the very elements we were the first
to recommend; and if we had the work to do over again, where
could we go to find a body of men so capable of supporting
that which is best worthy of support in the profession as those
who form this Council ? I do not allude to individual members,
but I allude to those bodies who are certain almost to send
here their very best men. But may I suggest to you that if
taxation and representation ought to go together, the body of
the profession has an inherent right to be largely represented
on this Board.. Observe, sir, that every pound that comes into
thecoffers of this Council cemesnot from the corporations or from
the universities, or from the Government, but from the general
practitioners and the physicians and surgeons of the kingdom.'
And as I have named the Government, it is only due to the
Government to say that it has always sent to this Council an
admirable body of men; but it cannot be said that, admirable
as they are—high in education, well-known as promoters of
the public health—that they represent the profession. But
although we have a large claim to be represented, the Associ¬
ation has no desire whatever to obtain a preponderating weight
of votes in this Council, but only in a minority of one-fourth;
and why we have asked for eight in the existing state of things,
if the Board should be, in consequence of the addition—sup¬
posing it to be made—considered too numerous, we should oon-„
rider if the numbers were reduced tha$ that reduction should
82 The Medktl Press sod Circular. GENERAL MEDICAL COUNCIL. 11117 8 , 1808 .
apply equally to those representatives of the profession as to
the representatives of the public bodies. l)r. Sibson then
pointed out a few of the advantages he thought would accrue
by the proposed change.
After a few remarks from Dr. Waters and Mr. Nunnelet,
the deputation thanked the President and Council for their
attention, and withdrew.
REPRESENTATION OF THE PROFESSION.
Dr. Andrew Wood then moved the following resolution:—
* That the Medical Council take into consideration its present
constitution with a view of determining whether it be not
advisable that it should be placed on a more popular basis, by
the addition of a certain proportion of members to be chosen
directly by the suffrages of registered practitioners.'* He then
said he was afraid he should be obliged to occupy the time of
the Council longer than he had previously done during the
session, as he thought upon so fundamental a question, the
Council should not decide pro or eon , without most careful
deliberation. He regretted that circumstances should have
devolved upon him the duty of bringing forward the question.
It had been proposed that the interests of the profession, and
of the corporations and universites connected with the educa¬
tion of the profession, should be handed over to a Crown Council
to be composed of about twelve members to regulate the pro¬
fession. That was the purport of Lord Elcho’s Bill which he
was happy to say the profession had succeeded in defeating.
The constitution of the Council afterwards agreed upon was
improved in the Bill brought in by Mr. Cowper, and Mr.
Walpole, and remains to this day as then laid down. They had
heard from the deputation that the British Medical Association
were the first to engage in medical reform, but while admitting
that they had contributed to the passing of the Medical Act,
he absolutely denied that they were mainly the cause of it.
He then drew attention to the presentconstitution of the Council.
England was represented by eleven members, of whom four
sit for universities, three for medical corporations, and four
for the Crown ; Scotland was represented by six members—
two for universities, three for medical corporations, and one for
the Crown ; Ireland was represented by the same number and
in the same proportion, so that there were eight university
members, nine of medical corporations, and six crown members,
which with the President was the total number of the Council.
The Council when founded had the almost universal approba¬
tion of the profession. It was not objected to by the British
Medical Association, they only suggested that the Crown
* nominees should constitute one-third part of the Council.
One great object why the British Medical Association were so
anxious the Crown nominees should be numerous was this—
that they might be representatives of the general practitioners.
He believed in the very first appointment made by the Crown
there were two representatives of the general practice of the
country in the persons of Sir Charles Hastings, who he believed
at that time was President of the British Medical Association,
and their esteemed and lamented friend Mr. Teale. Since that
time tiie only representative of the general practice sent by
the Crown was his friend Mr. Rumsey—so that if there were ex¬
pectations excited at that time, that the Crown nominees were
to be the means of representing general practice, those ex¬
pectations have not been fulfilled. He did not think they had
any reason to find fault with the nominees sent by the Crown,
and they had no reason to wish that we should get rid of them.
He had seen in some of the medical journals the pro¬
position made, that as the crown paid nothing for the ex¬
pense of the Medical Act, they should get rid of the
Crown nominees, and convert them into popular represen¬
tatives of the general body of the profession; but that
would be no part of the scheme which he was about to pro¬
pound, that the crown nominees should 'be diminished. It
was right, especially after what they heard to day, that
they should look at the pertond of the Medical Council as it at
the present moment exists. There are many misrepresenta¬
tions abroad in regard to this, and the cuckoo-cryatUe being
continually sounded, that general practice finds no representa¬
tive in the Council. It was quite true that general practice
did not find any direct representation such as had been pro¬
posed to them and such as he was about to propose; but there
were general practitioners upon that Council, and how the in¬
terests of general practitioners were looked after would appear
from the enumeration that he was about to give them. He
found, taking the 24 gentlemen who were sitting round that
table, that 8 of them were pure physicians, 8 were pure sur¬
geons, and 8 were general practitioners—men engaged at ordi¬
nary practice of their profession, who were neither consulting
physicians nor consulting surgeons. They had had three
scientific teachers who were not in actual practice, and, he
needed scarcely add, their presence amongst them was a most
valuable element; and that they possessed one gentleman ex¬
perienced in everything—in teaching, in examining, and*in
practice, he alluded to Dr. Farkes. It was right that that
should go forth, in order that it might be proved what general
practice was represented to a certain extent upon that Council.
As a member of the deputation rightly Btated, there was a itea-
son why that representation should not be direct when the
Medical Act was brought in, that is to • say, that their being
no Medical Register in existence at that date, it was therefore
impossible to arrive at the -opinion of the profession. Ce n se-
quently, they must not imagine that if there had been in ex¬
istence the means of making the votes of general practitioners
available, direct representation would never have been bro u g h t
forward and introduced into the Bill at all, constituting tost
Council. If he were asked whether he would choose to select
a council, composed in its entirety of popular representatives sent
by the general practitioners of the country and by the univer¬
sities,by means of the general councils of those universities which
have been recently enfranchised, more especially in Sootland, he
would say no; because, however desirous he might be of popular
representation, he was anxious that (t should be limited in quan¬
tity, and that they should not be reduced, as was said in regard
to the Reform Bill, to the dead level of Salisbury Plain.
Neither would he elect to have a council wholly nominated by
the Crown, nor to have an irresponsible council; he would
select something between. The council he should prefer, if he
had the means of carrying it out, would be the present council,
which contains the University element, and the choice of mem¬
bers by the primates of the universities; secondly, the medical
corporations and their election either by fellows, as In the oase
with his own corporation, and that of his friend Dr. Fleming,
and others, or by the Council, as in the case of his friend Mr.
Hawkins ; and, thirdly, the Crown element; but, in addition
to that, he would prefer members elected directly by the re¬
gistered practitioners, in order to add to those other three
elements, the popular element which he thought Would tend—
heterogeneous as those others certainly were—if joined together
in a chemical union, to make a homogeneous and salutary com¬
pound. He advocated such a council on account of its variety.
He thought it was of very great importance indeed, that they
should get a variety of constituents, because he felt satisfied
that by that principle of selection the different interests would
balance one another, the Conservative proclivity of the one
operating as a drag, perhaps, upon the radical tendencies of
the other, and vice vena. He might be permitted, he said, by
some of his numerous friends, witn the inconsistency of holding
very radical doctrines upon that matter, but at the same time
a Tory in general politics. *■
The President trusted that his friend Dr. Andrew Wood,
would not introduce general politics there.
Dr. Andrew Wood observed he used it as an illustration of
his subject, and he would show them the analogy. It was
that he thought that propounding so-called radical doctrine, he
was advocating the most conservative course it was possible to
adopt.
The President asked to be forgiven for reminding the
learned doctor that that assembly did not argue questions
there as to whether they were conservative or radical, but as
to whether they would be for the good of the profession or not.
Dr. Andrew Wood said he could show them how it was he
applied the illustration; he said it would be conservative of the
Council to adopt that reform, and for that reason, and that
alone, if the Council would not head the agitation which had
been going on outside, he would stand by its present constitu¬
tion, notwithstanding what they had heard that day hi regard
to agitation, which was sure to occur if they go to Parliament
for a bill; in all probability in the reformed Parliament-we
might have, he said, the old constitution of Council bouloent,
ana they might have perhaps those conservative elements
which exist in it destroyed. He thought he was quite justinad
in using the argument to induce them to take such steps as
would show that they are determined, having considered the
subject most carefully, not to be prevented by obstacles in the
way of introducing that popular element into their constitu¬
tion, which might perhaps be the preservation of the CouutfL
He thought it would tend to strengthen the hands of the jCoup-
oil, a thing they greatly needed; he was one of those who da¬
shed more than once to go to Parliament for the pusposg^flf
having additional powers conferred on them for enabtiRff Ihlt
Digitized by v joogle
The Xedfctl Ttm sad Greulsr.
GENERAL MEDICAL COUNCIL.
July 8 , 186 S. 33
to enforce their regulations ; bat he had no hope of success
in that, unless they put the Council on a more popular footing.
Another thing is that it would make the Council more popular
out of door. For whatever the deputation might have said to
them that day, that all they have done has been excellent,
jet true it was, and a verity, that for the ten years that
Council had been sitting, they had in some way or other—ex¬
plain it how they might—not . been so popular a body as
hithecte. He also thought the infusion of the popular element,
and the admission of members from different parts of the
country, would rouse an interest in their deliberations, which
was not at present felt by them; he had often been astonished
on making affusions to the Medical Council, and to what it
was doing, to see how little gentlemen in the provinces cared
about it, and how little they knew about it. But if they were
ever vested with the franchise, they would watch carefully to
see hew their representatives acted for that Council, and they
would take an interest in their deliberations, which would give
a force and influence to all which they hitherto had never
enjoyed. He thought also it would have the effect of giving
mort certainty to the decisions of their Council, and driving
away that debility—he did not mean it offensively—but he
might almost say a vacillation which had generally charac¬
terised the decisions of their Council. It would also, he said,
have the effect of producing among the professional gentlemen
an esprit de corps which they had not then. That had been his
experience in the 6ase of the Scottish Universities. Before the
passing of the recent act, the graduates attended their lectures,
took their degrees, and there was an end of their connection
with the universities, but he found at that moment that they
were in the midst of elections which were exciting the greatest
interest, both the election of our chancellor and in the election
of members of Parliament, and the result was that there is
amongst all the members of the universities an esprit de corps
raised, which had attached them to the universities, and which
he believed would greatly benefit those bodies.
At this point the President having to withdraw, Dr.
8 hispxt took the chair.
Dr. Avdrew Wood continued — Another reason why this
reform should be carried out was, that the provincial element
waanot sufficiently re p res en ted at present. His scheme would
be this, that the country should be divided into electoral dis¬
tricts. Taking the Medical Directory, he found there were
16,000 members of the profession : in England, 12,500 (com-
prising 2808 in London, and 9691 in the provinces), in Scot¬
land, 1717, and in Ireland, 2189. He therefore suggested the
advisability of increasing the numbers of the Council by six.
He Would add one member more to London, and by separating
the districts, or rather the provinces, into three districts.
Northern, Midland, and Southern, he would obtain manage¬
able electoral bodies of about 8000 voters, and then England
would be well represented. In regard to Scotland, with all
bis national love Mid desire to do what he could for her, he
thought, in justice, she could not by any possibility claim more
than one member, and the same with regard to Ireland.
There were reasons for dividing England into districts, other¬
wise all the members might be chosen from London, and the
provtnees would yet go unrepresented, and he would not hesi¬
tate to say that the gentleman who would get returned for the
provinces able men, high in their profession, who were now
there—would oe cordially welcomed by the Council.
Moreove r, other advantages suggest themselves of dividing the
dbtrista, which would enable one to obtain manageable mem¬
bers for-the position of scrutineers, &c., and the plan he
thought of adopting, was that the registrar of the Branch
Council of England would issue and receive the voting papers
for Tendon, -and appoint a special registrar for each three of
the AjglMi districts, one far Scotland and one for Ireland—
to whom the voting papers would be returnable. Then the
wimhiM would be summoned up by those registrars respec-
presence of the mover and seconders of the candi-
fefeMmtehe result being ascertained, would be sent up to
the fturidsnt, whose duty it would be to notify the election
h the f&UMffc to the country. He had given these particu-
bus In An# that the scheme he proposed was a practicable
<*» c o ur se, he was anxious that the matter should be
wfanMfl m w iywnit tee to consider the details. He was op-
pose&ie>unf Owtailment of the members of the Council, in
the popular representatives ; because, who was
h bMUmShd f He questioned if there were any Marcus
»into the gulf for the sake of purepatriot-
_h any attempt to modify the existing con-
rtltttway, would bring the whole house about
their ears. It had been often said, and especially by the
medical press, that there was a great deal too much talk in the
Council and very little work. In fact, some of the journals
had gone so far as to select the inveterate talkers, at the head
of whom he believed Sir Dominic Corrigan enjoyed a proud
pre-eminence; he (Dr. Andrew Wood) came second, and
his friend, Dr. Alexander Wood, third. He did not care for
that, for if they expected members to come here as
simply delegates to carry measures without discussion,
they had very much misapprehended their men. There
was no deliberate assembly in the world where there
was not a very great deal of superfluous chatter. Go to Par¬
liament, and ask the reporters if it was all wheat and no chaff
there, and they would soon tell you their knowledge of the
affair. The truth was that just in proportion as views got
ventilated in free discussion the consequences were good. He
therefore maintained that a great many accusations had been
brought against the Council with regard to talk, which were
unfair, and if it were hinted that the admission of popular
representatives would increase the talk, he answered that pro¬
vincial members were, as a rule, common-sense men, whose
opinions it would be most advantageous to the Council to hear,
because they were constantly in direct contact with large
numbers of their brethren in the profession and with the public,
and therefore knew by experience what were the wants of the
profession on the one hand, and the wants of the public on tbe
other. Again, it was said that the Council was already too
numerous. He did not think so ; and if anyone had come into
the Council-hall yesterday, and seen five or six committees,
they would arrive at a very different conclusion. He was
pleased to see a tendency, day by day, to increase working
committees ; and he believed that six more members upon the
Council would be a great assistance in this respect, and that
the deliberation of the Council would be shortened by having
the work done to a great extent by committees. But the great
master grievance was the expense, and he found that so distin¬
guished a man as the Bight Hon. Robert Lowe bad taken
occasion the other day to allude to this. He (Dr. Andrew
Wood) had for some time past deplored this expense. Being
subject to the reproach, whether justly or unjustly—he did not
think justly—worked in avery baneful way against the influence
of the Council, and therefore he would be the last to propose
any addition to the numbers of the Council; be was ready
to advocate a measure which would not increase but decrease
the expense. By reducing the fees from five guineas a day
to £4, and, still better, to £3 10s., there would be a diminution.
But better than that, he was thoroughly convinced that
it was the bounden duty of the Council, by a self denying
ordinance, to reduce their fees from five guineas down
to two guineas. Was it an object of money to any of
them ? He did not believe that the men who composed
the Council should be men who could be swayed by
pecuniary motives; and if the remuneration were levelled
to two Guardians, they would not only add to the expense of
the Council, by tbe addition of the six members, but would
save nearly £600 a-year. He was satisfied that just ih propor¬
tion as they decreased the expenses, and took away that cause
of opprobrium, the cause of the Council and its welfare out of
doors would increase. It must be but an honorarium at the
best—for he was satisfied that the majority of the gentlemen
sitting round, were attending even now at a large pecuniary
sacrifice ; and he felt, therefore, that they ought not to be
treated in the manner they had been in the medical journals,
in reference to this matter. However, he would say, take
away even the chances of such a reproach by adopting
such a scheme as no one could cavil at. As a member
of the executive committee, he had to come to London
from time to time, and two guineas a-day were considered
a sufficient remuneration for his services. Why should
they make fish of the executive committee, and flesh of the
General Council; let them embrace the low tariff and save
£600 a-year, and he would be bound to say they would not
feel the same difficulty that was felt with regard to the dis¬
establishment of the Irish Church, for they understood well
enough how to dispose of the money. It was said by this
measure they would introduce the element of discord and
agitation. He did not fear that—he never found when men
were enfranchised that they were one iota deteriorated—he
had been educated up to that point. He was certain a little
wholesome movement in the profession would, upon the prin¬
ciple of agitation puryate, be of vast service. He tendered
to the Council his best thanks for their patience in listening to
his proposed plan of action. Bj£ voting for the present
34 The Medical Press »nd Circular. CONSTITUTION;OF MEDICAL COUNCIL. «. ««•
resolutions they would not pledge themselves to any one
course, except a resolution containing the words—“ with a
view to determine whether it be advisable that it should be
based on a more popular footing/’ could be said to pledge
them. He was pleased to say Sir Dominic Corrigan agreed
largely in the great features of the proposal, and had paid him
the compliment to second the motion.
Sir D. J. Corrigan, in seconding the resolution, said he
would reserve any observations he might make to a future
period of the discussion.
(For continuation see page 87.)
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY 8, 1868.
THE CONSTITUTION
OF THE MEDICAL COUNCIL.
The great question of the week has been the Reform of
the Medical Council. Whatever else may remain doubt¬
ful in the conflict of opinions, it is now clear to all who do
not refuse to see the signs of the times, that the constitu¬
tion of this body is unsatisfactory to the bulk of the pro-
ession, and that its reform must be the one great object
for which all true medical reformers must strive. The
cry first efficiently put forward by men who had devoted
much time and attention to medical politics, and taken up
by the Medico-Political Association, and then by the
British Medical Association, has found an echo within the
Council itself. The result is that several plans are before
the profession, and each of these deserves earnest considera¬
tion. They may all be arranged under one head—pro¬
posals for the registered practitioners of the kingdom to
be represented in the Council which is supported by their
contributions. These proposals take two forms—first, that
of direct representation by increasing the number of the
Councillors by men chosen by the profession ; second, that
of indirect representation, by allowing those who hold the
diplomas of the Corporations to elect the representatives
of those bodies. The British Medical Association adopts
the first plan, and is supported in the Council to some ex¬
tent by Dr. Andrew Wood. The champion of indirect
representation is Dr. Prosser James, who has staked the
support of his professional brethren in his contest for a
seat in Parliament upon the plan of Medical Reform
which he has sketched in his address to the electors of the
Universities of Edinburgh and St Andrews, already pub¬
lished in our columns— (Medical Press and Circular,
June 24).
The Medico-Political Association in its programme only
demands the representation of the profession in the
Council, and we, therefore, presume that either plan may
calculate on ts support; though whether it would be
satisfied with either alone, and if not, which it would desire
first, does not appear.
Our readers will naturally anticipate some remarks upon
the subject, and we are aware that the profession is so in¬
terested in the question, that we give a much fuller ac¬
count of this debate than of the others which have occupied
the Council.
We have more than once felt constrained to give ex¬
pression to the fears that have been expressed in so many
quarters about increasing the number of the Council. Not
that we feel that increase of numbers must necessarily
multiply bad speeches—it might even rather increase
the proportion of good ones—but there are certain prac¬
tical difficulties not easily overcome. For example, the
question of expense, although magnanimously neutralised
by Dr. Andrew Wood’s proposal, will remain so long as
his proposition receives a cold reception. But there is a
much greater difficulty than this, and one which was most
aptly put by the President in his business-like, sensible,
and straightforward reply to the deputation of the British
Medical Association. He pointed out, most properly as
we think, that the Council is not self-constituted, and can
neither increase nor diminish its numbers without an Act
of Parliament, and he stated, what is well-known to all
acquainted with public afiairs, that there is no hope of
obtaining such an Act within any reasonable period. That
is an objection to the proposal for direct representation
which has never yet been answered. It applies equally
to the proposal of the Association, and to that of Dr.
Andrew Wood, and in fact, to every proposal to reform
the Council that has been made, except to that of Dr.
Prosser James, which, therefore, we may now consider.
This gentleman appears to have long-cherished the idea
that the profession may be adequately represented without
any legislative interference. In point of fact, the scheme he
has just published was proposed some twelve years ago,
before the Council came into being, and was at that date sub¬
mitted to Lord Palmerston’s Government. We think it is
to be regretted that a scheme so long before the public, and
which it would be so easy to carry out, should not have
received further consideration by the Council, especially
as parts of it were over and over again alluded to by vari¬
ous speakers, who seemed to lack the courage to explain it
in all its details, or to advocate something proceeding from
an outsider.
A few words would have given it in its simplicity. Dr*
Prosser James proposes that the representative of each
Corporation at the Council should no longer be appointed
by the governing committee of the Corporation, but elected
by those who hold its medical diploma. That, we believe,
is the pith of his scheme, and that would unquestionably
give representation to the profession. It would very possi¬
bly give a greater voice to the profession than the addition
of the largest number that has been asked for by the
advocates of direct representation.
Then, that this scheme is by far the most practicable,
and most easily attainable, appears from even a cursory
examination. For example, it does not require the inter¬
vention of Parliament. The Corporations themselves are
capable of carrying it out, and if the Council should ex¬
press its approval of the plan, we do not doubt that they
would be willing to do so. Besides, we heanPwith great
pleasure from Dr. Paget, that his constituents in full
| numbered 4600—that is, as he explained, every one of
| those graduates of the University could exercise the fraa-
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The Medical Press and Circular.
DEBATE IN MEDICAL COUNCIL,
July 8, 1868. 35
chise if they wished, and although, practically, the matter
is left in the hands of a small committee, the right still
exists. Here is a brilliant example of liberal treatment
set by the University of Cambridge, which other bodies
would do well to imitate. If all thus freely, accepted the
plan of Dr. Prosser James, it is not improbable that
there would be no further demand for a reform of the
Medical Council. Will the Corporations take the hint, or
will they stop the way until the profession outside is com¬
pelled to appeal to Parliament for itself?
Again, the scheme of Dr. Prosser James is more feasi¬
ble than the other, inasmuch as it is not complicated with
other subjects, on which differences of opinion are rife.
It does not affect the numbers of the Council. It would
not increase the numbers, and so would not play upon the
fears of those numbers which have been so freely ex¬
pressed. On the other hand it disfranchises none, and so
excites no opposition on the part of condemned memberc.
Further, it does not touch the question of expense, con¬
cerning which there seems no chance of any two people
coming to the same conclusion.
For these and other reasons we think this plan has the
merit of being eminently practical. A resolution that such
a procedure is just or desirable would, we anticipate,
suffice to bring it into general operation, and this much
can be effected without any preliminary difficulty, or any
need to wait the pleasure of a minister or the decree of
Parliament. • The Council then might do well to consider
the propriety of making itself the bond fide representative
of the profession, in a manner thus simple and effective.
The profession generally will think that such a resolution
as this would have been worth more than all the talk that
has been indulged in this session.
NOTES ON THE
GREAT DEBATE IN THE MEDICAL COUNCIL.
The constitution of the Medical Council has long been a
subject of interest, and it is capable of being looked at
from so many points of view that a few stray but discon¬
nected notes on the late debate may not be uninteresting.
GENERAL PRACTITIONERS.
Dr. Andrew Wood, in the course of his speech, said
eight members were already general practitioners. He was,
however, corrected as to this, more than one explaining
that he could lay no claim to the term. It is certainly of
little consequence what department a man practises, and if
the popular element, as it was more than once called, be
introduced, there will not necessarily be more general prac¬
titioners. If any new persons send new representatives, it
will be registered practitioners, and the terms are not syno-
nomous.
DR. ANDREW WOOD’S PLAN.
The scheme submitted by this gentleman will be seen
from our report, possesses many points of superiority to
that o£ the association. It is more definite, more complete,
more practical. He would add six members (four for
England, one for Ireland, and one for Scotland) to be
elected by registered practitioners. Ireland, he calculated,
contained 2139 registered practitioners, Scotland 1717,
England 12,500. fie would divide England into districts,
ana give London one member, Northern, Midland, and
Southern districts one each. No constituency would ex¬
ceed 3000, which is about the number for London.
How great a dread is entertained by many of popular
elections is shown by a remark of Sir B. Brodie’s, quoted
in the debate, to the effect that “ popular representation
*ls the v ery worst calamity that could happen to the pro-
fcnwtt.** We presume few people will endorse the opinion
etl fc r k te -bjuroaet on this point.
t.Ti - - -
TORIES AND RADICALS.
The introduction of the terms common in general politics
excited both amusement and surprise. The President said
that the Council did not argue questions as to whether they
were Conservative or Liberal, but good for the profession,
and asked speakers not to introduce general politics. He
did this firmly and well, and indeed throughout the session
performed his duty in a manner that gave general satisfac¬
tion.
TRADING IN DIPLOMAS.
In repartee, when interrupted, Sir D. Corrigan again
called attention to the monstrous fact that one body had
in one year taken £10,000 for diplomas given without
examination.
This was hard on the Northern College, which only erred
in amount, for did not the college in whose hall he spoke do
the same in a smaller way—nay, did it not set the example
of a year of (dis)-grace ?
TAXES OR FEES.
Dr. Paget very ably argued that the registration fee was
not a tax, and that to call it so was a misapplication of
terms. Moreover, he thought the Council diet not govern
the registered practitioner. No one pointed eut to him
that whatever may be the correct term, the money which
supports the Council comes from the profession, and they
who pay at present get nothing for their money but the
right to have their names on the official directory. Dr.
Paget admitted that if representation were, as he thought
not, a right by virtue of the tax or fee, it may be expedient
to grant it. His speech was one of the best we have heard
in the Council.
INDIRECT REPRESENTATION.
Several speakers alluded to the possibility of granting in¬
direct representation, by popularizing the mode of election of
the representatives of the corporations. This is the plan ori¬
ginated by Dr. Prosser James, and so fully explained lately
by him. It evidently commended itself to many who
could not tolerate the notion of direct representation. Dr.
Paget said the whole Cambridge University constituency
haa a right to vote for him, and he recommended Sir D.
Corrigan and Dr. Andrew Wood, who so ably advocated
popular representation, to try and carry out their views in
the bodies that sent them. He thought about twenty
men elected Sir D. Corrigan, and that the graduates of the
Queen’s University might fairly ask for a vote. The
Fellows of the College who sent Dr. Andrew Wood, should
be persuaded by that gentleman to give a vote to their
licentiates. Dr. Paget’s speech made a sensation in the
Council, which will be produced out of doors. The facts
and arguments will go far to establish the justice of all
that Dr. Prosser James has brought before the profession.
Several other members incidentally alluded to the plan,
but none spoke out so clearly and with such manifest ap¬
proval.
THE UNKNOWN FUTURE.
Dr. Stokes pleaded that all the machinery of legislatioii
takes up much time, and that the Council was a new body)
and more could not be expected of it. He dreaded the in¬
troduction of questions they could not decide if popular
measures were adopted. Such questions as remuneration
of medical men, or of witnesses, coroners’ fees, and above
all, private professional differences, might be dragged in by
members elected by the profession. Why not? The
Council is paid, and might very well direct its highly de¬
veloped talking capacity to subjects that would interest
those who pay.
GREEK.
A considerable portion of Saturday afternoon was oc¬
cupied with a lively discussion as to whether Greek should
be transferred to the compulsory subjects of preliminary
education. Each speaker seemed satisfied that he alone
comprehended the Alpha and Omega of the question, so
that the debate was more amusing than might have been
expected.
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36 T&e Itodieal Prtai tad Circular.
NOfES ON CtmMlNT TOPICS.
July 8,1888
We the lees regret that we have not space for a foil re¬
port of this vivacious discussion, as our readers, like the
few listeners present, would probably pronounce it “ all
Greek” to them.
As the language is so familiar to the Councillors, and
some confessed to reading it for pleasure, we beg to sug¬
gest that in future the proceedings should be conducted in
Greek, when it is probable that the Council would at
least be a little less loquacious.
- ♦ -
$3fotes frit Current Skip*.
Medical Statistics of the Abyssinian
Expedition.
We are enabled to publish the following authentic infor¬
mation of the health of our troops, and the mortality in
the recent campaign :—
Average daily sick to numerical strength, 5*8 per cent;
average of deaths to numerical strength, 1*3 per cent.;
mortality of officers, 11 per cent. ; of men who died in
the high lands, 17 per cent.; of men who died on the
coast and in hospital ships, 20 per cent. Three medical
officers died, one of whom was on his way to Magdala ;
and three officers met with violent deaths, of whom one
committed suicide.
The above figures speak eloquently of the perfection of
the sanitary arrangements, and of the activity and intelli¬
gence of those in charge of the department. Perhaps no
expedition attended with similar difficulties was ever
carried , to so complete a success with such insignificant
loss of life, or so few men put hors de combat.
The Future President of the Medical Council.
The approaching expiration 6f the term of office of Dr.
Burrows, who has so ably and so impartially carried out the
arduous duties pertaining to this important post during the
last five years, has caused a good deal of speculation as to
his probable successor.
We hear that, as it would cost some £300 to summon
the Council for the mere purpose of electing a president
before the session of 1809—as was the case on the decease
of the gentleman who, prior to the appointment of Dr.
Burrows, occupied the presidential chair, the Council were
resolved to proceed with the election during their present
sitting. To show (he appreciation of the manner their re¬
tiring president has conducted the business of the Council,
the members unanimously requested him to allow himself
to be re-elected unconditionally. It is therefore within the
province of Dr. Burrows to fill the office for one year, or
for the foil term of five years. This decision must be very
gratifying to Dr. Burrows; but we are credibly informed
that he will not fill the post after the expiration of the ses¬
sion 1869.
The Royal College of Physicians of London.
The nomination list of the College has at last appeared.
A glance realizes our predictions, and shows us how
utterly hopeless it is to look for better things under the
present system. The few recent good and able men
elected on the Council, who would do justice, are out-voted
and unable to snap the u red tape,” rotten as it is. But
how could a more just selection of members for the Fellow¬
ship possibly be made from a body which, as a rule, is care-
folly recruited horn the same unaltered source ? (the
system being, that the members of a clique elect their own
successors, who, there is little doubt, owe their selection to
unanimity of views, plans, and objects of their predeces¬
sors). The only chance of reform, in the acts of the Council,
must come from a reformed election of the Council itself.
This change may not occur in this year, still, little union as
there is in the medical profession, and much as the very nature
of the profession itself tends to isolate its members, we
cannot think so meanly of the majority of such highly
educated meu as to believe that when once awakened
to the absurdity of such a clique, dealing out (what ought
to be a well-won and honourably worn distinction), if not in
a direct spirit of favouritism, at least, on no comprehensible
principle, and subject to no control from the independent
body of the Fellows. Since the historic days of tyranny, 4
none has been so intolerable as that of an oligarchy, and
for the plain reason that it rules through the passions,
prejudices, and petty malice, not of one, but of many
minds. The worst of tyrants has moods in which justice
claims some share, but in the tyranny of a clique there is
always some member who has either a point to cany, a spite
to gratify, if not an actual injustice to commit.
The ultimate tendency of such a rule must be to sink
all the dignity of the College, to degrade the scientific char¬
acter of the Fellowship, and to alienate the respect and
loyalty of all its members.
Royal College of Surgeons of England.
The contest for election into the Council, which has been
more earnestly contested than usual, terminated last Thurs¬
day.
As we have previously explained, there were four vacan¬
cies, one occasioned by the decease of Sir William Law¬
rence, Bart., one by the resignation of Mr. Hodgson, and
the other two, the retirement in the prescribed order of
Professor Partridge and Sir William Fergusson, Bart; these
two gentlemen offered themselves for re-election. The
other candidates were Mr. Erasmus Wilson, F.R.S.; Mr.
John Gay, Surgeon to the Great Northern Hospital ; Mr.
G. L. Cooper; Mr. C. Brooke, F.R.S., Surgeon to the
Westminster Hospital; Mr. J. Simon, F.R.S., of the Privy
Council-office; Professor Humphry, F.R.S., of Cambridge;
and Mr. Luther Holden, Surgeon to St Bartholomew’s
Hospital. The election, whioh was by ballot, commenced at
two o’clock, and was not brought to a close until six o’clock,
when the President, Mr. Hilton, declared that the choice
of the Fellows had fallen on Sir William Fergusson, Bart,
Mr. Simon, Professor Humphry, and Mr. Holden. The
numbers polled by each candidate were as follows : Fergus*
son, 206 ; Simon, 157 ; Humphry, 148 ; Holden, 136 ;
Gay, 120 ; Wilson, 108 ; Partridge, 103; Cooper, 58; and
Brooke, 32.
We congratulate the successful candidates on their elec¬
tion, and call on them to show their regard for the profes¬
sion, by supporting a liberal policy.
Medical Parliamentary Representation.
An on dit is current in Dublin, that at the approaching
general election, Sir Dominic Corrigan, Physician to Her
Majesty the Queen in Ireland, will offer himself to the
electors. It is almost superfluous to say that Sir Dominic
Corrigan’s success would be a source of the greatest satis¬
faction to the entire profession in Ireland. We cannot,
however, think that the candidature of the learned baronet
is likely to be pressed, as the electors of the Borough,
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fuifaaibiiFnBiiidcirMiir. QJBNfiR^L MEDICAL COUNCIL. Joiy 8, *n*.37
~U . ' _
County, and University of Dublin, hare very decided
Conservative leanings.
Pirst-Pruits of Sanitary Reform in LiverpooL
There were registered in this town daring the last six
months 6952 deaths. This is 1640 less than the average
of the last ten years. Of the total deaths, 48 per cent,
were those of children under five years of age.
What should we Drink?
Under this title has appeared, from the pen of Mr. Den¬
man, the author of “The Vine and its Culture,” a very
smart criticism on Mr. Beckwith's report, and one that will
he read with great relish. We call attention to it, because
we have fully appreciated its full flavoured sarcasms, and
the great amount of information it contains. We are
about to resume our reports on wine, as soon as the Medical
Council report is complete, and shall perhaps again have
occasion to refor to the opinions of both Mr. Beckwith and
Mr. Denman.
Poor-law Salaries in England.
The profession, notably the Poor-law Medical Officers
of ought to feel shame that we should have to
make public the following statement made recently at a
public meeting by Dr. J. C. Reid :—
“The guardians in the north reckon their medical
officer's salary as so much * found money 7 to him. It is not
in London only that whole streets spring up as if by
magic; for in my district where there were only 100 in¬
habitants in North Seaton township sixteen years ago,
there is now one of the largest collieries in the kingdom,
captaining a population of about 2000 ; besides the increase
of streets, terraces, &c., in the sea-bathing town of New-
biggin itself which must have doubled its inhabitants dur¬
ing the period. Well then, with such an increase* I
felt justified in asking the guardians to give me .£20 a-year
instead of £10. Save the mark! More especially as
much younger men than myself, with no increase of popu¬
lation, had the salaries for their districts doubled, and in
some places tripled; and the clerk to the board had a
handsome addition made to his. But no, £20 a-year was
fiur too much ! Try £15. 1 Tell it not in Gath, publish it
not in Askelon/ The handsome remuneration of £15 per
ann^ m was rejected by a majority of three ! Ten pounds
a-year was deemed sufficient for attending the poor of eight
townships, some three, four, five, and six miles from my
residence, and providing medicines to boot i Mr. Chair¬
man,! blush for the cloth when I tell you that a rev.
honourable led the van of the opposition ; and whilst I can
oount mine by thousands, he only can reckon his few sheep
by hundreds. And whilst he annually receives his £1000
and odd hundreds, he thought me faUy remunerated by a
less sum yearly than he would purchase a dog for.”
We repent advisedly that the profession divides the
ignominy of these accusations with the Guardians, for its
members are responsible for having made such a state of
things possible. If there existed in our profession a pro¬
per esprit iecorpt, a legitimate trade's unionism, if the
public wish to call it so, such as protects the members of
the legal profession from the undercutting system, it would
be uselesa for Guardians, who now unhesitatingly avail
them^lvoa of oar -disunion, to offer such remuneration.
Saebpmd every member of Dr. Reid's board must of course
U w^ajrare that their salary did not even approach to
fapngjfo expenses of the office, but they also knew
objected to acoept £10, or half that sum,
be found good enough for paupers, if not
^yBfipation, who. would take the po?t at
perhaps nothing at all* but the hope
of stepping in front of a professional rival. In no other
profession but ours is the underselling system allowed to
exist, and we see no remedy for it but the same as is ap¬
plied elsewhere, a penitential “ Coventry” for every man
who takes the bread from his brother's mouth, and de¬
grades his profession by playing into the hand? of un¬
scrupulous Guardians.
Wx are happy to supplement our remarks on the drainage
of seaside towns, by stating that the works undertaken
and finished for St. Leonard's, have been in working order
for several months, and continue to give the utmost satis¬
faction ; whilst Jhose of the neighbouring town bf Hastings,
necessarily on a more gigantic scale—are nearly completed,
everything promising the most successful issue.
The decease of Dr. Kennion, F.R.C.P., of Harrogate, is
announced.
-♦-
GENERAL MEDICAL COUNCIL PROCEEDINGS.
(Continued from page 34.)
Dr. Rumsky wished to correct one or two remarks in Sir
Andrew Wood's speech. With regard to Crown nonHnees, he
begged at onoe to say he did not think they were appointed to
represent the interests of general practitioners. He had
accepted his appointment on purely public grounds—for the
protection and ultimate safety of the great community of this
country,in matters of health and prolongation of life. He depre¬
cated the thought of sitting on that Board as the representative
of any single interest, except the interest of the nation at large.
Again, Dr. Wood had said. Sir Charles Hastings, Mr. Teal,
and himself (Dr. Bumsey) were general practitioners. Sir
Charles Hastings was a pure physician ; Mr. Teal, that
great man had been called to rest since their last session, from
the toils and cares of an honourable and laborious life, he
was a pure surgeon ; and with regard to himself, it was many
yean since he was a member of that body—the general
practitioners of this country ; and he stood there either in the
capacity of surgeon or physician. Upon the general question
much respect was due to representations of great associations
whose deputation they had just received. He yet agreed
to a great extent in their viewB, and with what had dropped
from Dr. Andrew Wood, but still wished the Council
to bear in mind that just in proportion as the representative
element was strengthened in the Council, the less readily
would Parliament consent to commit to them those administra¬
tive and executive powers, which many considered should be
extended, so that, in fact, by increasing them in one way
they would be weakened in another.
Sir Dominic Corrigan drew attention to an observation
which had been uttered in the debate, namely, general prao-
titioner. The memorial referred to “ Registered Practi¬
tioners” of the United Kingdom, and it was obvious the dis¬
tinction should be made and supported; because the repre^
sentation of general practitioners, as a body, would be attended
with insuperable objections. He was sorry the President was
not there, because he felt compelled to question the course
which had been taken in the conference with the deputa¬
tion. He had challenged them to show that the Council
had ever omitted to guard the interests of the profession, tike
conclusion being that if they had so failed, there was no
necessity for any application. He recollected a time when the
monetary affairs of a vast body were at issue, and a mofiori
was proposed to have the financial matters put in better order
than before. An official of the company, instead of listening
to a discussion on the merits of the scheme suggested, jumped
up and challenged any person round the table to declare in
what respect he had been guilty of defalcation. He did not
regard it as fair for the President to treat with the depu¬
tation, and but for the tact of Dr. Sibson there might have
sprung up an angry wrangle on it. As regards the general
question, he thought the arguments might be considerably
narrowed, for he thought tke Council should net enter
on the consideration of any details by which the measure
should be carried out. The only topic to which he re¬
ferred, would be whether the principle was right or ttrong,
because if the principle tvasright then leave the details toa
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GENERAL MEDICAL COUNCIL.
July 8,18H.
38 The Medical Pre» and Circular.
committee, and if wrong there would be no necessity to dis¬
cuss details which would never be demanded to be put into
operation ; was the present constitution of Council then
satisfactory, to the profession in the United Kingdom,
amounting to nearly 15,000 people ? He considered, after
the evidence they had, and after the arguments they
had seen in the medical periodicals for a long time, it was
nearly impossible for any one to declare the present constitution
was satisfactory to a very large portion of the profession in the
kingdom. It was not necessary to discuss the question raised
by the president, that there was no chance of carrying a bill
this session or next, for that was not the question. He had
heard it said it was not necessary to add to the Council; that
its duties being confined simply to registration and education,
the representatives of corporations and universities, and of the
Crown, were quite competent to deal with those subjects. But
could they confine themselves to those two matters, or had
they done so ? Looking back at the journals in a cursory man¬
ner, he found that as long ago as I860 they had considered the
regulations of the Poor-law Board, and others, with regard to
apothecaries’ licences in England. Could any one say that was
a question either of registration or education ? Again, the
question of inquests had been brought before them in the same
year, and was it not obvious that they would have their know¬
ledge and experience vastly increased upon such a question of
state medicine by having among them men from different parts
of England, Ireland, and Scotland. He (Sir D. Corrigan) con¬
fessed that he had no practical knowledge whatever of inquests,
and if he had to consider the subject on a committee or else¬
where, he would be obliged to turn to these gentlemen whose
absence from the Council he now regretted. Again, on the
subject of vaccination—was there one member of the Council
practically acquainted with it, or who had spent days and days
vaccinating children and a register—not one. There, again,
the importance of having popular representatives would be
seen. . Again, upon the question of medical witnesses—what
experience had they upon the subject ? He found in 1863 they
had a very lengthened and able report on the Pharmacy Bill
then introduced into the House of Commons. Was there any
one in that Council, with the exception of Dr. Leet, who pos¬
sessed any practical knowledge on that subject ? The Weights
and Measures Bill was another instance in which they could
arrive at no satisfactory conclusion without the experience of
these men; and even upon the question Mr. Syme so ably
brought before them as to the best mode of education—whe¬
ther young men should go for the first two years to a general
practitioner, or the registered, or the surgeon of a county
infirmary, and so on, or serve an apprenticeship. Upon all
these matters the information which men who had acquired a
knowledge of their profession by going into the world, and
mixing in it, and practising, was required, and who knew what
their own defects were when they went out into the world,
could give, would,be most available to the Council, and was
not possessed by those members who at present constituted it.
Within the last two or three days they had had a most impor¬
tant subject before them—namely, the lunacy laws. Could
there be a subject upon which they must more regret the ab¬
sence of those men than that ? For one case of lunacy which
came before men in their position, five, ten, fifty, and one
hundred would probably come before the general practitioner.
Dr. Sibson had also put forward as a reason for advocating the
step which he proposed one of the most important principles
recognised everywhere in this constitution—namely, that there
should be no taxation without representation, and there was
no anomaly, as far as he knew, in England, of a representative
body paid for by funds derived from the taxpayers in which
the taxpayers themselves had no single vote in the appoint¬
ment of the representatives. He believed that any Medical
Act Amendment Bill in which there was not a clause
for the representation of the men who were taxed
to pay the Medical Council, would never be listened to by the
House of Commons. He also agreed that such a measure
would popularize the Council, for disguise it as they might,
they were looked upon at the present moment by the bulk of the
profession as a Corporation that had done very little hitherto
to protect the interests of the profession, and one with which the
profession had no-sympathy. Upon the subject of education,
in which they all expressed so deep an interest, he did not
think there was any body of men in the United Kingdom who
had so strong an interest in maintaining a high standard as
the registration practitioners, while on the other hand the in¬
terests of the corporation was to get in as great a number as
they could, so as to obtain as much money as they possibly
could. I do not say their motive is that, but I say it is their
interest. Had not they had a licensing body withrn their re¬
gulation which made XI000 in one year, by giving its qualifica¬
tions without any examination, and was he to be “ On, ohVT
at because he told the truth. He did not except the corpora¬
tion which he himself represented; The College which had
done him the honour of electing him president, was afraid to
advance much upon the subject of education, because licensing
bodies, with equal privileges, had not gone as far. The men
who represented the profession at large, would have a strong
interest in supporting nearly the whole of this Council (be¬
cause the representatives had very different feelingB upon the
subject from those whom they represented) in raising the
standard of education, because they would have very possibly
a direct interest to increase their own respectability by taking
care that no man entering the profession with alow status either
as to education or character. Lastly, the Council would be
able to command more respect from the Government of the
country. It was no use disguising the fact that when once
men obtained their degrees, every connection with the Univer¬
sity was severed. But once let them have a representation
upon this Council, and a great accession of strength would be
the result.
Dr. Alexander Wood then moved the following amend¬
ment—“ That the Council, as a committee of the whole Council,
take into consideration its present constitution, with the view
of determining whether any alteration should be made in its
constitution in any future Medical Act to be proposed.”
Mr. Hargrave, seconded the amendment. With regard to
the question which had been asked, what good had the Council
done ? he would give them one great fact amongst others—it
had brought the profession of the three kingdoms into union,
and if it had done nothing else but that and prepared the
Pharmacopoeia, it need not be ashamed of its labours.
Mr. Cooper supported the amendment.
Dr. A. Smith preferred the amendment of the two, as the
amendment did not bind the Council to adopt any particular
course.
Dr. Paget said he should not like to give a silert vote upon
this occasion. He had listened with very great interest to the
discussion because he had been anxious to hear what would
be said in favour of the resolution, particularly as it came re¬
commended by an association to which he felt somewhat at¬
tached, and to which he had the honour of being elected Presi¬
dent only a few years ago : an associotion which he believed
was doing a great deal of good by its gatherings and local
meetings. Some reasons in favour of the course proposed had
certainly been heard, but he confessed that in his mind
they had not preponderated over the objections which he saw
to the scheme. Before entering into them, however, he wished
to join Mr. Hargrave in rejecting the view which Sir 1). Corri¬
gan took of the course taken by the President, and he did so,
especially, as Dr. Burrows was not present to defend himself.
He thought the questions put by the President were perfectly
fair, and not only so but necessary. The very fact of a depu¬
tation coming to the Council, and requesting it to take intp
consideration, and actually to take part in steps towards the
alteration of its constitution, implied prima facts dissatisfaction
with the acts of the Council, and that was abundant justifica¬
tion for putting the question whether there was any charge to
be brought against the Council. Moreover, the resolutions which
were read implied the same thing in another way. One of them
was—-“That we are of opinion that if the Council, in conse¬
quence of the addition of the members to be elected by the
profession, should deem it advisable to recommend the diminu¬
tion in the number of representatives of the corporations, a
corresponding reduction may then be made in the representa¬
tives of the profession. What was that but a tolerably plaij
indication of an opinion that the proceedings of this Council
were rather adverse as it was at present constituted to the in¬
terests of the profession. Or else, why should a bargain he
proposed, that in proportion as the numbers of one part of the
Council were reduced, the numbers of another part should also
be reduced ? The question put by the President was therefore
not only fair, but necessary. There was one argument
which if he were to admit it, would at once convince him that
what was proposed ought to be done, and that was the ques¬
tion of right. That was put by one of the speakers of the de¬
putation, and repeated by Sir D. Corrigan—“ no taxation
without representation.” No doubt there was a just and pro*
per connection between those two things which was always
recognised in the constitution of the country, and properly re*
cognised; but they must not he' xnisled by mere words, they
The Modicafl Preaa and Circular.
GENERAL MEDICAL COtWCfL
JulyMSW. 3$
must consider what the principle involved in that phrase was.
It was this, that those who are liable to be taxed ought to be
represented in the body that taxes them. But how did that
bear upon the present question ? To whom were they propos¬
ing to give a voice in this Council T To the registered medical
practitioners. Well, had the Council any‘power to tax
them ? (Dr. Andrew Wood, Yes.) None whatever, ex¬
cept in the instance of a gentleman who, for 5s., wishes
to add an additional qualification to his name. He re¬
peated, the Council had no power whatever to tax the
registered medical practitioner. It was quite true that
the fee of £2 or £5, as the case might be, was paid by
gentlemen when they entered upon the profession, and wished
to put their names upon the register, but it was not proposed
that those gentlemen should be represented in the Medical
Council, they were either medical students, or those gentle¬
men who had hitherto abstained from registering. But the
representation was proposed to be pat into the hands of those
who had always registered, and those the Council had no
power of taxing. It was, in fact, a misuse altogether of the
term to speak of this fee as a tax. Every one knew the effect
of increasing or reducing a tax ; they felt it when the income
tax was reduced or increased so mnch in the pound. Apply
that test to the registered practitioners. Suppose registered
practitioners were reduced from £5 to £1, would the registered
practitioners be a bit the better off ? Or take the reverse, and
suppose the fees were increased from £5 to £50 (Dr. Andrew
Wood, you cannot). Suppose it were, by way of illustrating
the case, would any of the registered practitioners be a bit
worao off for that ? On the contrary, the only effect would be
to check the ingress of new members into the profession, and
the registered practitioners, as far as they would be affected at
all, would be better off with an increased tax than without.
Therefore it was really a misuse of terms to call the fee a tax
at all, it was a mere entrance fee ; the same sort of thing as
was paid by a man when he graduated, or took out a diploma
front the universities, or from one of the medical colleges.
The hour of six having arrived, the debate was adjourned
till to-morrow.
Wednesday, Jolt 1.
ADJOURNED DEBATE ON THE REPRESENTATION Or THE GENERAL
PRACTITIONERS IN THE COUNCIL.
Dr. Paget, in resuming his speech against the motion, said
it was represented that, because the Council was the govern¬
ing body of the profession, therefore there was a right on
the part of the governed to be represented upon it. He
felt he ought to apologise to the Council for taking up its time
in refuting that argument. But, as it had been repeated
again and again, until he had no doubt it was accepted gene¬
rally by the medical profession, it was necessary to say a few
words on the subject. Everyone in that room was aware that
there was no truth in the statement He would test it in this
way. If anyone of the registered members of the profession
were asked individually, whether since the time the Council
was established it had in any way governed him since his re¬
gistration, he would speedily answer m the negative. Looking
at the Medical Act, and reading it through, in what way did
it confer any power of governing the registered members of
the Council ? There was only one single instance—happily a
veiy rare one, in which the Council had direct power of inter¬
fering with members of the profession, and that was when a
registered member had been guilty of infamous conduct in a
professional sen*e. Not only were those cases extremely rare
—only happening about once a-year—but even in them the
Council did not act in a governing, but in a judicial capacity.
By clauses 18, 20, 2 1, and *22 of the Medical Act, powers were
given to the Council. What were those powers, and over
whom were they exercised ? They were to inquire into the
proceedings of the different universities and other licensing
bodies what their course of studies was for medical degrees ;
what their modes were of medical examination, and to test
those examinations by visitation. The Council had also powers
through the medium of the Privy Council of depriving those
univertities and licensing bodies of the right of granting
tftg!fees and diplomas. Those were the parties governed by
tbo'lCodJicil. Therefore, it was according to the very principle
been quoted by the supporters of this proposition
*“ Were the parties who had been represented on the
i aUnttiat be represented if the Council was expected
*sit had been done hitherto. The talk upon
1 1ts being a question of right, therefore must
there was another view of the subject*
Without there being any right in the matter, it might be
advisable that the general profession should have direct repre*
sentation on the Council. But then it was incumbent on the
advocates of the measure to prove that the addition of such
members would increase the power of the Council for doing
good, and would enable it to perform better than it hod hitherto
done the duties imposed upon it. The onue of proof is on the
advocates of the measure, and he confessed he had heard
nothing like a satisfactory cast nade out. He did not see that
the mode of election of those members would provide the
Council with more efficient members than it already possessed.
It did so happen that the members of the Council were composed
of professors and officials of the different universities and
medical corporations, and there were no medical practitioners
in the Council then there could be a strong argument in
favour of the present scheme, but, as a matter of fact, the
great majority of the Council were practitioners, and it was a
matter of almost certainty that their successors would continue
to be so. He could, therefore, see no reason why the present
members of the Council should uot be just as good judges of
matters which would come before them, as if they were elected
by the profession at large. Sir Dominic Corrigan had qnoted
instances in which the; questions brought before the Council
were not purely questions of education. No doubt those in¬
stances had some weight as far as they went ; but how far did
they go, and what a very small proportion they bore to the
amount of discussions and labour bestowed upon the subject of
medical education ? He could state, that since he had been a
member of the Council, he did not remember a single question
that had been brought before it, in which there had not been
An abundance of medical information afforded by the members
of the Council. Dr. Andrew Wood had stated very fairly and
truly, what was entitled to some weight, namely, that the
election of members in the way proposed would increase the
interest of the profession generally in the Council. That was
true qtuzntum valent. He also said that the members so
elected would be better acquainted with the feelings of the
profession generally. He (Dr. Paget) did not think so—he
doubted it very much. He would take this as a test, suppos¬
ing the alter ti. n to be made. In the natural course of things
the very gentlemen now appeared before them yesterday as a
deputation would be many of them, the majority of them prob-
j ably, returned as representatives of the registered members of
the profession, who, taking the recommendations of those
gentlemen (and they were as fairly open to criticism as the pro¬
ceedings of the Coancil) he did not think that they by any
means indicated a very near acquaintance with the feelings of
the profession. He would take one of them as an instance. He
found them stating this— 44 The sub committee entertain no
doubt that the profession will willingly pay the additional cost
of their own representatives.'* Now, as we must all know,
amongst the 20,000 registered practitioners, there was not one
in a thousand that entertained the same opinion as those
gentlemen forming the sub committee—namaly, that the pro¬
fession would willingly pay the additional cost of their own re¬
presentatives. Therefore he thought it was at least open to
doubt whether those gentlemen, eminent as they were, really
represented the feelings of the profession generally, better
than the members of the Council now sitting round the table.
Again, it was actually said yesterday by the advocates of this
matter, that it would strengthen the hands of the Council and
increase its influence with the Government and the public.
He cordially agreed with what Mr. Kumsey had said upon that
point. He thought it was about the greatest mistake possible
to think that the addition of those members would increase the
influence of this Council with the Government and the public.
Suppose the Council were very anxions to mend clause 40 of
the Medical Act, so as to gain increased power of putting
down the most notorious quacks, was it to be supposed that
when deputations from the Council to the minister were to
tell him their anxiety about the matter, that that deputation
would be listened to more readily, or its recommendations
more readily attended to, if they said we speak the voice
of the profession ? He (Dr. Paget) thought quite the
the contrary; the influence of the Council with the Government
and the public would be lessened by it being known or sup¬
posed that they represented the mass of the profession. He
, had read a communication which had appeared in one of. the
medical papers, from a gentleman who bad expressed his views
so admirably, that he would read his letter, as part of the ob¬
servations he wished to make. The gentleman's name was
Bewjey, and dated from Clara, King's County Ireland. He
appeared to be. favourable to the proposal now before the Coon
Digitized fc VJiOO^IC .
f
40 The Medical Pnii md Clreulir. GENERAL MEDICAL COUNCIL.
. Julf B.I88S.
dl, but he said— M The Council was never designed by the legis¬
lature to represent the interests of the profession. It was formed
for the promotion of the interests of the public, and it is my be¬
lief the legislature never cared, or will care, one straw for the
private or personal interests of the medical profession, or any
otherprofession as such. In the eye of the legislature, the'Medi¬
cal Council, as well as all the other licensing medical institu¬
tions, except only for one object, namely—the good of the pub¬
lic.** At thecloseof his letter, he gave the Coundl a little advice.
He said— M If we are wise, we shall keep our individual interests
in the background, and endeavour to prove, through the medium
of the Council, the Medical Association, and the Press, that it
is for the interests of the public, that every physician or sur¬
geon shall be an educated gentleman/* If he (Dr. Paget) could
express his sentiments so well as they had been expressed in
that letter he would not have borrowed it, but it seemed to him
to be the shrewd, good sense of the matter. There was one
objection to the proposed scheme which he thought should have
been attempted to be met in some way by the advocates of the
measure, namely, that the addition of members would increase
the amount of talk. Dr. Andrew Wood attempted to meet it
in this way, but I simply assert that the addition of six mem¬
bers would decrease the amount of talk. Now, with the
'greatest possible respect for Dr. Andrew Wood's opinion in this
particular instance, he would have liked to have seen it sun-
ported by argument. 'It seemed to him as a matter of arith¬
metic that the addition of six members would add to the talk
by exactly one-fourth ; and, indeed, if those gentlemen were
expected to advocate the interests of their electors (and that
was one of the grounds upon which the proposal was based),
they must make speeches in order that they might be read, and
his opinion was that they would add considerably more than
orie-fourth to the talk. In fact, that was one of the chief ob¬
jections, and it was not to be met by what was really nothing
more than an expression of opinion the other way. Again,
with regard to proportionate representation, the proposal of the
deputation yesterday was such that the vote of one gentleman
north of the Tweed would go further than that of three south of
the Tweed, the practitioners in England and Wales being more
than six times more numerous than in Scotland- He was quite
satisfied with the constitution of the Council as it was, ana he
thought that Mr. Hargrave hit a good point yesterday when
he said, what a good thing it was that by means of«the
Medical Council, the medical men of the three kingdoms had
been brought together, and had come to a common understand¬
ing upon so many subjects. He quite agreed with that, and
he was prepared to maintain that the Medical Act had done
for medicine what legislation in the Houses of Lords and Com¬
mons had never been able to accomplish for the other learned
professions. Not to refer to religious questions—look at the
profession of the law. Englishmen could scarcely understand
Scotch terms of law, and he supposed there would be quite an
outcry‘in Scotland if it were proposed to adopt the term “ en¬
dowment*, instead of “ mortification.*' Or if it were proposed
to assimilate the law of marriage in Scotland to that of other
countries, he would be quite prepared for a rebellion.
(Hear, hear, from Dr. Alexander Wood.) But on the
subject* of medicine, the Medical Act had brought about a
complete union between the countries. Again, the method of
election which was proposed would not be so simple as seemed
to be imagined. He (Dr. Paget) represented an university
where the elections were conducted by voting-papers, and it
hod taken the recognised official, with the assistance of three
assessors, sitting three or four days, and working hard, in order !
to get through the labour. The number of votes given was
8334, and he ventured to say that if all the votes had been
given by voting-papers, as proposed by this scheme, it would j
have taken more than four days—and very hard work it was.
The legitimate expenses of advertising, Ac., to which the two.
members had been put amounted to above £2000 at the last
„ election, and it was not by any means a strong contest, both
gentlemen being of the same politics. But the proposers of
this had no notion of what they were putting upon the regia-
• trar, or of the questions that would arise in cases where, there
Wfcs a close contest. This question was not one of sentiment,
* but what they had to consider was whether it was. good
and ought to be followed. He felt bound to give a
little advice to the proposer and seconder of the resolution,
and hoped they would take it in a friendly way. The body
that returned Sir Dominic Corrigan was a very popular body.^
All the old Universities of England
^- Upturned him thw ‘
d j, Uvi or moTSBKr* tiuua wy ot
[St tVI,**
the electoral districts proposed by Dr. Andrew Wood—it
numbered 5400 voters. He would suggest to Sir D. Corrigan,
who was elected by a most distinguished body of twenty
gentlemen—the council or senate of the university—that the *
Queen’s University in Ireland had, like the University of Cam¬
bridge, a number of graduates. At Cambridge the franchise
was restricted to Doctors and Masters of Arts, and supposing
the Doctors and Masters of Arts of the Queen’s University of
Ireland were to be privileged to elect their representatives to
the council, that would be a good beginning of public represen¬
tation, and might be carried out without any difficulty. Again,
he would give the same advice to Dr. Andrew Wood, with re¬
gard to the body he represented, and he gave that advice the
more readily, because he was sure the choice of those bodies,
upon the basis of a wider constituency, would still fall upon
the same gentlemen to represent them.
The debate was continued by Drs. Sharpey, Stokes, Storrar,
and Risdon Bennett, who opposed the motion, and' endorsed the
views of Dr. Paget.
Dr. Parkes spoke in favour of the motion.
Dr. Alexander Wood expressed a wish to withdraw his
amendment, stating, at the same time, his entire opposition to
the motion ; and ,
Professor Syme moved the following amendment:—“ That
under present circumstances it would not be expedient for the
Council to consider the propriety of attempting to obtain a
change of constitution.”
Mr. Cjjsar Hawkins seconded the amendment. ^ •
Dr. Acland would vote with some reluctance against the
motion, for he would much have preferred moving “ the pre¬
vious question,” if that course were open to him. He believed
the proposition was most unfortunate and inopportune, and
regretted extremely it should have been brought before the
Council at the present juncture, when so many important prac¬
tical measures were under deliberation. _ .
The President said it was necessary to consider thft the'
deputation which had been received professed to be a depute*
tion from the oommittee of the Council of the British Medical
Association, which title seemed to him to diyiinfr h the force of
the memorial, but he wished to know whether the memorial
was to carry with it the force of the great association itself, op
whether it was merely a memorial coming from an active
committee of that association, to ascertain which he had put
those somewhat searching questions. They would sec
by the wording of the memorial, “ The deputation from the*
British Medical Association beg to submit to the consideration
of the General Medical Council -the following propositions?
founded on resolutions passed at the anniud meeting.”
So that it was not with the resolutions passed then, but pro/
positions founded upon them, with which the Council bad t<?
deal. Resolutions, it was well known, might be passed at a J
general meeting, but upon being put into the hands of a com*',
raittee, propositions might come out of those resolutions which*
were really not exactly the precise opinions of the body which 2
had sent the resolutions to the committee, and, therefore, he*
wanted to know distinctly whether those propositions really 9
had the sanction of the whole Inwly or not. He did not sup**
pose for a moment there was any attempt to deceive the*
Council, but he thought it doubtfnl whether the proposition**
had been proposed separately to the meeting at large. If theft
had been, they would have great force ; but if not, that fore**
would be diminished. 1 He made that explanation, not lor hi#
own sake, but to those members of the Council who were not quit#*
satisfied with the course he had pursued With respect to tb#
question upon the motion of Dr. Andrew Wood,seoohded
Sir Dominic Corrigan; he had before him a printed copy oflt
the speech of Dr. Paget, and, he would say; I beg you t# 1
accept it as my speech, in the same way as Dr. Paget hitnsettf
has read those admirable observations from a practitioner**
Ireland. There was no doubt the Council did represent i
interests of the profession in. matters over which it had cofi
tool, and it ought to represent the interests of the public i
well; if the Council did not represent the interests of tl
public as well as those of the profession, he did not- believe 1
would have anything like the influence or authority
it has. As Dr. Storrar had well pointed out,
nut an
carry
As Dr.
Council was an administrative body to
of Parliament If it were a council tC
interests of *he profession, Ha material and!
and those other social questions which had*
forcibly and ably by Dr. Stokes, then he _
4 he Council did not at present repesent the ids
Md tUt mmm rack cUoge,
tfc Midkftl Press sad CbwHfc
GENERAL MEDICAL COUNCIL.
JtOj £jl*8 41
proper and right. But the Council did not attempt to repre¬
sent such interests, and having in view its proper duties, if
these suggestions were carried out he could not say that the
Council would be unproved. They must all bear in mind that
the Council had limited objects in view, and they were quite
aware that there were many men in the profession who did
not find the routine of the profession sufficient to occupy their
They were fond of discussing public questions, ques
ing the interests of the profession, they would also be defending
the welfare of the public, whom they were bound in honour to
protect.
Dr. Leet, as the representative of pharmacy in Ireland,
entirely objected to the extension of the bill to that country
in its present form, and to show how unwise it would be to do
away with the wholesome regulation now in force, which for-
w v. __^ F .-; bade, under heavy penalties, anyone compounding or dispen-
tiom nf social science, and sanitary questions. Then there sing medicines without first having undergone the examination
were many excellent men who saw and knew that there were | at, and received the certificate of the Apothecaries* Hall of Ire*
a mat many things bearing most unjustly upon the members j laud, he would read a short extract from thd report of the
of their profession, and who felt that the profession did not Queen’s University, dated June 20th, 1855 The Senate
hold that social position which it ought to hold, and that some 4,1 ~
of its members got a very inadequate remuneration for their
services ; men of that class seize every opportunity to assert
the rights of their profession. If the proposition were
adopted a body of such men would be introduced into their
Council, and possess the confidence of many in the profession,
at they would represent its interest. But these gentlemen
would not assist the Council in dealing with higher questions,
and therefore he was opposed to adding to the number of
members as proposed by the motion ; and if the Council were
net increased, some members must retire to give place to the
new representation, and be did not know who could be asked
to retire. If the Council was to hold control over the various
interests and licensing bodies they must not be deprived of
their representatives. On the other hand, no one could think
of asking the Crown nominees to retire. If such men were
taken from the Council, its weight and influence with all
classes would be seriously diminished. He could not, there¬
fore, meet the wishes of the memorialists by reducing the
number of members. He thought the Council should do its
duty as it had hitherto done, and as he believed they all desired
to do, and however they might differ in their modes, the action
should be carried out, and he agreed with Dr. Acland that
this important matter should have been brought forward so
inopportunely, when the Council had so much ou its hands
Re must, therefore, vote against the motion.
-Dr. Andrsw Wood, having briefly replied,
Professor Stub's amendment was put to the vote, and
carried by HIto 4. • Upon being put as a substantive motion,
the numbers were 18 to 4.
THE PHARMACY BILJ*
The following motion by Dr. Rumhry, seconded by Dr.
P.A6KI—
.“That a committee be appointed to consider and report on
tb* bill for the regulation, of pharmacy now before Parliament,
m order that if it. should appear desirable the opinion of the
General Magical Council may be represented by petition to
Parliaments or by memorial to Her Majesty’s Ministers, before
tkq said b*U shall become law.”
was ushered in by an elaborate speech, of which we give an
abstract. Dr» Bumsey stated that the present bill ignored
sjmo& every recommendation of the committee of the Medical
Coonol ip j<865. In the first place, its provisions were not
extended..to Ireland. . Moreover, there was no requirement
that, chemists and druggists should dispense prescriptions
scpordfpg to th« Pharmacopoeia. And further, the bill con-
tapped prohibition against the practice of medicine or sur¬
ging by onemig# ppd dmggiata. The oommittee of this Counoil
ryomrnpnded that pharmaceutical chemists should be subjected
%q pomp oontrpUipgf body, but the bill contained no such
»«caritj,,a»dths public there!ore were in danger of having a
number unqualified men let loose upon them, the conse-
qpcupoiul Whijm might be most dangerous to the public health
t&irtjttj, ThMioiiMin, whkh wm now so largely consumed
variouaways was, emitted altogether from the list ^
. jgh edpl rt A* .He Was in favour of extending the
•jfTf jeftrictioiM to the sale of this and other fatal
pejfMn^p*indent in the case; <rf arsenic, for the purpose of
the purchaser. * More satisfactory evidence of
qup^ggptfon. ttodd. be required. What could be more mon-
ntyiuihw dio Present b«A which afforded protection to the
lmrtttjilmt nf chemists and druggists, who might be mere
gagtyk ssmmoA drapem, .by permitting them to register
a^msp^pd chemists ; and not only so, but extending their
pglgpigp tfepaaistante also, 1 even te those boys who had served
lliceship. ; A number of persons would thus
ithey five to become octageiiariafis, to poison
r4he r pootsotfen of* this bal, for fifty or sixty
pfasu* earnestly. trusted the Council would not
^the mottos d hy him, for, in consider-
f . *• . - • ' ' *
has to observe that the practice of pharmacy is already pro¬
vided for in Ireland by the Apothecaries’ Act of 1791. This
Act has worked well, and carried out its objects, especially in
providing well educated Apothecaries for the public service ;
it therefore does not appear necessary to legislate for this
department, neither does it seem important or desirable to alter
the present state of the law.” The Council would see by this
why he opposed its extension to Ireland. The present regula¬
tions answered admirably, and for that reason, he hoped they
would not be disturbed.
Dr. Alexander Wood considered that the Council and the
profession at large, were' deeply indebted to Dr. Rumsey for.
the care and labour he had bestowed upon the subject of State
medicine, and for the elaborate and • satisfactory arguments
adduced by bhn on the important subject of pharmacy. He
remembered some years ago there was an agitation on the
pharmacy question, and a select committee was appointed for
the same purposes, proposed in the present bill. Whilst admit¬
ting that much had been done since then by the Pharmaceuti¬
cal Society towards the elevation of pharmacy, and it had
therefore claims upon the Council that certain privileges should
be extended, he was, nevertheless, opposed to the admission
by law of this body to the status of the profession. They were
essentially traders, and as a trading body were entitled to re¬
spect, but to incorporate them with the profession would have
the effect of ruining the majority of the general practitioners
in the empire. As the representatives of the whole profession
therefore, he considered they should let their voices be heard
before this bill—which, in some of its bearings, was very
obnoxious—became law, and for this purpose he would sup¬
port the proposition of Dr. Rumsey for tie appointment of a
committee.
Mr. Cooper expressed similar opinions.
Dr. Aquilla Smith objected to the quotation by Dr. Leet,
relative to the pharmacy question in 1855. Since that time
pharmacy had greatly degenerated in Ireland since the passing
of the Medical Act in 1858, which was attributable to the
monopoly held by the Apothecaries* Hall of Ireland, in fact,
so low had it become, that a physician would have great diffi¬
culty to get a prescription made up by an apothecary in Ire¬
land. He maintained, with Dr. Wood, that it was but a trad¬
ing body, and he did not therefore see why the Society of
Apothecaries in Ireland should demand an examination of the
subjects which pertained to the study of medicine, which were
not at all necessary for a chemist to know—on the pain of a
refusal of a license to compound and dispense medicines. No
chemist, however eminent—he might mention that were Mr.
Squire, *h*n whom few had done so much to elevate the
science of pharmacy—would be allowed to open a shop for
compounding prescriptions, under the penalty of a fine of £20.
He desired to see a spirit of reciprocity between each division
of the kingdom, considering it unjust that a monopoly should
exist in Ireland, which gave the Apothecaries’ Hall power to
prohibit any person coming from England or any other part of
the country, from following his business as a chemist, unless
he first obtained the certificate from that body, whilst any one
crossing the channel from Ireland, Would be entitled to esta¬
blish himself as where he chose without such a restriction.
Sir Dominto Corrigan stated that the extract quoted by
Dr. Leet, from a report of the Senate of the Queen’s Univer¬
sity, of which he (Sir Dominic) had the honour to be a member,
was given in 1855, and was, therefore, prior to the passing of
the Medical Act, 1858. Circumstances and opinions had under¬
gone a great change since then. He had recently received
letters from two members of the House of Lords—asking his
opinion to the working of the Medical Act in Ireland, and the
Council would see what his opinions were if he read to them
the danse he proposed to be introduced in the 11 Pharmacy Act,
1868/* now passing the Houses of Parliament:—
, ' * That from ana after the passing of this every person
duly qualified and registered under this act, and thereby en-
Digitized by * ^.ooQie
GENERAL MEDICAL COUNCIL.
42 The Medical Press and Circular.
- - --
titled to open shop as ‘compounding chemist* in Great Britain,
shall in like be entitled to open shop as ‘compounding
chemist* in Iceland, without being subject to any prosecution
or penalty, notwithstanding any enactment to the contrary in
the Apothecaries* Act of Ireland, 1791.’*
He was not surprised that Dr. Leet should oppose the motion
of Dr. Rumsey, because if it passed, it would virtually put
an end to the extraordinary powers now possessed by the
Society he represented, namely the double power of licensing
in pharmacy and registering as medical practitioners, besides
which a source of its income would be thereby stopped. As had
been before stated, no man was allowed to compound medi¬
cines in Ireland, without having first obtained the licence of the
Apothecaries* Hall. And what are the subjects enforced by
this Society ; they are : that a man should be examined in
the principles and practice of medicine, diseases of women
and children, midwifery, Ac., Ac. Why, should this be de¬
manded of a compounding chemist, would the Council
imagine for one moment that to be able to compound he must
understand midwifery or be a good surgeon ? It was simply
ridiculous, and the effect it had in Ireland was this : that no
man would settle down in Ireland as a compounding chemist,
because if he had the money, and was compelled to pass such
an examination, he preferred becoming a member of the pro¬
fession of medicine or surgery on the completion of his educa¬
tion. He was therefore decidedly of opinion, that some of the
provisions of the Pharmaceutical Society of Great Britain
should be extended to Ireland, that the monopoly now pos¬
sessed by the Apothecaries* Hall should henceforth cease, and
that any man who could produce satisfactory evidence of his
knowledge of pharmacy, with the certificates of the Pharma¬
ceutical Society as a voucher, or from the Apothecaries* Hall
of Ireland, that he should he allowed to compound medicine
in any part of the United Kingdom he chose, without being
subjected to the penalties now existing in Ireland.
Dr. Acland was of opinion that after the -Very lucid re¬
marks of Sir Dominic Corrigan on the subject of pharmacy,
little remained to be said. It was quite clear that a man
should be either a chemist or a surgeon, and it was equally
clear that no examination should be required as would fit him
fcfr both. As the powers now possessed by the Apothecaries'
Hall of Ireland had not worked well, he hoped that the com¬
mittee appointed by Dr. Kumsey would deal with it, and that
the provisions should be the same in all parts of the United
Kingdom.
The motion of Dr. Bnmsey was then pnt to the vote and
carried unanimously, the following gentlemen being appointed
at the committee:—Dr. Rumsey, Dr. Acland, Mr. Cooper,
Sir D. Corrigan, Dr. Alexander Wood, and Dr. Leet.
BirORT OF THE PHARMACOPOEIA COMMITTEE.
u TKe Pharmacopoeia Committee appointed by the General
Council for watching over the progress of pharmacy, and for
making such additions and corrections as would facilitate
hereafter the preparation of the next editions of the British
Pharmacopoeia, b eg leave to report that, in accordance with
the authority given them by the Council—(Minutes of June 8,
1867, vol. v., p. 186) to obtain such assistance as they might
think necessaky for carrying out the foregoing object, they
engaged the services of Dr. Redwood, whose services had been
so valuable in the preparation of the last edition of the work.
“ In accordance with the request conveyed to hhn t Dr.
Redwood has prepared and placed in the hands of the com¬
mittee a report, which is well calculated tp be useful in all
further proceedings connected with the work. A portion of
this report refers to some typographical and minor errors,
which, though ef no great importance, require correction in the
Pharmacopoeia of 1867. The committee recommend that
portion of the report should be published, so that those who
possess the Pharmacopoeia may themselves be enabled to make
the necessary corrections ; and the committee also recommend
that these corrections be printed as a slip, in the copies hereafter
tbc oommitfbe beg leave to report that they have expended
425' of the sum of £50 placed at their disposal at the last
session of the Council, and they recommend that a like sum
of £50 be placed at their disposal for the next year.
*Dr. Quain moved :— ’
That
r the BBB o! 1867, to be paid to
X U4SV
.feted by
July 8,18&.
Dr. Bedwood for his special and extra services in the prepara¬
tion of the work, but omitted in the amount submitted for
payment to the Council at its last session."
Dr. Apjohn stated that the resolution proposed by Dr.
Quain could not, in his opinion, be entertained, because it con¬
tained a statement which, in point of fact, was not correct.
Dr. Apjohn went on to say that there was most certainly
some misapprehension. The report of the Pharmacopoeia Com¬
mittee was made June 3, 18G7. He had read it through more
than onoe, and he was in a predicament to state .positively that
there did not exist in it any such recommendation as is as¬
sumed in the resolution of Dr. Quain. He was not, indeed,
surprised to find Dr. Quain expressing himself in terms so
irregular. During the existence of the committee to which the
preparation of the Pharmacopoeia of 1867 had been entrusted,
he had found it very difficult to act in co-operation with Dr.
Quain. A meeting was convened for the purpose of organ¬
izing machinery for continuing the operation of the Pharma¬
copoeia Committee, and, in particular, for indicating a plan for
watching over the progress of pharmacy, and for making such
additions and corrections as would facilitate hereafter the pre¬
paration of the next edition of the Pharmacopoeia. The meeting
of the committee he (Dn Apjohn) of course attended, but
when the members were, as he conceived, about to consider
the important subject for which they were called together, Dr.
Quain announced to them that he had already a plan proposed,
and that it was quite unnecessary for the time of the council
to be taken up with the consideration of a matter for which he
had already provided. Dr. Apjohn, therefore, thought it
necessary to state that he would no longer act on the com¬
mittee. After this explanatory statement, into which he said
that he had entered in his own justification, Dr. Apjohn moved
the following amendment on Dr. Quain*s motion :—
“ That there has been no recommendation from the Phar¬
macopoeia Committee to pay to Dr. Redwood £50 for what
are called special and extra services in the preparation of the
Pharmacopoeia, and that, under such circumstances, it is not in
the power of the General Medical Council to allocate any stun,
however small, to the purpose specified by Dr. Quain."
After further discussion the Council adjourned.
Thursday, July 3..
Dr. Aquilla Smith took exception to the manner in
which Dr. Redmond** report had been brought before the
Pharmacopoeia committee, which met on Monday, 29th June.
The report had not been seen by Dr. Christison, or by Dr.
Smith, and no opportunity had been given to the members
of the committee not residing in London, of making any
suggestions respecting the matters mentioned in the report.
Dr. Smith expressed his approbation of the tenour and mat¬
ter of Dr. Redmond** report, and, at the same time, that he
regretted not having had an opportunity of suggesting many
particulars similar to that portion of the report which the
committee recommended in their report to be printed. Dr.
Smith submitted bis resolution, and explained that his object
was to place before the profession the suggestion for the im¬
provement of the Pharmacopoeia, in order that they might be
considered.
Dr. Sharpey expressed it as his opinion that the objection
raised by Dr. Apjohn could be satisfied by substituting the
term “ voted” for that of “ recommended" in the motion of
Dr. Quain. -
This suggestion was accepted by Dr. Apjohn, who then
withdrew his amendment.
Dr. Quain regretted that Dr. Aquilla Smith had not been
a member of the committee ah initio , or he would not have
complained of the mode of proceeding. Dr. Aquilla Smith’s
suggestions would have been most acceptable. It was his
own fault, if that of any one, that they were not offered.
The report could not have been submitted to the committee
until the committee met, in fact, the report was in the hands
of the committee within a few' hours of its receipt. The
report may or may not be published as the Council might
think fit. It was proposed as a record for future use, and
not for publication, but the committee had no objection to
the publication, though they thought it neither necessary or
desirable.
Dr. Andrew Wood was of opinion that no committee
should be appointed for the ensuing year, as he saw no good
from the last, thereupon
Dr. Quain withdrew his motion, and, at the same time,
expressed a desire, owing to the great labour it entailed upon
Digitized by
% The Medical Ptm sod Circular.
GENERAL MEDICAL COUNCIL.
July 8, 1606 . 43
him, and the few thanks he obtained for his work, to with¬
draw from all connection with the committee.
The subject then dropped.
The Council then adopted a report from the committee on
lunacv certificates, recommending that a letter be addressed
to the Home Secretary on the subject, as follows:—
REPORT OF THE COMXITTEE ON LUNACY CERTIFICATES.
A Utract of Letter to the Home Secretary ai to Medical Cert&catet
»» Lunacy.
Sir,—I am directed by the General Medical Council to a
difficulty which has arisen on the construction of the Lunacy
Acts for England, Ireland, and Scotland, with reference to
tiie medical certificates which are necessary to autliorise the
detention of a lunatic in an asylum.
By the English Act £ and 9 Viet., cap. 100, sec. 45, such
certificates are to be signed by “ two physicians, surgeons,
or apothecaries,” who shall not be in partnership, and a false
certificate is punishable as a misdemeanour.
By the Scotch Act 20th and 21st Viet, cap. 71, sec. 34,
such certificates are to be signed by “two medical persons,
one of whom may be the medical superintendent or consult¬
ing physician of a public or district asylum.” And the giving
a false certificate is made an offence punishable by a penalty
not exceeding £300, or imprisonment not exceeding twelve
months.
By the Irish Act 5 and 6 Viet., cap. 123 (continued by
subsequent acts), secs. 14 and 15, such certificates (sec. 14) are
to be signed by two physicians, surgeons, or apothecaries,
and (sec. 15) by two medical practitioners not being in part¬
nership, and each of them being a physician, surgeon, or
apothecary.
By the Medical Act (1858), 21 and 22 Viet, cap. 90, sec.
31, every person registered under that act is entitled to
practise in any part of her Majesty's dominions ; and by sec.
37, no certificate required by any act then in force, or that
might thereafter be passed from any physician, surgeon,
licentiate in medicine and surgery, or other medical practi¬
tioner, shall be valid, unless the person signing the same be
registered under that act.
The question which has arisen is, whether the certificate
of a practitioner resident in England is sufficient to authorise
the detention of a lunatic in Scotland or Ireland, and rice
vena.
This question in 1867 was submitted to you by the General
Board of Commissioners in Lunacy for Scotland. You took
the opinion of the law officer* of the Crown, and the follow¬
ing communication waa made by your direction to the Board
of Commissioners:—
“I am directed by Mr. Secretary Hardy to inform you
that he lias laid a ease before the law officers of the Crown,
and that they are of opinion that upon the true construction
ef the statutes certificates signed by medical men in Scot¬
land do not constitute a valid authority for the detention of
lunatic patients in England and Wales, and vice vena. The
aania rule plainly applies to such certificates granted by
medical men in Ireland.”
It will be observed that the language of the several lunacy
acts is quite general on the subject, and the grounds on
which the opinion of the law officers was formed is not stated.
Probably, however, the opinion was founded upon some such
considerations as are stated in the 20th report of the Com¬
missioners in Lunacy in England, page 48, as follows:—
“ Connected with this subject it also became necessary
that we should point out, in the course of the present year,
that certificates signed by medical men in Scotland, in Ire¬
land, or it» any place out of England and Wales, do not con¬
stitute a valid authority for the detention of lunatic patients
under an extract which is ex pres sly restricted to England
tud.Walns. it had been the practice to receive within the
time specified in the statute, the certificate of registered or
or other practitioners possessing th* proper qualifications set
forth hi it,even though they might have signed In a place not
Odette ia England or Wales; but upon the commissioners
faring had their' attention called to a case in which the
tpftlMA was specially raised, it seemed to them to be among
tag strict requirements of the Lunacy Acts that all persons
ijfinrn certificate should not merely bo duly qualified
but should also, by residence within the juris-
diction, be responsible for tlu penalties expressed in them
contravening their provisions; and that a
MMOggaiaeO whom such penalties could not be recovered
■M event of Illegality or irregularity being found in the
certificatc*signed by him, is not a person whose certificate is
contemplated by the act, or receivable under it. The com¬
missioners regret to have arrived at a decision which has
been complained of as closing the door of English asylums to
the patients of medical men practising in Scotland and Ire¬
land, but the law leaves no alternative ; and as this rule will
in future be strictly enforced, it is necessary that all alleged
lunatic persons whom it may be desired to place in hospitals
or licensed houses within the jurisdiction of the commis¬
sioners, should first be brought to some place within that
jurisdiction, with a view to the necessary personal exami¬
nation, before certificates can be signed.”
Considering the importance which these certificates have
as affecting the liberty of her Majesty’s subjects, it must be
admitted that the objections stated by the Commissioners in
Lunacy are entitled to great weight, but at the same time
the adoption of the rule infringes the privileges conferred on
the medical profusion by the Medical Act, and leads to con¬
siderable inconvenience when it is desired to place a lunatic
in an asylum which is not in that part of the United King¬
dom where the lunatic resides. The object can only be effected
by bringing two med cal gentlemen from England, Scotland,
or Ireland, as the case may be, to the place of the lunatic’s
abode, or by taking the lunatic, without any legal authority,
from his abode to that part of the United Kingdom where
the asylum in which it is desired to place him may be.
I am instructed to suggest to you that an act should be
passed, applicable to the United Kingdom, which, while it
will give to the medical profession the full privileges contem¬
plated by the Medical Act, will at the same time ensure that
no person giving a false certificate shall escape the punish¬
ment justly due to his offence.—I have the honour to be, sir,
your most obedient humble servant, &c.
The Right Hon. Gathorne Hardy,
Home Secretary* Whitehall.
The following report of the Committee on Vaccination was
next received, and a proposal was made by Mr. Osesar
Haw kins for the issuing of recommendations to the licensing
bodies that they should require from every candidate for
their degrees or diplomas a certificate that he had studied
vaccination under a competent and recognised teacher at
some school or hospital providing ample means of study.
This was opposed by Sir D. Corrigan, who said he considered
the proposed certificates worthless, and moved an amend¬
ment recommending direct examinations in vaccination by
the licensing bodies. After a full discussion the amendment
was put and lost, and the motion of Mr. C. Hawkins was
adopted, as was also a letter proposed by the committee to
be addressed to the Medical Department of the Privy
Council embodying the recommendations of the Medical
Council.
Although the legal power of the Privy Council in enforcing
vaccination relates only to England, yet, considering the
great importance of the subject, and the general objects of
the Medical Act, the committee consider that it is the duty
of the Council to endeavour to further the views of the Privy
Council towards improving the knowledge of this subject in
all parts of the United Kingdom.
It is the object of the Privy Council “ that the fact of a
person’s admission to the Medical Register, or at least his
admission uuder some particular title or titles therein,
would virtually guarantee bis being thoroughly skilled in
vaccination,” and thus do away with the necessity for the
special certificate which the Privy Council have hitherto
required from every contractor for vaccination in England,
whatever may have been the source of his medical quali¬
fication.
The Branch Council for Scotland report (vol. v. p. 305)
that all registered practitioners are allowed to certify as to
vaccination, that the existing Vaccination Aet has been very
successful, and that as far as Scotland is concerned there is
no necessity for further change. The Branch Council are,
however, of opinion that “it might be well that all examining
boards should require every candidate for their licenses to
produce a certificate from a dispensary or other public insti¬
tution where vaccination is practised attesting that he has
been practically instructed in the operation, and is ac¬
quainted with the appearances which follow its perfor¬
mance.”
Responding to this expression of opinion (see minutes of
Branch Council, February 21, 1868), the Universities of
Edinburgh, Aberdeen, and. °*
44^ tlu Madfcat uri
GENERAL MEDICAL COUNCIL.
July S, 18*.
Surgeons of Edinburgh, and the Faculty of Physicians and
Surgeons of Glasgow, all agree to require a certificate from
public bodies only. The Royal College of Physicians of
Edinburgh think certificates from special vaccinators unne¬
cessary, but recommend their examiners to examine every \
candidate as to his knowledge of the practice of vaccination '
and of the progress of the vaccine vesicle.
The Irish Branch Council (see minutes, vol. v., p. 347)
approved the objects of the Privy Council, and requested th^
opinion of the qualifying bodies.
The University of Dublin recommend their students hence¬
forward to obtain instruction in vaccination at the Cow-Pock
Hospital.
The Queen's University in Ireland, and the King and
Queen's College of Physicians in Ireland, place no depen¬
dence on certificates, but will draw the special attention of
their examiners to tfiesubject, with the object of their testing
the knowledge of candidates in this branch of medicine. Both
bodies say that they are not aware of any complaints in Ire¬
land on the subject. The College of Surgeons in Ireland is
of opinion that every effort is made by their examiners to
secure proficiency in the performance of all surgical opera¬
tions, vaccination included. The Apothecaries' Society in
Ireland already require certificates from a public vaccine in¬
stitution, or from an authorised vaccinator, and will in future
require candidates to pass an examination in all that relates
to the due performance of vaccination.
The English Branch Council expressed an opinion that
the subject of vaccination required the early and serious
attention of the General Council, and requested the presi¬
dent to draw the attention of the English licensing bodies
to it.
The committee regret that no communication has been
received from the University of Oxford or the Society of
Apothecaries.
The Medical Board of the University of Cambridge think it
advisable that arrangements should be mads at all medical
schools for efficient instruction in vaccination, and that all
candidates for medical or surgical practice should produce a
certificate of having seen the process of vaccination in a cer¬
tain number of cases.
The University of Durham will hereafter require examina¬
tion ms to vaccination of all candidates for a licence in me¬
dicine or surgery.
The University of London will hereafter require a certifi¬
cate from one of the authorised vaccinators appointed by the
Privy Council, and that every candidate shall be practically
examined in vaccination.
The Royal College of Physicians of London will hereafter
require a certificate from vaccinators appointed by the Privy
Council, or from recognised teachers of vaccination in me¬
dical schools, that the students themselves have performed
the operation, and are thoroughly skilled in vaccination; and
the college called the attention of the examiners to the im¬
portance of ascertaining the competency of all candidates in
the theory and practice of vaccination.
The Royal College of Surgeons of England state that they
believe that the steps taken by them in 185iM>0 are such as
to secure proper instruction and proficiency in vaccination;
that the certificate required from all candidates was espe¬
cially framed with that object; which certificate may be given
by any fellow or member of the college, when ascertained by
a duly authenticated certificate that he possessed the neces¬
sary opportunities for the proper instruction of the pupil in
this operation in surgery.
The college observes in addition, that as these certificates
liave only been enforoed since Oct. 1st., 1860, sufficient time
has not elapsed to enable the Lords of the Privy Council to
jodge fully of the effects of that requirement as affecting the
efficiency in that branch of surgery of fellows or members
admitted subsequently to that date.
This observation appears to the committee to possess con¬
siderable weight in reference to the proportion of new
vaccinators contracted with annually to the whole number
of medical practitioners employed under the Poor-law Board
iu England.
From consideration of these documents, and the knowledge
thus acquired of the sentiments of almost all the licensing
bodies, and from such further information as they have been
able to obtain, the committee are led to believe that imper¬
fectly performed vaccination is only one of several causes of
the prevalence of small-pox; but still, in order to obviate
this deficiency as far as possible, they venture to propose
that the Council should sanction, and Issue to each licennng
body in England, Scotland and Ireland, for their adoption,
the following recommendations:—
1st. That a certificate should be required by each licensing
body from every candidate for its degree, diploma, or licence
to practice medicine or surgery, that he has studied vaootaa-
tion under a competent and recognised teacher; that he has
himself performed the operation successfully under the
teacher's inspection; that he is f amil iar with the different
stages of the vaccine vesicle, and with the methods of pre¬
serving lymph, and is thoroughly informed in every necessary
part of the subject.
2nd. That such a certificate should only bo received by any
licensing body from recognised vaccine stations, or from
recognised vaccine departments in medical schools, or hospi¬
tals, or other public institutions, where the appointed
teacher of vaccination is not liable to frequent change, and
where ample means for study are provided by not less than .
such a number of cases (perhaps 8 or 10 on an avenge
weekly) as may be found, after due inquiry in the first
instance, confirmed by authentic returns, or inspections
from time to time, to be sufficient for this purpose at each ,
place.
It is obvious that for the two-fold object of the proper
study of vaccination and the preservation of a due supply of
lymph for national purposes, only a small number of sta¬
tions or schools for vaccination can be provided in each divi¬
sion of the United Kingdom, with a sufficient and continuous
number of cases.
The committee are informed with regard to Ireland, that
although certificates in vaccination are iu practice chiefly
given from the Cow-Pock Hospital in Dublin, yet they might
possibly be received from any one of many hundred public
dispensaries, whose opportunities for instruction will there¬
fore require investigation in every instance before certificates
from them can be considered trustworthy.
Again, with regard to England, although the very small
number of vaccine-teachiug stations nominated by the Privy
Council, in London, and a few provincial towns may, per¬
haps, after the inquiry suggested by the committee, be
somewhat enlarged with increased convenience to medical
students, and without interfering with the views of the Privy
CdudciI for the national welfare, yet, on the other band, the
wide latitude granted at present by the Royal College of
Surgeons of England to its fellows and members will
henceforward cease under the limitations recommended by
the committee.
In conclusion, the committee submit a draft letter to the
medical department of the Privy Council Office for the con¬
sideration of the Council.
Cjesab H. Hawkins, Chairman.
The Medical Council trust that considerable improve¬
ment has taken place since that time, as to the knowledge of
vaccination, by the action of some of the licensing bodies,
who have required proof of competence from a large number
of persons admitted in the last few years to the Medical-
Register which would every year have been more sensibly felt
as the proportion of persons thus taught became larger rela¬
tively to the whole of the medical profession.
The Medical Council beg to assure the Lords of thePrivy
Council that they have found the greatest desire on the
part of the universities and medical corporations generally to
forward their lordships* views regarding vaccination, and
entertain no doubt of their concurrence in such measures
as may be considered necessary still further to secure this
object.
The Medical Council, 'on mature consideration of the
question in relation to the whole empire, have agreed to issue
to all the licensing bodies placed by the Medical,Acts under
their control, recommendations to the following effect•
1. The Medical Council entertain a confident expectation
that by the general adoption of these recommendations great
improvement will be produced in the method and extent of
the teaching of vaccination, and that a complete and prac¬
tical knowledge of the whole'subject will be enforced upon
every person who seeks admission to the Medical Register, so
as to secure the proper performance of the operation, and
subsequent observation of its effects*
2. The Medical Council believe that, when the proposed
system is fully in operation, the Lords of the Privy Council
may be led to feel tbet confidence in the skilfolnees in* vac¬
cination of all persons hereafter admitted to the Madical
Register which would enable their lordships, as they desire,
Digitized by
Goog
TheJMteti tnd Circulir. DRYSDALE ON PROSTITUTION. JnJy 8 , 1868 . 45.
to dispense with the speeial certificate now required from
contractors for vaccination in England.—I have the honour
to be, sir, jour obedient servant, . •
Frakcis Hawking, Registrar.
Dr. Aclmnd then rose to move the following motion, the
direnskffi on which was adjourned to the following day, and
the meeting separated:—
“That the treasurer*be authorised to pay XI00 to Dr.
Richardson, F.R.S., to aid him in his researches into the
elves of agent# which can with safety be used as Anesthetics;
that one-half be forthwith paid, and one-half on presentation
of a report, which shall have special regard to the several
properties of the said agents, and their fitness to be introduced
into the British Pharmacopoeia."
Friday, July 4.
The Council met in private conference from one till twe
o’clock,In order to elect a president vice Dr. Burrows, whose
tenure of office would expire before the meeting of the next
Council.
At two o’clock the proceedings commenced as usual, by the
reading of the iriinutesof the preceding day, and these being
confirmed, it was announced that the differences existing on
the previous day, relative to the appointment of the Phar¬
macopoeia Committee for the ensuing year, and the additional
grant to Dr. Redwood, had been arranged to the satisfaction
of Dr. Quain, and the appointment of the same gentlemen
who acted upon it during the past year was agreed to, Dr.
Auuilla Smith’s name being included on the list.
The adjourned debate on the motion moved by Dr. Adand
at the close of yesterday’s proceedings was resumed.
After a discussion, occupying nearly two hours, on the
propriety and legality of the proposed grant, it was ulti¬
mately agreed to— 1 “That the motion be not put toa division,"
by permission of the Council. It was then withdrawn.
’ Dr. Andrew Wood, on behalf of Mr Syme, who was una-
voidald v absent, reported that the committee on the subjects
of medical education, after taking into consideration the
points referred to them, have put in train a series of arrange¬
ments by which they hope to be able to obtain valuable
evidence from the principal teachers and examiners in the
kingdom which may aid the committee in drawing up a
complete report for the next meeting of the Council.
The report of the Finance Committee was next submitted
to the Council.
Moved by Dr. Stobbar, and seconded by Sir Dominic
Corrigan:—
** That the report of the Finance Committee be adopted.”
Amendment, moved by Mr. Hargravr, and seconded by
Dr. Riimsky:—
“Thatinstead of X35, recommended by the Finance Com¬
mittee to be given to Mr. Bell and Mr. Koope, an addition of
£60 be made to the salary both of Mr. Bell and Mr. Roope."
The amendment was carried.
Moved by Dr. Parkbs, seconded by Dr. Afjohn, and
agreed to:—
’’That the best thanks of the Council be given to the
Director-General of the Army Medical Department; to the
Director-General of the Navy Medical Department; and to
the Right Honourable the Secretary of State for India, for
their kindness in furnishing to the Council the returns of the
exaittifiatidtt of candidates for the respective medical services
of the afriny, navy, and India.”
The application from Dr. Frederick Milford to be regis¬
tered 44 M.D. (by examination) Heidelberg, 27tb June, 1860,
was unanimously acceded to; and the letter from Dr. James
Mason, relative to the Medical Acts Amendment Bill, was
ordeted to bC received and entered on the minutes.
A eomfrntl n f ca tlon from the Branch Council for Ireland,
relative to two applications for registration in the 41 Student’s
Registerwas acknowledged, and the course taken approved.
UJam the letter from Dr. Edwards Crisp; relative to the
adjudication of the Carmichael Prize, being brought before
thtCcratttil,
'Mfc HAJtafeAvfe rose to mote that It was not within the
prCvintteo? the Council to give its opinion thereon. The
CdttneiVoF thb College of Surgeons Of Ireland had always
acted wisely, legally, and with the utmost impartiality; l«e
t ^ l hi Mf g eowteWded that it was not a matter in which they
couhfor shOtfld feel desirous to interfere.
' WM np/ifamfevtft remarks the CouncH were agreed,
WfW 0 dropped, Dr. Alixandir Wood naively
suggesting, Amidst considerable merriment, that the subject
be referred to the Committee on Lunacy.
The second letter from Dr. Edwards Crisp, on the increase
of half-qualified practitioners, since the passingof the Medi¬
cal Act (1868), Ac., was ordered to be entered on the minutes,
and referred to the Committee on 44 Tho Licensing Bodies
and Registration of Students.”
A memorial from the North of Scotland Medical Associa¬
tion relative to the position of parochial medical officers, was
acknowledged, intimation being given that it was not within
the province of the Council.
A letter from Dr. R. Barnes, relative to the use of bis sur¬
name by a non-registered person, in offensive advertisements,
was read by Dr. Bennett, its justice acknowledged, and the
general purport ordered to be entered on the minutes.
The report of the Committee on Preliminary Education,
was then gone into, and occupied the attention of the Coun¬
cil until six o’clock, at which hour the debate was adjourned.
Saturday, July 4.
, The Council were engaged nearly the whole afternoon in
a discussion on the series of proposals of Dr. Alexander
Wood, the chairman of the Committee on Preliminarv Edu¬
cation, which, owing to the extreme length of the debate on
the reform of the Medical Council, we are compelled to omit
this week, as also the report and the debate on the 41 Report
of the Pharmacy Committee,” including the regulations on
the scale of poisons, which was proposed by Dr. Rumsey,
who has bestowed much labour to bring this important
matter before the Council, with a view to the presentation
of a petition to Parliament before the Bill 44 The Pharmacy
Act, 1868” becomes law, and seconded by Mr Hargrave.
Some of the suggestions contained in both reports are ex¬
ceedingly valuable, and we therefore purpose giving them in
exteneo in our next number.
Monday, July 6.
The Council met to-day two hours earlier than usual, in
order that the business of the session might be concluded
before rising. The various questions before them were
accordingly disposed of, and the session, which has lasted
longer than usual, was concluded with the customary votes of
thanks to the President, the Council of the College of Physi¬
cians for the nse of the rooms, to the officials, Ac.
The debatet of Friday , Saturday and Monday mil be given in
our next
- ■ ■
DR. CHARLES DRYSDALE ON PROSTITUTION.
At two full meetings of the Dialectical Society on the evenings
of May 18 and 25, at which were present, among others, Lord
Ambtrley, vice-president of the society, Mr. M. Conway, Mr.
Acton, Dr. Pross er James, Dr. Oppert, Mr. Nasmyth, Dr. Ed¬
munds, Dr. Chapman, Mr. Dyte, Ac., a paper was read on the
causes and consequences of prostitution by Dr. C. R. Dryiklale,
Physician to the North London Hospital for Consumption. The
author observed that there might be said to be about 10,000
prostitutes in London and 6000 in Paris ; but the importance
of this class of unfortunate women, and the part they played in
spreading contagious diseases of a most dangerous kind, made
the class one of the most interesting to the philanthropist and
to the medical man. The chief causes of prostitution were
the sex appetite, a constant force like gravitation always im¬
pelling the sexes towards each other. Then came, as subsidiary
causes of prostitution, the love of dress, idleness, want of edu¬
cation, the decrease of marriages in Europe, drunkenness, and,
above all, the low wages of the female sex. The sex appetite,
being dependent on organism, could not, and ought not, he
thought, to be letocned, but only to be regulated . The love
of dress was a cause of prostitution in many instances, and
also the desire to get money without toil, which was, indeed,
the cause cf many of the vices of both sexes. Want of educa¬
tion : In Bordeaux, of 105 prostitutes, only 9 could sign their
names. Idleness was often caused by the low remuneration of
female labour. Pov e r ty was the most fruitful cause of the
venality of women. The wages of some workwomen was de»
plorably low. Thus, Dr. Edward Smith had given, in the sixth
report of the Privy Council, a statement, that many needle¬
women only earned 3s. lljd. a week on an average. Dwretue
of marriaget was observed in all European States, owing partly
to the irrevooabihty of the contract, and to the difficulty of
| rearing offspring in the already crowded state of society of old
‘ Digitized' Google *
46 The Medical Pres* and Circular.
CORRESPONDENCE.
July 6,1868.
countries. In Paris one-third of the births were illegitimate.
In Munich more than half. Dr. Drysdale showed the extreme
frequency of venereal diseases in London and elsewhere, by
mentioning that 43 per cent of the out-patients of Guy's Hospi¬
tal were said to suffer from the diseases which were kept up by
prostitution. He spoke of the sterility of prostitutes, as ac¬
counting for the existence of the class: in Paris 1000 of these
women do not produce one child a year among them ; were it
otherwise, infanticide would be far more prevalent than even
at present. Prostitutes were rather healthier than the average
of the female sex, with the exception of suffering from venereal
diseases. Hvsteria, especially, was rare among them, probably
owing to the latter disease being more common among women
who lived a life of celibacy. Dr. Drysdale hoped that before
long society should have been sufficiently enlightened to desire
to stamp out such foes to life as the venereal diseases, by
admitting prostitutes, when diseased, immediately into hospi¬
tals, and also by encouraging them to attend to cleanliness
and to their own health, by scrupulously avoiding contagion
from their visitors. Hut the chief means of preventing prostitu¬
tion was to raise the wages of women, by enlarging their in¬
dustrial employments, and educating them in science and in¬
dustry. As long as families were so large in overcrowded
countries, so long would poverty and its attendants—degrada¬
tion, filth, and vice—abound. Should mankind, however, ere
long, become tired of the prevalent theological dogmas about
the necessary degradation of human life, and take their own
destinies in their own care, and have only that number of
children which was compatible with good wages and the full
employment of all, prostitution would disappear ; and he, Dr.
Drysdale, fully believed that, eventually, this would take place.
He approved of great facility of divorce, as in Indiana, U.S., as a
remedy against prostitution. In Indiana, six months and the
will of either party suffices.
Mr. Conway (of Virginia) said, that in no part of the world
had he seen so much domestic happiness and fidelity, as in
Indiana, U S. The reason of this was, that divorce was at the
will of either party ; and thus marriage became a real joining
of congenial natures. Poverty was the great cause of prostitu¬
tion. Wherever women had low wages there was prostitution,
as in New York aifd London ; in Indiana, Ac., there was none
of it.
Mr. Levy, although agreeing with the two former speakers,
that a facility of divorce was desirable when women were able
to gain good wages, thought that in overcrowded countries like
this it would be injurious to the interests of women. Women's
employments should be extended first.
Dr. Chapman thought that it was as well to do half a good
if we could not do all that was needed. It was cruel to keep
together persons not truly married, as this law favoured infi¬
delity and prostitution. Prostitutes should be admitted into
hospitals when diseased, which hitherto religious bigotry had
opposed. Registration of prostitution and police supervision
was much opposed to justioe, and the matter should be openly
and freely discussed, since the problem was one of the most
important of all those of social science. Sexual appetites
were too strong and ungovernable, in proportion to the other
appetites, at the present time.
Mr. Smith also believed that the appetite of sex was capa¬
ble of being much lessened as civilisation advanced, and cul¬
ture extended.
Mr. Fox Bourne contended that those women were not to
blame, who when very ill-fed and starving, took to prostitu¬
tion. On the principle of the “ greatest happiness ” they cer¬
tainly gained more than they lost by so doing. And, as they
were reported to be barren, prostitutes often were much less
Injurious to the working classes or receivers of wages, than
those wives who were mothers of large families, and who brought
low wages and starvation upon their unhappy offspring. He
thought the police examination of prostitutes no more an in¬
fringement on liberty than other hygienic regulations, such
as emptying dust bins, Ac. Women should be more employed
in industry.
Mrs. Frith (formerly matron of the British Lying-in Hospi¬
tal), did Rot agree in the views stated as to the facility of
divorce. She would have divorce more difficult, in order to
protect women more. Women ought to be educated well and
enabled to get their own living. Novel reading was dangerous
to female virtue, and alcoholic drinks given to children tended
in this direction. The overcrowding in towns was injurious.
Many poor girls would gladly ret ur n to industry, could they
see their way to do so, and many of them had shown charity
and great — to their poor relations. Emigration *:
women should be much encouraged to countries where they
were less crowded than here.
Dr. Edmunds dilated on the importance of providing occu¬
pation for women. The emigration of men had left such a
disproportion between the sexes in this country that, when
a paltr} situation, such as that of governess, was vacant, a
perfect host of applicants were always found ready to compete
for it. Industrial employment for women was the grand re¬
medy for prostitution. Women should be made to be inde¬
pendent.
Mr. M‘Grzgok Allen said that the present laws of legiti¬
macy were a disgrace to civilisation. A mother of an illegiti¬
mate child received only 2s 6d. a-week, and was thus forced
into prostitution or infanticide. The grand cause of prostitu¬
tion was poverty, and this, as was well-known, was due to
the large families so common in this country and in many
other over-peopled states* Chastity was not the greatest
virtue in women.
Mr. Laurie raid it was a farce to suppose that a poor
girl, earning only 2s. 6d. a week could be expected to be
chaste, when she would only starve as an alternative to be¬
coming a prostitute.
Dr. Oppebt said that England was now the great obstacle
towards the stamping-out of venereal diseases.
Dr. ROBEBT8, although opposed to large families, was Also
averse to industrial employment of women. It made them bad
wives.
Mr. Gough thought that production would be increased if
women were employed; and thus there would be more for
society to consume.
Mr. Nasmyth spoke of education A3 the great want. The
appetite of sex had hitherto been ignored as one of the impera¬
tive wants of human beings. It must not be ignored, but regu¬
lated, in future, and then prostitution might disappear.
Mr. Acton had been greatly pleased with the debate. Pro¬
stitution was an inevitable evil at present. How oould its ill
| effects be palliated ? Most prostitutes led this life for a year
or two, and then got married. 'J hey did not die. but were
usually very healthy, having good food and an easy life. Much
might be done to render prostitution less dangerous to public
health, and he had been deeply gratified with hearing a lady
express her opinion. This led him to remark that if prostitutes
oould be advised to keep themselves more cleanly, and also to
examine very carefully their customers, as they almost univer¬
sally now did in Paris, they might themselves escape infection,
and also assist in stamping out these serious contagions. How
far it was advisable in this country to cany out the continental
system of registration and police examination of prostitutes, he
was not quite sure; but, at any rate, ample hospital accommo¬
dation for diseased women should be secured. At present it
was scandalously inadequate. Persuasion and humanity would,
he believed, effect as much as force in this matter.
- -»■
ON DINING.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—O ne of the most important questions, in a sanitary point
of view, for the medical profession to solve, as regards their
patients and themselves, is How and TTAro to Dine t
Many of our social habits require reforming, and they are
only tolerated and kept up because no one is courageous
enough to commence the necessary innovations. The prevail¬
ing manner of dining in fashionable society, for instance, is
conducive neither to health nor oomfort; faint grumblings find
their way into the papers occasionally on the subject, but the
complaints are only heard in a whisper, §0 they Boon die away
and are forgotten.
Now, when an evil of this kind is generally felt, bnt
feebly suffered to go on, it is well for some one to come forward
and attack it in an outspoken way. I venture to undertake
that duty, and I feel sure I shall have the support of your
readers in bringing forward the present suggestions. There
can be no question that heated rooms, bad ventilation, and late
hours, render the present style of dinnersa great infli c t ion upon
all persons who possess rational ideas on the subject.
There are people, of ooorse, and, I suppose, always will b^
who take a strange ddighi in sacrificing health to f a shio n,and
are content to live a life of senseless excitement, if even
u "he effort to cany on inch an abno rm a l txistf&c*
Digitized by LV~
TMftkfyad Frs« snd Circular.
MEDICAL NEWS.
July 8» 1868. 47
Above all things the dinners require to be under sani¬
tary regulation; they should be very much simplified and
curtailed. Somebody lately wrote to one of the morning papers
to'complain of the inconvenience of (fining hurriedly in order
to he in time for the opera. Imagine under what difficulties
the digestive processes must be carried on in a heated atmo¬
sphere, immediately after partaking of a steaming and a
harried repast ; it is not, moreover, the best preparation for an
intellectual treat. I propose that a more simple meal should
be introduced, at a much earlier or a later hour, than that
which is now the rule : a kind of “ meat tea ” at five o'clock
or «t nine, would conduce much to health and economy, and
we should thus get rid of the daily heat, worry, and other dis¬
comforts attending a two hours’ sitting at a fashionable
dinner.
The idea of a number of people being invited to meet to¬
gether for the purpose of eating, is not a refined one ; the chief
object of an entertainment should be intellectual; refresh¬
ments more or less elaborate could be introduced incidentally.
We are not entitled to the distinction which we, English
claim, of being the most civilised nation in the world, while
we continue to make Dining the chief mode of entertaining our
friends, and cherish a kind of faith in the idea, that to give
44 good dinners ” is the only means of keeping up our position
in society, and of conciliating that exacting, meddlesome, busy¬
body, 44 Mrs. Grundy.”—I am, Sir, yours obediently,
July, 1868. S anitas.
-♦-
ROYAL MEDICAL BENEVOLENT* FUND SOCIETY
OF IRELAND.
A meeting of tiie Central Committee of this Society was held
in the Royal College of Surgeons on the 1st inst., Dr. Fitz¬
patrick in the chair.
Dr. Whabton announced that he was authorized to tender
Dr. Duke’s resignation of the office of Honorary Treasurer, in
consequence of his continued ill-health.
Dr. Walsh then proposed, and Dr. Stewart seconded
the following resolution, which was unanimously agreed to:—
44 That Dr. Duke’s resignation be accepted, and that the
cordial thanks of this Committee be presented to Dr. Duke,
for the efficient manner in which he discharged the duties of
the Honorary Treasurer to the Royal Medical Benevolent
Fund Society for the past six years, and that this Committee
can not be satisfied with a mere formal acknowledgment of
Dr. Duke’s services, but beg leave to take advantage of this
op p ort u nity to express their deep regret at the cause which
has led to his resignation, and to express an earnest hope that
his retirement for a time from professional pursuits will have
the effect of producing a restoration of his health.
Proposed by Dr. Quinan, seconded by Dr. Walsh, and re¬
solved :— 44 That Dr. James Little be requested to accept the
office of Honorary Treasurer of the Royal Medical Benevolent
Fund Society of Ireland.”
The following awards were made by the Central Committee
during the past month—subsequently to the annual distri¬
bution :—
1. A widow, set. 50. Husband dead some years. This was
4 case which has been annually relieved, but the application
was received too late for the general distribution. Recom¬
mended by Sir Dominic Corrigan, Bart, and Dr. Benson.
Granted £5.
2. Three female orphans ; father dead three years. Appli¬
cation late for annual distribution. Recommended by
Limerick Branch for a final grant of £15 to assist them to
emigrate. Granted £15.
3. A spinster. For several years a recipient. Application
late for annual distribution. Recommended by Linjerick
ftranchl Granted £4.
4. A medical man, totally unable, from heart disease, to
(allow his profession ; has six children, and no means of sap-
port, Recommended strongly by the Cork Branch. Awarded
OIL Hus Was an urgent case, and had come under the notice
at.tif Cork Branch subsequently to the annual distribution.
•A. wIdQW, «t. 70. Relieved last year. Friends sup-
V tat are now all dead. Recommended by Clare
..._
asurdr, Dr. Little, reported that from the
eftedc^njTqxm the funds of the society (owing to the
u^aKTVral abdications after the annual awards had been
VI. bank to meet the awards to the last
two cases not quite £5. It was, therefore, ordered that £4
be immediately sent to case 4, as most urgent, and that as
funds were available the balance should be remitted; as also
the amount of the award to case 5.
Iptol gfrfos.
The Public Health.— In the week that ended on
Saturday, June 27,4776 births and 2997 deaths were registered
in London and in thirteen other large towns of the United
Kingdom. The annual rate of mortality was 24 per 1000 per¬
sons living. The annual rate of mortality last week was 24
per 1000 in London, 24 in Edinburgh, and 18 in Dublin, 21 in
Bristol, 18 in Birmingham, 27 in Liverpool, 27 in Manchester,
20 in Salford, 31 in Sheffield, 31 in Bradford, 20 in Leeds, 25
in Hull, 22 in Newcastle-upon-Tyne, and 29 in Glasgow. The
rate in Vienna was 28 per 1000 during the week ending the
20th instant, when the mean temperature was S‘3 deg. Fahr.
higher than in the same week in London, where the rate was
20. The deaths registered in London during the week were
1454. It was the twenty-sixth week of the year, and the ave¬
rage number of deaths for that week is, with a correction for
increase of population, 1304. The deaths in the present return
exceed by 150 the estimated amount, and exceed by 226 the
number recorded in the preceding week. The mortality from
diarrhoea exhibits a considerable increase. In the week which
ended the 6th of June, the deaths from diarrhoea were 27, in
the two following weeks 81 and 66 persons died, and last week
the deaths recorded were 171. It is essential at the present
critical period of the year that the greatest care should be taken
by the engineers and others, who have the control of the water
supply of London, so as to prevent any contamination of the
water. The ventilation of the sewers also demands attention.
Professor Franklin says that 44 The long-oontmued drought has
rendered the river waters supplied to London unusually pure.
The previous sewage contamination of these waters is on the
average much lower than has ever before been observed. The
Southwark Company’s water was again turbid from the pre¬
sence of much suspended matter; besides giving the water a
repulsive appearance, this suspended matter is nitrogenous, and
therefore highly objectionable. With the exception of the
East London Company’s water, which contained, however, only
traces of suspended matter, the rest of the samples were per¬
fectly bright and transparent.” At the Royal Observatory,
Greenwich, the mean height of the barometer in the week was
29*869 in. The highest day temperature was 88*0 deg. on
Saturday, June 27. The lowest night temperature was 48*4
deg. on Tuesday, June 23. The highest reading of the ther¬
mometer in the sun was 157 deg. on Saturday, June 27. The
mean degree of humidity of the air was 68, complete saturation
being represented by 100. Rain fell to amount of 0*29 in. The
general direction of the wind was S.W. Ozone was observed
on six days during the week; the greatest amount was on
Monday, June 22.
From the House of Commons on Friday last the
following business is reported :—
Medico-Legal Inquiries. —Mr. Clive inquired whether the
government had determined to appoint a Royal Commission
to inquire into the present mode of conducting medico-legal
inquiries, and as to the operation of the sanitary laws. Mr.
G. Hardy said that the government had not lost sight of this
subject, and they would see what was a proper inquiry to con¬
stitute in reference to it.
Austria and the Cattle Plague. — In reply to Mr.
Moffatt, Lord Stanley Baid he was aware that the Lower
House of the Reichsrath had passed a bill having for its object
the prevention of the introduction of the cattle plague into
Austria from Gallicia or Hungary, but not having yet received
a copy of it he could not say what were the exact provisions
of the measure. He had, however, written for a copy of the
bill, and hoped to receive it shortly.
Poor-law and Medical Inspectors (Ireland) Bill. —This
bill passed through committee.
Poor Relief (Salary of Auditors)— The report author*
ising the payment of these salaries was brought up and agreed
to.
Burials (Ireland Bill). —This bill was read a third time
and passed.
Digitized by VJ‘OO^l0
8 The Medical Press and Circular. NOTICES TO CORRESPONDENTS.
July «,H«.
THE JOURNAL OF THE IRISH MEDICAL
ASSOCIATION.
The unusual pressure on our columns from the reports of the
General Medical Council, compels us, although we have in¬
creased the size of the Journal for their accommodation by
one-third, to forego the publication of The Journal of the
Irish Medical Association for one week. We have felt our- I
selves excused in doing so, because the important debates on
the representation of the medical practitioner in the Medical
Council embodied in the report are of such close and imme¬
diate interest to the Irish provincial practitioner that, under
any circumstance, it would have been necessary to lay them
before the readers of the Association Journal We have in
type an abstract of the Poor-law Commissioners’ report just
issued, which we hope to give in our next.
-+--
COPY OF
“ MEDICAL PRACTITIONERS’ (COLONIES) BILL.”
Wherbas by the Thirty-first Section of “ The Medical Act,”
passed in the Session holden in the Twenty-first and Twenty-
second Years of Her Majesty, Chapter Ninety, it is enacted as
follows:—“ Every Person registered under this Act shall be
entitled, according to his Qualification or Qualifications, to
practise Medicine or Surgery, or Medicine and Surgery, as the
Case may be, in any Part of Her Majesty’s Dominions, and to
demand and recover in ’any Court of Law, with full Costs of
Suit, reasonable Charges for professional Aid, Advice, and
Visits, and the Cost of any Medicines or other medical or sur¬
gical Appliances rendered or supplied by him to his Patients
And whereas it is expedient to amend the said Enactment:
Be it enacted by the Queen’s most Excellent Majesty, by and
with the Advice and Consent of the Lords Spiritual and Tem¬
poral, and Commons, in this present Parliament assembled,
and by the Authority of the same, as follows :
1. This Act maybe cited as “The Medical Act Amend¬
ment Act, 1363.” %
2. The Term “ Colony” shall in this Act include all of Her
Majesty’s Possessions abroad in which there shall exist a
Legislature as hereinafter defined, except the Channel Islands
and the Isle of Man.
The Term “ Colonial Legislature” shall signify the Autho¬
rity, other than the Imperial Parliament or Her Majesty
in Council, competent to make Laws for any Colony.
3. Every Colonial Legislature shall have full Power from
Time to Time to make Laws for the Purpose of enforcing the
Registration within its Jurisdiction of Persons who have been
registered under “ The Medical Act,” anything in the said
Act to the contrary notwithstanding: Provided, however,
that any Person who has been duly registered under “ The
Medical Act *’ shall be entitled to be registered in any Colony,
upon Payment of the Fees (if any) required for such Regis¬
tration, and upon Proof, in such Manner as the said Colonial
Legislature shall direct, of his Registration under the said
Act.
--♦-
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in England on or before Friday morning are
expected to be returned to the Editor, at the office, 90, King
William-street, Strand, TOC. .before five r.n., on Friday afternoon.
Proofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two f.m. on Saturday, which is
an early closing day. Duplicate proofs are sent to author^ in
order that they may correct and return. one copy, and knap ths
other for private use. Contributions should be lboiblt written, on
one side of the paper only.
- 4 -
BOOKS, PAMPHLETS, Ac., RECEIVED. '
Braithw&ite’s Retrospect of Medicine.' Vol. LVJLI. London :8faag-
kin, Marshall, and Co.
On the Reform of the Out-patient Department of the Hrapjtals. By
E.H. Sieveldng, M.D.
Bible Animals. Part VH.
The Journal of Cutaneous Medicine. By Erasmus Wil son, F.RJ&
Half-yearly Abstract of the Medical Sdenoea. Vol. XLVII. London:
Churchill and Sons.
The Journal of Mental Science. Vol. XIV. London: Churchill and
Sons.
The Practitioner. No. I. Macmillan and Co.
Lectures on the Diagnosis and Treatment of Functional Venrous
Affections. By Brown-S6quard, F.R.S. London: Williams and Nor-
gate.
The Pharmaceutical Journal
Hardwicke's Science Gossip.
The Homoeopathic Review.
The British Journal of Homoeopathy.
The Westminster Review. No. XLVTI.
The New York Herald of Health.
NOTICE TO ADVERTISERS.
gpirial firm anir GDirnte
OFFERS UNUSUAL ADVANTAGES
OR the Insertion of announcements from its extensive
and largely increasing circulation in each of the three
divisions of the United Kingdom and the Colonies. Being also
supplied to the Hospital Libraries, Ac., it will be found a most
valuable medium for Advertisements of Books, Vacancies md
Appointments, Sales, and Transfers of Practices, Surgical Instruments,
Chemicals, ana Trades generally.
The scale of charges is as follows
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When advertisements are given for a series of insertions, a vary oon*
siderable reduction from the above scale is made.
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OrriCK, on Saturday*, by Thbkr o’Clock.
EXPORT OF THE CARLSBAD NATURAL
-Ei MINERAL WATERS.
List of Entries in the Register of the Branch
Medical Council, Ireland, for the month of June, 1868.
Michael Joseph Keating, 4, Cumberland-place, North Circular-road,
Dublin.Lie. R. Coll. Surg. Irel., 1867, Lie. K. Q. Coll. Phys. Irel., 1868;
Michael Strahan, Arklow, co. Wicklow. Lie. R. Coll. Surg. Irel., 1866,
lie. R. Coll. Phys. Edin., 1866; David Bigger, Portadown, co. Armagh,
Lie. R. Coll Surg. Edin., 1868, M.B. Univ. Glaag., 1868; Philip Somer¬
ville Warren, 9, Summer Hill, 8outh, Cork, Lie. H. Coll. Phys. Edin.,
1867, lie. R. Coll. Surg. Edin., 1867: George M. Dowidge, Chesterfield,
Parsonstown. King’s County, Lie. Apoth. Hall, Dublin, 1836; Thomas
Ryan. Baylick, Middleton, co. Cork, M.D., 1867, and Mast.-9urg., 1867,
Qu. Univ. Irel.; Charles Edward Crean, Ballenvilla, Claremorris, co.
Mayo, lie. R. Coll. Surg. Irel., 1867, Lie. 1868, and Lie. Midwifery, 1868,
K. Q. Coll. Phys. Irel.; Richard H. |Porter, 64, Darae-street, Dublin,
Lie. Apoth. Hall, Dublin, 1868; Benjamin Frederick Bradshaw. Bansha,
co. Tipperary, Lie. R. Coll. Surg. Irel., 1868, Lie. 1868, and Lie. Mid¬
wifery, 1668, K. Q. Coll. Phys. Irel; Robert Hunter. Kilrea, co.
Derry, Lie. R. Coll. Surg. Edin., 1867; Richard Creed, Glas-
nevin, co. Dublin, Lie. R. Coll. Surg. Irel., 1868; James Berry Kenny,
Killeshandra, co. Cavan, Lie. K. Q. Coll. Phys. Irel., 186*, Lie. R. Coll.
Surg. Irel., 1868; Arthur Vernon Macan, 10, Gardiner’s-place, Dublin,
M.B., 1868, and M. Ch., 1868, Univ. Dublin; George Ivie Mackesy, 88,
Lady-lane, Waterford. M.B., Univ. Dubl., 1868, Lie. 1868. and lie.
Midwifery, 1668, R. Coll. Surg. Irel.; Henry Clarke, 26, Holles-street,
Dublin, Lie. 18h8. and lie. Midwifery, 1868, K. Q. Coll. Phys. Irel.,
lie. R. Coll. Surg. Irel., 1866; William Sharpe, ManorbamUUm. co.
Leitrim, M.D., 1866. and M.Ch., 1868, Qu. Univer. Irel.; William West
Fulton, Lough Brickland, co. Down, M.B. Univ. Glasg., 1868, lie. R.
Coll. Surg. Edin., 1868; John Joseph Neville, Macroom, co. Cork.
L. R.C. Phys. Edin., 1867, L.R.C. Surg. Edin., 1867.
The wonderful natural properties of the Mineral Waters of Carlsbad
are too well known to require commendation; they are a fact proved
by the experience of many centuries. The waters can be used in the
same way at home as at the Spring. The usual dose is One Bottle of
Mineral Water each morning, taken at intervals of twenty minutes,
either cold or warm, and after open-air exercise if practicable, or at
home and in bed if necessary. To increase the aperient qualities of the
bottled Carlsbad Waters, one teaspoonful of the Sfbudbl Salt should
he added. ■ _
All orders for the MINERAL WATERS, 8PRUDEL SALT, and
8PRUDEL SOAP will be promptly executed at the Denote in all large
towns, or direct by the Brunnen Nertendungs, direction of Heinrich
Mattoni, Carlsbad, Bohemia.
LIQUOR 0PII 8EDATIVUS “ HEATHFIELD’S”
AS BATTLEY’S.
B EING Agents for this preparation, we beg to call the
attention of the Medical Profession and of the Dto-
pensing Chemists to i(s claims. It has been much prescribed by the Ppo*
fession for many years, and we offer it with the greatest confidence aa
being prepared exactly on the same manner as Battley’s. As a seda¬
tive the “ Liquor Opii” has no equal, and aaafavourite of forty yean*
standing it has mamtained its position almost without a rival. We
take this opportunity of urging its reputation and soliciting orders im
same.
BOILEAU AND BOYD,
Wholesale Druggists,
99, BRIDE-STREET, DUBLIN.
Digitized by v^,oo
f£fte gft*j n & Cirfttta*.
“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, JULY lo, 1 868.
Co ntent s.
ORIGINAL COMMUNICATIONS.
Movbid Conditions of the Throat in
their Halation to Pulmonary Consump¬
tion : their Diagnosis and Treatment.
By 8. Scott Alison, M.D.. Edin. page 49
Notes on some Peculiar Cases of Syphilis.
By Angus M. Porter, M.D. 60
Three Cases of Mitral Disease, in which
there were no Murmurs on account of
the Intensity of the Valrular Lesion.
By Lawson Tait. 51
Short Notes on Nice.—No. in. By James
Btannus Hughes, M.D., F.R.C.8.I. 62
HOSPITAL REPORTS.
Richmond 8ceoical Hospital—
Excision of the Upper Jaw. Under
the care of Mr. William Stokes.
(IUtutrated) . 64
City op Dublin Hospital—
Double Anthrax on the Abdomen.—
Anthrax on the Abdomen.—
Pudendi. Under the care of
Mr. Croly. 65
PAOE
LITERATURE.
A Handbook of Vaocination. By Edward
C. Seaton. M.D. 57
The Essentials of Materia Medica and
Therapeutics. By Alfred Baring
Oarrod, M.D., F.R.8. 67
Bodent Cancer, with Photographic and
other Illustrations. By Charles H.
Moore, F.R.C.S. 67
| Bandages and Splints. By W. Fairlie
Clarke, M.A., F.R.C.8. 57
Education and Training considered as a
8ubject for Legislation. By a Phy¬
sician. 68
Half-yearly Abstract of the Medical
Sciences. Vol. 47—Jan. to June, 1868.
The Retrospect of Medicine. Edited by
W. Braithwaite, M.D., and James
Br&ithwaite, M.D. Vol. 57—Jan. to
June, 1868. 68
LEADING ARTI0LE8.
i 8 ext to Coventry. 68
| Notes ox tub Debates or the Medi¬
cal Couxcil. 69
paob
NOTES ON CURRENT *OPifcS.
Royal College of Surgeons of England.—
University of Edinburgh.—The Abys¬
sinian Medical Service.—Chloroform.—
Glazing the Streets.—Evils of Bad
Cooking.—Muzzling Dogs.—DUst-binh. 69-60
OBITUARY NOTICES*
Dr. Eennion. — Dr. Ramsbotham,
F.R.C.P.—Matteucd.—Pouillefc. 67
’CORRESPONDENCE.
Ashe on Medical Reform. 68
Atkins on the Pharmacy Bill. 68
Donovan on Iodide of Sulphur in the
Treatment of “ Porrigo Favosa.”. 69
MISCELLANEA.
General Medical Council. 68
General Council of Medical Education
and Registration. 61
Medical News, Notices to Correspon-
, dents, &c.69-70
©rifliiiHl Cjammuiuratitfiisi. |
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION : THEIR
■ DIAGNOSIS AND TREATMENT.
* Bt S. SCOTT ALISON, M.D. Edik ,
FELLOW OF THE ROYAL COLLEGE OP PHYSICIANS, LOXDOX, AXD
PHYSICIAN TO THE HOSPITAL POE CONSUMPTION AND DISEASES OP THE
CHEST, BROXPTOX, AND THE SCOTTISH HOBP1TAL.
No. II
-1 now come to disease of the trachea and larynx and ad¬
joining parts in their relation to pulmonary consumption
as a simulator. This relation it is the great object of this
paper to exhibit. Throat affections, when simulating
pulmonary consumption, present that relation that is most
interesting, inasmuch as they give rise to suspicion of
dangerous disease that does not exist, constantly give
way under skilful treatment, and carry away with them
every fear of pulmonary mischief, or remain only for a time
without impairing the value of life. These simulative
diseases give scope to the exercise of that exemen eruditum
which enables the physician to declare with certainty the
existence of only minor and generally curable disease, and
the absence of a complaint most generally fatal. How useful
and comforting this skill proves to the patient and to his
friends, how valuable in many aspects—as, for instance, in
rotation to business affairs, to arrangements in domestic
life, to travel, to place of residence, to life assurance, the
value of annuities and reversions, and how pleasing it is to
•the physician, and how creditable to that art to which
many are even now so prone to affix the stigma of incom¬
petence.
^ That ft is a common thing for purely throat affections to
simulate chest disease, and more especially pulmonary
consumption, I may safely say. Amongst some forty patients
*lwMri under my carnm the Brompton Hospital, I con-
djflnqgdiave some whnhave, as far os I am able to judge,
J&'mlMe whatever of the chest. During the eight years
the charge of in-patients, I have constantly had
yB jW m tf thc absence of all pulmonary mischief, and the
disorder of the trachea and other parts of
foe timer portion of the air-tube apparatus. These patients
have Man under -observation in reasonable time to
Aiimr and rqpeted examination, and have not
been dismissed until the most careful further scrutiny has
confirmed the original diagnosis.
I have constantly had occasion to recommend the early
dismissal of patients under such circumstances, and in no
case have I heard that the dismissal turned out to be un¬
fortunate—that is, was followed with evidence of disease of
the chest. Such cases, it should be added,* have been sent
to the hospital as often as consumptive ones, and with me¬
dical certificates.
At present there are in the hospital under my care six
patients with affections of the upper air-tube apparatus
simulating more or less strongly pulmonary consumption :
three are females and three are males. The chief morbid
conditions are infected pharynx, enlarged tonsils, and con¬
gested condition of the trachea. The total number of
patients is 43, and these six cases give a percentage of 16.
The total number of pulmonary consumption cases is 26,
and the six cases of simulated consumption with affections
of the upper air-tube apparatus give the result of 23 per
cent to tne cases of pulmonary consumption in the hospital
under my care.
One of the most common forms of disorder of the trachea
and other connected parts is a state of roseolar congestion
of the trachea, larynx, and glottis, conjoined with nervous
irritability and spasmodic action. Sometimes there is
associated a general deterioration of the health and some loss
of flesh. Sometimes the general health is good and the
nutrition of the body is unimpaired, but in this latter case
there is less likelihood of consumption of the lungs being
successfully simulated. A condition of trachea giving rise
to suspicion of tubercle of the lung, involving the form and
calibre of the trachea, has frequently come under my notice,
and I rather think has received little or no notice from
pathologists. This condition is one of constriction or nar¬
rowing of the tube immediately above the bifurcation. The
reduction of the calibre begins about an inch above the
! bifurcation, increases for half-an-inch, and then gradually
I reduces in the direction of the bifurcation. The extent to
which the narrowing occurs varies, but is very manifest to
| the eye in many cases. The narrowing affects the whole
circumference of the tube, and does not proceed from pro¬
jections at particular spots. The cartilages remain of the
normal length, the soft parts of the posterior wall only
I being reduced in breadth. This narrowing of the back wall
devoid of cartilage is very obvious, and depends gene-
I rally upon an undue amount of muscidar contraction. No
morbid lesions are found, saving narrowing and 'signs of
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50 The Medical Press and Circular.
PORTER ON SYPHILIS.
July 16,1668.
over-vascularity and some thickening of the mucous mem¬
brane. When the measurements of the contracted part
are compared with the calibre of the joint calibre of the
two bronchi at the bifurcation they are found to be greatly
deficient. The calibre of the narrowed part is also found
unduly less than that of the trachea in its upper part. It
should be mentioned that in health the trachea is narrower
below than above, and the calibre of that part is less than
the joint calibres of the two bronchi.
The excessive narrowing of the trachea gives rise to a
certain continuous difficulty of respiration, great sense of
oppression in the upper front part of the chest, including
the region of the sternum. The difficulty is liable to
exacerbations, an exposure of the patient to cold, and an
occasion of increase of vascular congestion or of spasmodic
action. This narrowing gives rise to difficulty in inspira¬
tion and also to difficulty in expiration. It is this condi¬
tion of narrowing which so frequently leads to emphysema
of the lungs—a state occasionally associated with tubercle.
The expiratory effort is opposed by the obstruction offered
to the volume of air in course of expulsion, and the tender
walls of the lung air-vesicles give way, dilate, coalesce,
and give rise to wheezing lung inspiration, sibilant and
sonorous rhonchi, imperfect oxygenation of the blood, in
some cases purple countenance, and laboured and inefficient
action of the heart, often accompanied with dilatation and
softened flabby walls of that organ. The respiration through
the trachea is highly noisy and constrictive, and this applies
to the expiration as well as to the inspiration. The seat of the
most intense constriction sound is immediately close to the
sternum, where the stethoscope should be placed.
This morbidly narrowed condition of the trachea from its
causing shortness of breath, serves to suggest the idea of
consumption, and when it is associated with streaky haemop¬
tysis, which it sometimes is, with cough, general derange¬
ment of health* and loss of flesh, the idea- of tubercle of
the lung acquires strength with non-professional people,
and even with medical men, who neglect the careful em¬
ployment of auscultation and of other exploratory tests.
The excessive shortness of breath in such cases, coupled
with only moderate wasting of the body, the highly con¬
stricted respiration sounds in the throat, and the almost
normal state of the respiratory voice, and percussion sounds
of the chest, and of the shape and movements of that re¬
gion, permits little doubt to rest in the mind of the
practised physician as to the comparatively soft nature and
generally local character of the disease, and as to the chance
of tubercle in the lung.
It may serve to guard the young practitioner, however,
to say here that such a narrowing of the trachea as has been
described above, is sometimes associated as a sequela of tu¬
bercle of the lung, but exploration of the chest will easily
establish this coincidence where it occurs.
In the healthy state, the trachea presents a difference in
its volume at different parts. An inch above the bifurca¬
tion, on careful measurement of a healthy trachea, I found
that a cord passed over the exterior measured three inches,
while a cord passed round it immediately above the bifur¬
cation, measured only two inches and seven-tenths.
The capacity of the trachea immediately above the bi¬
furcation is greatly less than that of the conjoined capa¬
cities of the two bronchi at their origin. The internal
circumference of the trachea at this spot, I found on careful
examination of a normal organ, to be two inches and two-
tenths, while the conjoined internal circumference of the
two bronchi amounted to three inches and three-tenths.
The right bronchus exceeded in its internal circumference
the left by one-tenth of an inch.
Stricture and constriction of the trachea have been re¬
ferred to in various works on the throat, but their morbid
conditions, as there described, have been more restricting
and partial than the constricted condition of the trachea
which I have endeavoured to describe. The partially con¬
stricted condition of the trachea, which points from tumours
and foreign bodies in the tube, and from tumours outside ,
and from injuries by violence, are, of course, altogether dis¬
tinct from the narrowing of the trachea, which I have de¬
sired to bring under the notice of the reader.
Hypertrophy and engorgement of the mucous follicles of
the posterior wall of the pharynx have been, in some cases of
suspected pulmonary consumption, the only pathological
conditions discemable under the most careful and repeated
exploration. The posterior wall has been seen roughened
and unduly injected, presenting an unusually florid colour,
or an undue clarety aspect, together with enlarged and
various venous twigs.
The uvula, in some few examples, has been the only
structure that has presented a morbid condition ; generally
it has been injected, often it h^s been hypertrophied ;
sometimes, on the other hand, it has been greatly reduced
in size, or totally obliterated, but this part has often been
found unduly long, occasionally clubbed at its extremity,
but more frequently tapering to rather a fine point, mem¬
branous and almost transparent.
The tonsils, in numerous examples of merely simulated
pulmonary consumption, have been the only parts which,
under diligent and repeated examinations, have presented
a morbid condition. The morbid condition has varied,
but in most examples it has been one of considerable en¬
largement, undue redness and vascularity, with mucous
depressions, as if scarred, or chopped, or pock-pitted. This
state has usually been shared by both tonsils, but occa¬
sionally it has been confined to one. When both tonsils
have been enlarged to the size of walnuts, they have, by
approaching each other, greatly contracted the entrance
into the. pharynx, and interfered with the free pendency of
the uvula. In such cases the voice has had an unduly
nasal tone, and some little difficulty has been experienced
in swallowing. The respiration through the trachea in
most cases has been highly constrictive, and I have ob¬
served in a majority of the patients a sensible amount of
hardness of hearing.
That cases such as the above are sometimes treated as
examples of pulmonary consumption, there is no doubt
whatever. The cough, the occasional streak of blood, and
the impediment to free perspiration, suffice to this end.
Such cases of simulated pulmonary consumption are com¬
mon in children, and in young persons about puberty.
A girl about 12 years of age came into the Rose ward
lately with such a condition of tonsils as has been de¬
scribed. She was rather plump. ' No sign of tubercle of
the lung being made out, I enquired more particularly into
her history. She li^d come to the hospital from a place in
the country many miles from town, and she informed me
she had seen (I believe) some eleven doctors. It was clearly
a case for surgical aid, and Sir W. Fergusson, the surgeon
to the hospital, being sent for, removed the hypertrophied
parts, and the patient was then sent home, carrying with
her no signs whatever of chest disease recognizable by my¬
self, the house-surgeon, or my clinical assistant.
NOTES ON SOME PECULIAR CASES OF
SYPHILIS.
By ANGUS M. PORTER, M.D.
(Continued from page 26.)
Case 3rd necessarily includes two parties—husband and
wife.
On January 11, 1868, Mr. D. came to get advice for
what appeared to be herpes preputialis. He said he had
been treated for the same affection some three years before,
and that the late Dr. Halliday cured him in a very short
time. He remembered the name herpes to have been used
by Dr. Halliday on that occasion. The gentleman’s
regular habits, and unimpeached character, seemed to
place him beyond suspicion of impurity of mind or body,
still great caution was required in answering his pointed
questions, as he seemed in greater dread of the disease than
its condition at the time warranted, or his past experience
should have admitted of. Considering that the patient
should be prepared for the possibility of evil oonsequence^
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The Medical Press and Circular.
TAIT ON MITRAL DISEASE.
July 15,1868. 51
I reserved judgment, and suggested the likelihood of his
having contracted the disease m a foul privy, which hint
he willingly accepted, as furnishing a respectable fons tt
origo maii .
He had been away on business in the south of Ireland,
and two days before coming to me he first noticed itching
of the prepuce. He was a most temperate and regular
man, as already mentioned, and lived happily with his wife
(who at this time was about seven months pregnant).
Rest, repeated bathings, the application of dilute lead
lotion, and a mild purgative, were the remedies advised.
On January 14th he was quite free from the local dis¬
ease, no irritation whatever remaining, but nocturnal per¬
spirations had become a great source of discomfort to him ;
for this he was recommended to sponge with tepid water
impregnated with sulphuric acid.
He returned on February 4, suffering from marked
febrile symptoms (hot dry skin, headache, constipation,
and quick pulse). For two days he had observed a bright
scarlet rash (roseola) to come and go on his chest and ab¬
domen. On examination the glandule concatinatre were
found enlarged, copper-coloured stains were discovered at
the flexure of his right elbow and the back of his neck, his
forehead had become very rough, but not discoloured.
His throat was simply erythematous. The glands of each
groin remained unaffected.
Corrosive sublimate in compound infusion of gentian, to
betaken with cod-liver oil, as in ease 2 , also 15grs. of
Dover’s powder each night, rest, and plain nourishing diet
constituted the treatment at this stage of his illness. Tie
was recommended strong alum water gargle for his throat.
Eleven days later (February 15), on visiting Mr. D. at
his own house, I was glad to see that a great improvement
had taken place in his health. The cutaneous disorders
were dying »way ; his throat was much better with the ex¬
ception of a small nicer which had attacked the left tonsil.
The glands at the back of his neck were not so perceptible,
and the stains mentioned before were not feo distinct. He
stated that he had derived considerable benefit from spong
ing with the acidulated water. He complained now of his
eyes being rather sore, and his sight weak, but I could not
detect any morbid appearances.
His wife had now unfortunately become a sharer in his
sorrow, and evidently a partaker of the forbidden fruit.
Her chest was as red as the shell of a boiled lobster ; the
glandulse concatinat® greatly enlarged, and the throat very
sore, but not ulcerated. She was depressed in spirits, and
feverish. She readily submitted to an examination, when
for the first time she became aware of a number of ragged
ulcers on the mucous surfaces of the labia. To the inside
of each thigh was a patch of vesicles, which were highly
inflamed and intensely itchy. A thick row of pustules
extended up from the fundament to the end of the coccyx.
There was no tenderness in either groin, nor could any
hardness be felt, the chancres, also, were free from indura¬
tion.
After cauterizing all the chancres with nitric acid, and
the pustules and vesicles with nitrate of silver, the parts
were all stuped with poppy-head water, then dilute lead
lotion on lint covered with gutta-percha tissue was applied,
and the patient kept in bed. The internal medicines con¬
sisted of iodide of potassium in six grain doses, with
three drachms of fluid extract of sarsaparilla in water, three
times daily ; ten grains of Dovers powder occasionally at
bed time, and full doses of liquid extract of senna, as an
aperient, when required. For the throat a powerful
astringent gargle was ordered, containing tannic and the
mineral acids.
February 18th.— Some superficial ulcers which had
foraied on the tonsils were burnt with lunar caustic.
Oalomnl was dusted on the vulva and perineum.
On.the 23rd inst., considerable improvement had taken
both locally and general. The calomel seemed to
■JJfl thoroughly withered up the pustules, and the con-
1«of the chancres had so far unproved, as that no
^ WB experienced.. The throat was again
touched with nitrate of silver, and the other remedies
continued.
On March 14th, Mr. D.-, who had been away on
business, and persevering with the prescribed treatment,
returned, complaining of severe rheumatism in his right
arm, which he could not bend nor raise to his head.
Febrile disturbance, ulceration of the tonsils, weakness
of sight, and falling out of his hair, were the accompany¬
ing symptoms. He was now recommended Donovan’s
solution, and stimulating applications to the hair, as in
Case 2 . The following liniment greatly relieved the pain
in his arm :—
R Lin. aconiti.
— Bellad.
— Chloroform.
— Opii aa. ^ss.
— Camph., co. 50 . M.
Ft. linim.
The ulcers on his tonsils were being daily brushed with
a strong solution of nitrate of silver, and thereby improved
rapidly. Two days later (March 17) Mrs. D.’s right arm be¬
came affected in precisely the same way as her husband’s,
when the same embrocation as was used in his case proved
equally efficacious in the removal of pain.
In the course of a week both parties were |>erfcctly free
from this latter symptom.
Doth patients continued to improve from this for¬
ward, save as regarded the ulcers of the throat, which in
each case seemed difficult of cure.
On April 14, a bald ulcer appeared on the right side of
Mrs. D/s tongue, for which she was recommended chlorate
of potass in ten gr. doses, as was also her husband.
23rd.—The lady was confined of a very fine healthy son,
free from any mark of disease or delicacy. For it she had
a plentiful supply of milk, of which it partook freely.
Her mouth and throat had quite returned to a normal
state. All remedies were now dispensed with, it being
considered unnecessary to further continue their use.
Mr. D., who had been travelling on business from the
preceding Saturday, arrived home on April 25th, and, I
may say, almost recovered. His hair had ceased to bill
out. No cutaneous eruption whatever remained, but the
throat was still slightly troublesome, and his sight still
impaired. I ordered him a strengthening eye-wash, and
told him to continue the chlorate of potass and the oil,
which he did till the end of the month, when, being appa¬
rently cured, he left off taking anything in the shape of
medicine.
In this last case, or joint ease as it may be termed, the
first peculiarity noticed was the herpetic character of the
primary disease, and the rapidity with which it. was cured,
contrary to the law of specific sores ; secondly, the occur¬
rence of night perspirations (generally looked on as a late
symptom of constitutional syphilis) five days after the first
appearance of local disease, or as soon as the latter was
removed ; thirdly, the development seventeen days later
of secondaries (roseola, copper-coloured stains, and ery¬
thema of throat), the lymphatic ganglia of the groin re¬
maining unaffected. Fourthly, the presence of vesicles in
the lady’s case on the inner surface of each thigh, precisely
similar to those which were observed on the prepuce of her
husband, and the absence, as with him, of glandular en¬
largement in either groin. Fifthly, the almost simultaneous
attack of rheumatism in the two persons ; and, lastly,
the equally satisfactory results which attended the treat¬
ment of the one by iodine and the other by mercury ; and
the untainted condition of their infant when born.
THREE CASES OF MITRAL DISEASE, IN WHICH
THERE WERE NO MURMURS ON ACCOUNT
OF THE INTENSITY OF THE VALVULAR
LESION.
Br LAWSON TAIT.
In the summer of 18GG I placed a young Irishman under
the care of my much-lamented friend, the Tate Dr. Scoresby-
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52 The Medical Vi'ts* and Circular.
HUGHES ON NICE.
July 15,1868.
Jackson. The patient was about twenty-four years of age,
and suffered from rheumatic fever about five years pre¬
vious to the time I first saw him. The history of his ill¬
ness pointed to pericarditis as the lesion from which he
had suffered; but no very definite history could be ob¬
tained.
The appearance presented by him was not very much
that of a man suffering from heart-disease. He was breath¬
less in going up a hill, complained of uneasiness over his
heart, and great weakness. At first sight I took his case
to be one of phthisis; but examination did not give any
reason to support this. The action of the heart was irre¬
gular, or rather every now and then there occurred an
interval of rather greater length than a beat, during which
the heart seemed to be still, and then there was very
markedly that vermicular motion under the skin supposed
to indicate adherent pericardium. The latter, indeed, was
the condition that I diagnosed; and Dr. Jackson agreed
that this probably was the case. The patient was examined
by several competent stethoscopists, and while several con¬
curred with us, none, if I remember rightly, suggested
mitral disease. The patient left hospital, and died in three
weeks. After a very great deal of trouble I got permission
to examine the condition of the heart, and found, very
much to my surprise, not only that the pericardium was
not adherent, but that, with the exception of a few milk-
spots, it was perfectly healthy. The heart was considerably
hypertrophied. The mitral valve admitted only the fore¬
finger, and was perfectly rigid, being, in fact, only a ring
of calcareous matter, from which the endocardium on the
upper side had been denuded by ulceration. Many of the
chords tendinca were ruptured, or had been ulcerated
through.
J. G., set. 37, had never suffered from any form of rheu¬
matism, but for the last five years had suffered from symp¬
toms which led his medical attendant to believe that he
had some form of disease of the heart. He presented an
extremely anaemic appearance, had some general symptoms,
such as slight cough, occasional bloody sputism, breathless¬
ness on exertion; but there was no murmur, only the same
irregular and tumultuous action of the heart. I had no
means of registering the heart’s action, but it might be
roughly represented thus, taking the period from the be¬
ginning of one beat to the beginning of another as 5:—
5:5:12:5:3:3:5:5: 12:
From the above conditions I suggested mitral disease
as the cause of his symptoms, and ventured to diagnose
a condition similar to the case first mentioned. He
died in a few months, and I found my diagnosis most sin¬
gularly well established; the mitral orifice would not admit
the fore-finger, and it only wanted an extension of the
deposit for an eighth of an inch at one spot to make it a
complete circle of cretaceous material. The endocardium
seemed to be still intact over the foreign substance. The
heart was considerably hypertrophied. As both the above
examinations had to be conducted hurriedly in private
houses, with friends of the deceased looking on, weights
and measurements could not be more accurately taken.
A. P., set. 29, presented an extremely anajmic condition.
A year before I saw her, she had her right breast removed
for malignant disease, in St. Mary’s Hospital, Manchester.
For some months after her recovery she acted as a bar¬
maid, and enjoyed fair health. About seven months after
the operation she found that on any unusual exertion she
became breathless, and this increased so rapidly, that in
two months more she had to give up work. Her con¬
dition, when I saw her, indicated serious disease; and from
the physical signs being identical with those of the second
case, I diagnosed mitral constriction with inelasticity of
the valvular appendages. The question came up—Might
it be malignant disease? and I was inclined to believe that
it was. The fatal issue occurred three weeks after she
came under my care, and post-mortem examination showed
that I was right as to the condition of the valve, but wrong
as to the disease. The valve admitted the middle-finger,
and both flaps were much ulcerated on the upper surface.
The disease was ordinary atheroma, softer, however, than
in the other two cases, and extended completely round the
orifice. The aortic valve had only two segments, and the
pericardium was congenitally absent.
That the intensity of the murmur ha3 no general relation¬
ship to the amount of lesion, and that many very serious
forms of heart affection are entirely without murmur, are
facts well understood and frequently insisted on ; but that
the murmur in valvular affections may be in abeyance from
the very intensity of the disease, is a condition not so
generally recognised.
SHORT NOTES ON NICE.
By JAMES STANUUS HUGHES, M.D., F.B.O.S.L,
PBOFF.PSOn OF SURGERY IK THE BOY AI. COLLEGE OF SURGEON'S, IRELAND J
SURGEON TO JKRVI8-STRKKT HOSPITAL; CONSULTING BURGEON TO Tilt
COOMBE I.YING-IX HOSPITAL { BURGEON TO THE LORD LIEUTENANT’S
HOUSEHOLD, ETC.
No. III.
Some of the best published observations I have read on
the climate of Nice are the following, which are contained
in that excellent little work of Dr. Edwin Lee’s, which he
has published under the heading of “ Nice and its Cli¬
mate,’’ a book I can strongly recommend to those about to
visit Nice, viz.:—
“ The frequentation of Nice and its environs on the
score of health dates from the period of the occupation of
the country by the Romans, when patients were frequently
sent from Rome to Cimiez; and the reputation of this
climate has ever since been maintained ; many professional
and non-professional writers having spoken highly in its
favour. About 100 years ago, Smollett observed in his
‘Letters from Nice,’ ‘There is no place where rain and
wind prevail less (in winter) than here. To give you an
idea of the serenity of the air, I can assure you that during
whole months one sees above one’s head nothing but a deep
blue. The air being pure, dry, and elastic, mu3t exercise a
salutary influence upon the constitution of persons affected
with diseases of the nervous system; it must also be Suited
to those who suffer from checked perspiration, from relaxed
fibres, and a tendency to languors. For my part, since I
have installed myself here, I breathe more freely than I
had done for several years before, and I feel myself trans¬
ported with a vivacity previously unknown to me. The
Nice air has likewise relieved me from a slow fever,
which had resisted every treatment and had rendered
life an intolerable burden to me. I do not take
cold here so easily as in France or in England; when
I do, it is not attended with the same serious symptoms as
in other countries. The air is so perfectly dry that in sum¬
mer and in winter one may pass the evening, and even the
night, sub dio, without experiencing inconvenience, or feel¬
ing the least moisture. Fog is here altogether unknown.’
“ A German physician, Dr. Sulzer, likewise wrote at a
later period (1792) : ‘I cannot quit this country without
panegyrising its climate, which is excellent among the most
privileged. The English who are accustomed to leave their
cloudy island in autumn to pass the winter in the southern
zones of Europe, have greatly contributed to bring into re¬
pute the remedial and comforting influence of the environs
of Nice, and assuredly this reputation is well merited in
more respects than one. Persons who do not look for the
noisy pleasures of large capitals are sure of finding here a
benignant and constantly warm atmosphere in which the
body feels its infirmities disperse, and its youth regained.
Here, one is sheltered from cold, snow, and fog, and one
enjoys in the depth of winter the delights of a perpetual
spring.
“ ‘Theair of Nice seems to me to be much more pure
and serene than anywhere else. A tolerable judgment
may be formed of its character in this respect from the
brightness and sparkling of the constellations, and the num¬
ber of shooting stars, which are only visible in Germany on
the finest winter nights. There is, perhaps, no town in
Europe which is so well adapted for the establishment of an
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HUGHES ON NICE.
July 15,1868. 58
observatory ; for even in rainy weather, one does not per- I
ceive that the air becomes saturated with humidity, or that
it is thick. Hence, an invalid who wants to breathe a pure
and dry air, and to take exercise, will find at Nice all that
can hasten his restoration. The promenade around the
town is really very agreeable, though rather short ; but
those who like variety should make excursions among the
valleys and on the hills, where the beauty and the variety
of the points of view are inexhaustible. In this privileged
climate nature does not repose during winter ; the gardens
retain their green foliage, and spring flowers are constantly
seen. The uncultivated places on the mountains are per¬
petually clothed with grasses ; the plains are embellished
with flowers and trees bearing blossoms and fruits, among
which the orange and lemon trees display a brightness of
colouring that is remarkable at such a time of the year.’
44 A more recent author (Foder^) remarks respecting the
district : 4 Six leagues of the coast constitute the maritime
portion of this country, and comprise the towns of Nice,
Villefranche, Monaco, and Menton ; as also the villages of
Rza, Turbia, and Roquebume, which are placed on rocks
bordering the sea. This territory is remarkable for its
olive woods, its carob trees, and .especially for its orange
and lemon trees, which, being always green, and laden with
fruit and flowers, present to the traveller the aspect of per¬
petual spring.
44 ‘ The mountainous part of the district, which is the
most extensive, differs in its productions according to its
eastern, southern, northern, or western exposure. In the
former all the successive chains of mountains, rising higher
and higher, which close the horizon of this maritime coast,
produce the vine and olive at their base and on their sides;
their summits being bare. From all the more elevated
points of these mountains, at a distance of four, five, and
six leagues from the coast, the sea is visible, and from all
these points the warm and soft breath of the south and east
winds blow. On their opposite side the north wind pre¬
vails, and the country produces only wheat and baney.
One is really surprised to find, frequently in two villages at
a very short distance from each other, productions of an
entirely different nature. The lower chain of these Alps is
the most populous and the most fertile. It comprises
the villages of Falicon, St. Andre, Tourette, Aspremonte,
Contes, Chateauneuf, and Levens, to the right of Nice; on
its left those of Drap and Scarena.
44 ‘ The beauty and serenity of the atmosphere, and an
always reviving nature, add fresh charms to that of the
mild temperature. Nowhere on the fine days of autumn
and winter is the sky of a purer blue, or more cloudless,
than in lower Provence ; we begin to admire it on descend¬
ing the Rhone, after passing Valence ; it is like the sky k of
Greece, and Provence is the Greece of the Gauls.’ l
“The above eulogiums are likewise in some measure
applicable to other localities which were not known at the
tune they were penned ; and, * notwithstanding the flatter¬
ing picture they present, it must not be supposed that Nice
is exempted from some material drawbacks to its enjoyment
as a place of winter abode.
44 Even Smollett, who speaks in such high terms of the
climate in general, remarks with respect to the transitions
of temperature that are frequently experienced : ‘It often
happens in winter, and especially in spring, that the sun
has so much power that one can hardly take exercise without
its producing sweating, and without any transition the wind
arises so cold and piercing that it is liable to produce a very
dangerous effect, and diseases with an inflammatory com¬
plication may result from this sudden change.’
“ 4 Heaven forbid ’ likewise says a native writer, 4 that
we should seek to conceal any of the inconveniences of the
place ; the inconstancy of the winds is extreme ; they
Rtiquently change several times a-day. It likewise some¬
times happens that several winds blow strongly at the same
time; an cerial tempest ensues, and then this fine climate
changes from hot to cold, and vice versa. These changes some¬
thin occasion, especially in spring, such an unexpected
U f “Voyage aux Alpee Haritunoe.”
return of cold weather, that if there is no winter at Nice,
it may also be said there is no spring ; in fact, the winter
is so mild, and the spring comes in so quickly, that unlese
the course of these seasons be interverted by stormy
winds, the transition from winter to summer is scarcely
perceived.’i
“All this sheltered part of the Mediterranean coast
presents, however, in my opinion, more advantages and
fewer drawbacks as respects climate, and is more applicable
to a large class of invalids from northern countries than
most other places of winter resort ; and I am desirous, in
corroboration of this opinion, to show the estimation in
which it is held by medical and non-medical authors who
are not residents, and whose opinions may, therefore, be
considered as exempt from local bias. The following
favourable notice is taken from a small work already
quoted: 4 1 have no hesitation in saying,’ writes Mr.
Dunbar, ‘that by most persons, whether in invalid or in
robust health, Nice must be considered a most desirable
and agreeable place in which to spend the coldest months
of the year. Of course the climate has its peculiarities,
which are found to suit some complaints and some consti¬
tutions better than others.
44 4 But apart from such specialities, if any one seeks a
mild yet dry and invigorating atmosphere, an almost in¬
variably bright and serene sky, giving a cheerfulness of as¬
pect to all things without, and tending to communicate
itself to the mind within ; if it he desired to avoid the ex¬
treme of cold, or even the ordinary gloom and severity of
our northern winter, then I can confidently recommend a
winter at Nice. If my opinion on such a matter is worth
anything, it ought to be regarded as a testimony all the
more favourable to Nice, from the fact, that my impression
of it has been formed during a season somewhat exceptional
for its changeableness even here, and acknowledged to have
been the most severe and inclement that has visited other
parts of Europe for many years. My own register of the
thermometer, and observation of the weather generally,
during the last few months, show a degree of mildness and
steadiness of temperature, not to be surpassed probably in
any other locality in Europe. This I find to be fully borne
out by meteorological tables, kept by residents here for a
series of past years.
“ 4 It is not, however, to be inferred that the climate of
Nice is free from all disagreeable changes or drawbacks.
There are quite sufficient of these to make unreasonable
grumblers occasionally announce their disappointment that
the weather is not every day and every hour entirely per¬
fect. After several weeks, perhaps, of steady mildness and
clear skies, a’clay or two of clouds will occur, and forthwith
you hear, ‘Is this your boasted climate? Why it is no
better than a November day in London.’ A chilly morning
or a cold wind displeases them. 4 It could not be much
colder in England,’ forgetting that while the prevalence
of fine weather may be reckoned by weeks, the reverse is a
matter only of days. For my own part, I can bear this
testimony to the credit of the climate : that, with the ex¬
ception of a few days of chilly rain and sleet in the middle
of December, and two or three shaqj frosty mornings about
Christmas, I have seen nothing this season that at all re¬
alizes our idea of winter. January was a month of unin¬
terrupted mildness and even warmth of temperature, the
sky always serene, for the most part cloudless, and marked
by a singular absence of wind, or any disturbing influence;
the frosty mornings above alluded to occurred, bo it ob¬
served, when all the more northern parts of Europe were
benumbed and paralyzed by an intensity of cold, such as
will make the December of 1860 memorable for generations
to come.
44 4 From a series of tables extending over seven years, I
observe that t he thremometer d icl not fall as low as t he freezing
point more than two or at most three times during the win¬
ter, and that it never reached lower than 28. These observa¬
tions were taken in a northern exposure, and in the shade.
The number of days characterized throughout by clear
1 Roubaudi.—“ Nice et ees Environs.**
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54 The Medical Press and Circul&r.
HOSPITAL REPORTS.
July 15, ides.
sunshine have been reckoned at 180 in the year, divided as
follows : winter 42, spring 42, autumn 40, summer 56 ; the
remaining 185 days include those that are dry and tine
though cloudy (which occur principally in autumn and in
the first winter months) ; those that are showery, and those
that are regularly wet. Another most agreeable and, to
the invalid, most valuable feature of the climate, is the re¬
markable number of calm days during the winter. Blus¬
tering winds, so fatiguing to the body, and so trying to the
organs of respiration, are here but seldom experienced
(through November, December, and great part of January).
Even when the air is sharp, and comparatively cold in the
morning, its undisturbed stillness, combined with its elas¬
tic dryness, render the early part of the day peculiarly
pleasant and invigorating for out-door exercise. The March
winds, with their cloud of dust, though undoubtedly the
drawback of Nice in the latter part of the winter season,
are, in my experience at least, neither so frequent nor so for¬
midable as they are often represented/
“ As regards the effect of the climate, after adverting to
the benefit derived by patients * in numerous cases of gene¬
ral delicacy, or temporary derangement of health, arising
from a feeble organization, a sluggish state of the circulation
or secretions, resulting in a low nervous tone, physical and
mental/ this author adds, i I have known several cases,
among the many that continually occur, of feeble, delicate
children having been brought to Nice in a condition in
which it seemed as though a few weeks or months must ter¬
minate their existence, but on whom the invigorating air
and sunshine of this place has proved like a new life
breathed upon them, causing their little frames to vegetate
with a strength and vigour almost from day to day.
“ 4 Common sense will at once perceive that a climate
with properties so strongly marked must be unsuitable to
some persons, and some stages of disease, just from the very
causes that make it beneficial to others. But, if I may
form any opinion from the number and variety of cases and
complaints among the visitors I have known and heard of
here this season, and the effects their sojourn at Nice has
produced upon them, I am inclined to think that such ex¬
ceptional cases are much fewer than are generally sup¬
posed/ i
(To be continued.)
♦
RICHMOND SURGICAL HOSPITAL.
Cases under the care of Mr. WILLIAM STOKES.
(Reported by Mr. James Crawford.)
• EXCISION OF THE UPPER JAW.
This operation, which, although one of modern date, Mr.
Lizars, of Edinburgh, in 1826, having been the first to
propose the entire resection of the bone, and, as we learn
in the exhaustive chapter on the subject in Mr. Butcher’s
“ Operative and Conservative Surgery, v was first performed
by M. Gensoul, surgeon to the Hotel Dieu, at Lyons, in
1827, is one, which, though very rarely performed, has
associated with it the names of many of the most illustrious
surgeons of the Irish, British, and Continental schools of
surgery. Not to particularise any of the eminent living
surgeons who have performed, and truthfully recorded the
results of their experience of this great operation, the names
of Cusack, Liston, Dupuytren, Lizars, Gensoul, Mott,
Velpeau, Dieffenbach, and LLsfranc, may, in truth, be men¬
tioned. As it would be out of place in an hospital report
to enter into particulars in reference to any historical de¬
tails connected with this operation, we may proceed at
once to detail with brevity the particulars of a case which
was recently under observation in Mr. Stokes’ wards, in
the Richmond Hospital, and for which the operation of
excision of the upper jaw was performed by him.
James M., set. 50, was admitted into the Richmond
1 “From London to Nice, 1861.”—Hamilton, Adams, and Co. See
also the Addvada.
Hospital on the 1st of last March, having been recom¬
mended to Mr. Stokes by his colleague, Dr. Lyons.
The patient stated that about a year before the date of
his admission into hospital a small ulceration appeared at
the junction of the soft and hard palates. This ulceration,
which presented all the external characters of epithelioma,
was removed by operation last September. After some
time, however, the disease returned, and spread slowly,
both anteriorly and posteriorly. It never extended, how¬
ever, beyond the mesial line. About a month before the
patient’s admission into hospital the disease appeared ex¬
ternally, on the cheek namely, and from this opening there
was a constant oozing of clear fluid, which, as the opening
was in the immediate vicinity of Steno’s duct, was most
probably saliva. The general health of the patient was
excellent, and there was only one small gland which was
perceptibly enlarged, and which was situated immediately
below the angle of the jaw. The epithelial ulceration,
which was very irregular, extended considerably both in
front of and behind the junction of the soft and hard palate.
There was occasional but very slight haemorrhage from
the ulceration. The patient slept well, and his appetite
was excellent.
Having regard as well to the external characters of the
disease as to its clinical history, it was tolerably evident
that the case was one of epithelioma, which had originated
in the muco-periosteum of the hard palate, and which sub¬
sequently involved the bone to a considerable extent.
Although, doubtless, the case could not be considered a
typical one for the operation of resection, permanent benefit,
as Professor Syme observes, being in all cases more confi¬
dently to be expected from the operation, when the consis¬
tence of the tumour is essentially firm, yet, considering the
comparatively limited extent of the disease, the case was,
in Mr. Stokes’, and also in Professor Adams’, opinion, one
that demanded prompt operative interference.
On March 4th the patient was brought into the operat¬
ing theatre, and placed seated in a strong and high-backed
chair. His arms and leg3 having been carefully secured
by bandages to the chair, chloroform was then admini¬
stered. When the patient was brought fully under its in¬
fluence, Mr. Stokes commenced by making an incision
from the inner angle of the eye downwards and outwards
to the inner edge of the salivary fistula. The incision was
then carried horizontally inwards towards the mesial line,
near the septum of the nose, and finally brought vertically
downwards, a little to the right of the central line, through
the red border of the lip. The incision thus made was,
therefore, somewhat 2 shaped, as may be seen by reference
to the annexed woodcut—
Mr. Stokes’ Incision for Resection of the Upper Jaw.
The inner flap, or that next the nose, was dissected care¬
fully backwards towards the left side, and then the two
superior maxillary bones were separated by Charriere’s
long bone forceps, one limb of this powerful instrument
being placed along the floor of the nose, and the other in
the mouth. The separation of these bones was effected by
this admirable instrument with the utmost facility. The
Th# Medical Press and Circular.
HOSPITAL REPORTS.
July 15,1868. 55
posterior flap was then dissected backwards towards the
arch of the zygoma. At the junction of the superior
maxillary bone with the malar, the separation was effectu¬
ally accomplished by one of Langenbeck’s small resection
saws. When this was done the saw was then carried up¬
wards and inwards, below the infra-orbital ridge, up to the
junction of the nasal bone with the nasal process of the
superior maxillary bone. Great care was taken not to in¬
terfere with the floor of the orbit. The necessary division
of the osseous structures having been now accomplished,
the separated bone was seized with one of Sir William
Fergusson’s lion forceps, and without much difficulty was
removed. Other portions of bone which were found to
be diseased were carefully removed by straight and rect¬
angular gouges, and the horizontal plate of the palate bone
was also removed by strong forceps; portion of the soft palate
on the right side was also excised by strong curved scissors.
The haemorrhage was not at all so great as was anticipated.
Only one vessel had to be ligatured. Any haemorrhage
from others, was effectually arrested by the free application
of the actual cautery. No plugs of lint or any dressings
were placed in the cavity. The edges of the wound were
then brought together by numerous metallic points of suture.
As regards the progress of this case, little that is specially
remarkable is to be observed. No secondary haemorrhage
occurred. Two days after the operation, symptoms of
erysipelas of the head developed themselves, commencing
on the bridge of the nose. However, under the use of
antimonials and mild purgatives, &c., they subsided. The
wound in the face healed with surprising rapidity. Four
of the sutures were removed on the third day, and the
remainder on the fifth. The case progressed in every way
most favourably. On the tenth day after the operation
the following note is in Mr. Stokes’ case-book :—“ The
patient is free from all pain and uneasiness. Eats, drinks,
and sleeps well. His articulation is becoming more dis¬
tinct every day. There is no evidence of the reformation
of a salivary fistula.”
On March 23, exactly nineteen days after the operation,
the patient was photographed by Mr. Foster, of West-
moreland-street, and on the following day he returned to
the country.
CITY OF DUBLIN HOSPITAL.
Surgical Cases under the care of Mr. CROLY.
Case 1 . —double anthrax on the abdomen.
GL W., aged 60 years, of bilious temperament, and pre¬
viously healthy, presented himself amongst the extern
patients, suffering from well-marked double Anthrax, situ¬
ated on the upper third of the right rectus abdominis
muscle. He said they commenced as pimples about ten
days previously, and gradually spread. He has suffered
from burning pain in the part, and slept very badly for
several nights. The tumours are situated near each other
with an inch of sound integument intervening. Each
Anthrax measures three and a-half inches by two and a-
half; they are flat, and a number of small openings have
formed on the surfaces; more pain than usual b felt, in
consequence of the action of the rectus muscle.
Treatment. —Mr. Croly proceeded to strap each Anthrax
separately as follows—half-moon shaped strips of soap
plaster were evenly applied above and below the Anthrax,
commencing at the circumference, and overlapping each
other, a small circular opening being left in the centre to
allow the slough to escape. When the strapping was com¬
pleted the patient said he felt immediate relief from the
pain. Quinine, with chlorate of potash, was prescribed in
mixture, and the patient was directed to live well, which
his circumstances admitted of. Carbolic acid ointment
was applied on lint over the central portion of the Anthrax
during the day, and an emollient poultice was directed to
bs applied at night. The patient continued to attend as an
extern patient, and the strapping was regularly renewed ;
tlje <Uad areolar-tissue became detached gradually, and
Apatite ulcerated surface healed by granulation.
A drawing of this rare case of double Anthrax on the
abdomen, was taken by Mr. Burnside.
Case 2.—single anthrax on the abdomen.
T. M., aged 43 years, a cooper by trade, presented hittr
self as an extern patient with an Anthrax in circumference
the size of a small orange, situated on the upper third of
the right rectus abdominis muscle. He noticed a smAll
pimple some days previously, it gradually increased in
size ; he fancied the “bit and brace, ” with Which he
worked, was the cause of the disease. He did not sleep for
several nights, and suffered severe pain of a burning char-
acter. The Anthrax was flat, and a number of small open¬
ings had formed on its surface. The same mode of treat¬
ment was adopted as in the preceding case—viz., strapping
with soap plaster and tonic medicines, with liberal diet.
This case also recovered quickly.
Mr. Croly made some practical observations on these
cases—he alluded to the comparative rarity of Anthrax
on the abdomen (especially when double), and the extreme
pain produced by the disease when situated in that re;
gion, caused by the action of the rectus muscle ; he alsd
mentioned Dupuytren’s opinion regarding the sloughing of
the subcutaneous areolar-tissue in Anthrax, and the more
modern view of N^laton, who believes the so-called
slough to be a false membrane, analogous to that formed
in croup and diphtheria. The treatment by strapping in
these cases afforded instant relief (probably by fixing that
portion of the muscle on which the tumours were situ¬
ated), and the mode of applying the plaster in half circles,
adopted by Mr. Croly, was very satisfactory. The names of
N^laton and O’Ferrall were mentioned as the earliest adop¬
ters of strapping in cases of Anthrax, with a view of support¬
ing the capillaries and hastening the discharge of the slough
or false membrane. Mr. Croly tested the urine in both these
cases, but did not discover any saccharine matter, which
probably is never present except when Anthrax occurs in
diabetic patients. Mr. Croly added that the treatment
by crucial incisions (the long approved practice for An¬
thrax) is now becoming obsolete, except in some special
cases; incisions are not only very painful but pro¬
duce considerable shock, acting on constitutions already
debilitated.
Case 3. — noma pudendi.
A. E., a delicate, anaemic-looking child, was presented
amongst the extern patients. Her mother states she
noticed a scalded appearance between the right labium
and thigh some days previously ; the part became swollen
and painful ; the child perspired at night and lost all ap¬
petite for food. On examination, a large oval black slough
was observed occupying the right labium there was
much foe tor from the slough.
Treatment .—The part having been dried with lint, Mr.
Croly applied the strong nitric acid to the diseased sur¬
face, and prescribed chlorate of potash in syrup of bark.
A liberal supply of wine and beef-tea was also directed to
be given. The acid was applied on several occasions sub¬
sequently as the disease was inclined to spread; the
case ultimately recovered well.
Pauperism— The annual New Year’s-day return
of persons in relief from the rates in England and Wales
shows that on the 1st of January, 1868, the number was
1,040,103, being an increase of 76,903, or 8 per cent, over
the number on the 1st of January, 1867. The proportion of
paupers at the beginning of 18e8 was therefore one in 19, or
5*2 per cent, of the actual population. New Ye&rVday being
in the depth of winter is, of course, a time when the number
of paupers is large; and the numbers stated are about 1 per
cent, lower than the truth, by reason of deficient returns.
The adult able-bodied paupers, 185,630, were 27,822 (17*8
per cent.) more than on the 1st of January, 1867; 68,487
were men, 132,143 women. The whole number of adults
receiving relief (including 42,026 insane persons), were
220,097 men and 434,042 women. 6129 vagrants were also
receiving relief, but among these the adults are not dis¬
tinguished.
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u Hie Medical Press and Circular.
GENERAL MEDICAL COUNCIL.
July 15,186ft.
GENERAL MEDICAL COUNCIL.
The following Returns were received and entered on the
Minutes of the General Medical Council, at the Annual
Meeting held on the 24th of June, 1808 :—
Statement of the Qualifications of the Candidates for
the Medical Department of the Army, who in August,
1867, PRESENTED THEMSELVES FOR EXAMINATION.
The Indian Army, February, 18C7.
Candidates. —Successful, 44 ; failed, 8. Total, 52.
Two of the candidates had each four qualifications, and five of the
candidates had each three qualifications, which add9 nine to the re¬
quired number of qualifications (two each) of the fifty-two candidates.
Eight of the passed candidates were deficient in one subject each, but
not to such an extent as to necessitate their rejection.
February, 1868.
Qualifications.
Names or LicifraixO Bodies.
Number of
1 Qualified-
I tions.
Names of Licensing Bodies.
Qualifications.
No. of De-
Qualiflca- ficient
tions. in
|
Qualifications.
| Number of
Qualitka-
Deficient in
tions.
Names of Licensing Bodies.
1
•d
V,
00
i
%
Total.
i
&
1 1
£
it
.9
*3
§
a
o
1i
CO
6
&
■ <
0Q
a
c.
O
%
Roy. Col. of Phys., Lon.,
Lie.
1
1
Roy. Col. of Surg., Eng.,
Mem.
12
10
2
2
i
1
Tho Apoth. Society, Lon.,
Lie.
9
9
1
...
...
Roy. Col. of Phys., Edin.,
do.
15
11
4
2
1
i
8
1
Roy. Col. of Surg., Edin.,
K. & Q. Col. of Phys., Ire.
do.
8
5
3
2
1
2
1
do. ,
11
8
3
2
1
i
1
Apothecaries’ Ilall, Dublin
, do.
1
1
... 1
...
Roy. Col. of Surgeons, Ire.
do. 1
20
17
3
2
1
3
2
i
Fac. of Phys. Ai Surg., Glas., do.
University of Edinburgh, M.D.
!
2
i
i
...
i
—
Ditto
MB.
1
i
•••
Ditto
M.O. |
1
i 1
...
Ditto Aberdeen,
MB.
2
2
.. 1
...
Ditto
M.C. !
2
o
...
Qneen’s University, Ire.,
M.D.
12
12 j
...
l
2
Ditto
M.C.
5
5
Trinity College, Dublin,
M.B.
6
6
l
Ditto
M.C.
4
4
i
Total number of Qualifications
113
97
“1
14
4
8
10
T 1
1 12
Total. 1
No. Passed. 1
No. Failed.
Anatomy. I
Surgery.
Medicine.
*
a
Roy. Col. of Phys. of Lond.,
Lie.
1
1
Roy. Col. of Surg. of Lond.,
Mem.
8
6
2
3
1
i
The Apoth. Society of Lond.,
Lie.
6
4
2
3
1
l
Rov. Col. of Physicians, Edin.,
do.
7
6
1
2
1
Roy. Col. of Surgeons, Edin.,
do.
7
6
1
2
1
...
K. Sc Q. Col. of Physicians, Irel
, do.
19
14
5
1
1
2
3
Roy. Col. of Surgeons, Ireland,
do.
23
17
6
2
1
2
3
Apothecaries’ Hall, Dublin,
do.
1
1
...
...
Fac. of Phys. and Surg., Glas.,
do. |
1
1
...
University of Edinburgh, .
M.D.
2
2
University of Glasgow,
M.B. i
1
1
...
University of Aberdeen,
M.B.
2
2
...
University of Aberdeen,
M.C.
2
2
...
University of St. Andrews, .
M.D.
1
1
1
Queen’s University. Ireland,
M.D
3
3
...
Ditto diitto
M.C.
2
2
...
... |
...
Trinity College, Dublin,
M.D.
9
7 |
3
1
Ditto ditto
M.C.
6
6 |
JJ
2 1
_ 1
JJ
Total .
*1
101 |
61 1
20 |
19 !
6
8
Roy. Col-of Phys., Lon., Licentiates
Roy. Col. of Surg., Eng., Members
Soc. of Apolh., Lon., Licentiates
Roy. Col. of Phys., Edin., Licentiates
Roy. Col. of Surg., Edin., Licentiates
Univ. of Edin. ... I £ acl ? elor °J Medicine
\ Master in Surgeiy
Cniv. of Aberdeen j £“1^“
Univ. of St. And., Doctor in Medicine
/ Doctor in Medicine
Univ. of Glasg. ... J Bachelor in Medicine
(Master in Surgery
King and Queen’s Col. of Phys., Ircl.,*Licen
tiates
Roy. Col. of Surg., Irel., Licentiates
Queen’s Univ., Irel., Doctor of Medicine
Univ. of Dub..
Apoth. Hall, Dubl., Licentiate
Total Number of Qualifications
REMARKS.
Candidates.— Successful, 25 ; failed, none.
Diplomas and Degrees. —Successful, 53.
Three of the candidates had a third qualification.
Some of the passed candidates were deficient in one or more subjects,
August, 1867.
Qualifications.
Names of Licensing Bodies.
No. of
Qualifica¬
tions.
• 1 1
1 i* !i
Candidates. —Successful, 80; failed, 10. Total, 40.
X.B.— Three of the successful candidates had each a Third Q<ialifl-
'‘ation.
Four of the passed candidates were deficient in Anatomy.
Roy. Col. of Phys., Lon. ... Licentiates )
Roy. Col. of Surg., Eng. ... Members
Soc. of Apoth., Lon. ... Licentiates !
Roy. Col. of PhyB., Edin. ... Do.
• ( Bachelor of Medicine
Univ. of Aberdeen ’ Master in Surgery
(Doctor in Medicine
t- , - ri , „ \ Bachelor in Medicine
t m\. of &los 0 . ... j , n Surgery
King and Queen’s Col. of Phys., Irel., Li¬
centiates...
Roy. Col. of Surg., Irel. ... Licentiates
Queen’s Univ. of J Doctor in Medicine
Irel. ... I Master in Surgery
TotAl Number of Qualifications
REMARKS.
Caudidatea. —Successful, 12 ; failed, 4. Total, 16.
Diplomas and Degrees. — Successful, 20; failed, 8. Total, 34.
X.B.—l. Two of the candidates had a third qualification.
2. Of the four candidates returned as successful, three were qualified,
but were not accepted, as only twelve appointments were to be made.
The annual meeting of the Northern Branch of
the British Medical Association was held at Darlington, under
the presidency of Dr. Charlton, on Wednesday, July 1st. The
next gathering will be at Newcastle, the president-elect being
Dr. Embletou. In the evening the members dined together,
Mr. Jobson, the new president, in the chair. Dr. Phillipson
occupied the vice-chair.
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LITERATURE.
July IS, 1868. 5?
#bitu<rrjr ffolins.
DR. KENNION.
On the night of June 3oth, there died at his residence,
Oak Lea, Harrogate, Dr. George Kennion, F.R.C.P. Lond.,
well-known for many years as an active and prosperous
Physician by all who were at all familiar with Harrogate
and its famous waters.
Dr. Kennion’s father was rector of Christ Church, High
Harrogate, and removed thither from the vicinity of Lon¬
don when the late Doctor was only twelve years of age.
After studying physic both in London and Edinburgh,
Dr. Kennion commenced practice at Harrogate in 1540
as successor to Dr. Richardson. He gradually and
steadily rose to eminence, so that of late years a large
number of the highest classes of the community resorted to
Harrogate for the sake of his advice, and during the season,
between the hours of twelve and two, there was always a
vast concourse of people waiting to consult the Doctor on
his return from his morning round of visits.
Dr. Kennion did much towards promoting the proper
and judicious use of the Harrogate waters.
The Kissengen Spring in Montpelier Gardens, which has
of late years become so famous, owes very much of its popu¬
larity to Dr. Kennion, and he, in conjunction with Dr. She¬
ridan Muspratt, brought also into prominent notice the Pro¬
tochloride of Iron Spring, one of the strongest and most
powerful chalybeates to be found anywhere on the globe.
Dr. Reunion's small work on the “ Medicinal Springs of
Harrogate,” now in its sixth edition, is well-known probably
to most of our readers.
While endeavouring thus to speak of Dr. Kennion’s
well-earned fame as a scientific and skilful physician, we
shall be doing him scant justice if we omit to speak of
him as a kind and most hospitable gentleman, and as a
true and liberal-minded Christian. In his busiest time,
when working hard from early morning till near midnight,
he would gladly welcome to his house any professional
brother who might be introduced to him, and of his great
liberality and kindness to those of his patients who might
not be prospering like himself, much can be said and told ;
the Harrogate physician was indeed one who carried out
his religious profession in his daily work, and who
thoroughly enjoyed doing acts of kindness and charity.
During nis severe illness Dr. Kennion was most carefully
attendedby his friends in the neighbourhood, and on hearing
of his danger his friend Sir Wm. Jenner at once went off
to see him ; for a time there were some hopes of a recovery,
but these unfortunately were but transient, for it was de¬
creed that the patient’s work on earth was done, and the
best human aia proved of no avail.
On Thursday, July 2, the mortal remains of Dr.
Kennion were interred in the churchyard of High Harro¬
gate. A large number of the carriages of the neighbour¬
ing gentry joined the procession, and among the medical
gentlemen present were Dr. Myrtle, Dr. Bennett, Dr. De-
ville, Mr. Scaife, Mr. Short, Mr. Millner, and others from
places at a distance front Harrogate.
DR. RAMSBOTHAM, F.R.C.P.
We have to announce the decease of this well-known phy¬
sician, the last edition of whose standard work on obstetrics
we reviewed a few months ago. Dr. F. H. Ramsbotham
inherited, as all our readers know, a name illustrious in
this branch of our art, and he bore it worthily through a
long career, having reached the ripe age of sixty-seven.
From the time he entered practice, he devoted himself to
obstetrics, and was at an early age a recognised authority.
He was a graduate of the University of Edinburgh. He
began practice in the city, was Physician to the Royal
Maternity Charity, and afterwards Obstetric Physician to
tha London Hospital, at the medical school of which he
was for many years Professor of Midwifery. Later in life
ba left the city for the West-End. For some years past his
health has declined, and a little more than a year ago he
gave up his professorship. He had previously retired from
practice. He died at Perth on the 7th inst., where he had
been for a short time.
MATTEUCCI.
The Italian journals announce the death of this illustrious
man. His fame is heard in all schools of science, and his
name universally reverenced by the medical profession.
He was minister of Public Instruction in Italy.
POUILLET.
This well-known author has also died at the ripe age of
seventy-eight, to which he had retained the full use of his
great faculties.
-♦-
Igitmtirr*.
VACCINATION.
Those whose interest in vaccination has been sufficiently
roused by recent pamphlets to desire to know all about the
subject, as well as students generally, will do well to consult
Dr. Seaton's Handbook, 1 which is at once the fullest and best
manual on vaccination that has appeared. The position of
the author as a medical inspector to the Privy Council has
afforded him unusual opportunities of acquiring much infor¬
mation respecting details, many of which are exceedingly
complicated, but all of which are clearly explained in the
admirable .volume before us.
MATERIA MEDICA.
Garrod’s Manual of Materia Medica 1 has always been a
favourite one, and we have much pleasure in stating that the
third edition has been carefully revised so as to bring it down
to the present day. The book is full of facts so well arranged,
that there iB no difficulty in finding everything by reference to
its place in the work. At the same time, we should add that
the index is* very complete. We are very glad to find this
manual has the edges cut by the binder, and we only wish
publishers of other works of reference would follow the excel-,
lent example.
RODENT CANCER.
Mr. C. H. Moore has published some graphic illustrations of
rodent ulcer of the face in a neat volume, which has been for
some time in our hands. 3 The attention which Mr. Moore has
paid to the subject of cancer generally, and the reputation he
has established as a surgeon and author, will ensure candid
consideration for whatever opinion he may advance. In the
terrible disease commonly called rodent ulcer, and which causes
so much disfigurement of its victim, Mr. Moore sees the cha¬
racteristics of cancer, and names it accordingly. He thinks
any constitutional property far from essential to cancer, and he
seems to consider that cancer does not exist prior to its first
manifestation as a tumour, and as an entity apart from that.
We do not think it essential to endorse or controvert this idea.
Our intention on the present occasion is only to mention the
conclusions of a careful observer, who has met with great suc¬
cess in his treatment of these cases.
BANDAGING,
Mr. Fairlie Clarke has published as a small volume on Ban¬
dages and Splints, 4 a supplement to his Manual of Surgery.
It is illustrated by seventy-eight good woodcuts, and forme a
handy little pocket-volume. We have only one fault to find
with it—that the necessary use of the paper-knife leaves the
edges ragged and unsightly, and thus takes away some of the
neatness every pocket-volume should possess. When will pub¬
lishers attend to these little things, and compel binders to finish
their work. Authors will soon have to see after such things
themselves.
1 A Handbook of Vaccination. By Edward C. Seaton, M.D., Medi¬
cal Inspector to the Privy Council. London: Macmillan and Co. 1868.
2 The Essentials of Materia Medica and Therapeutics. By Alfred
Baring Garrod, M.D., F.R.S. Third Edition. London: James Wal¬
ton. 1868.
3 Rodent Cancer, with Photographic and other Illustrations. By
Charles H. Moore, F.R.C.8., &c. London: Longmans andCQ.
4 Bandages and Splints. By W. Fairlie Clarke, M.A., F.R.C.S.
London: Renshaw.
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58 The Medical Press and Circular.
SENT TO COVENTRY.
Jolrl5,W8.
EDUCATION.
We have read with much interest a work on education, 1 just
published by a Physician, who does not furnish his name, but
has evidently bestowed much attention on the great subject
he treats in four careful essays. He advocates a much further
application of compulsion than we have as yet been convinced
to be necessary, and he anticipates a complete social reforma¬
tion by the enforcement of his proposals, which, although giv¬
ing the children a much longer and more efficient training,
would, he believes, cost less to the country. If everyone were
to advocate his views with the same moderation as the author
of these four essays, we should probably soon see much more
agreement than has hitherto appeared likely to be ever at¬
tained.
PERIODICALS.
We have to notice the appearance, punctual to the day, of
the two half-yearly volumes2 that form so excellent an epitome
of the practical papers that have appeared in the more fre¬
quently-published periodicals. We cannot indicate a preference
for either—both are good, and both, we find, have watched our
own pages, and those of our contemporaries. Everyone should
possess one, and those who can afford it may advantageously
take both.
Another number of the Journal of Cutaneous Medicine has
been issued, with articles by Erasmus Wilson, Handheld Jones,
Hoblyn, C. Drysdale, arid others.
We should also mention another quarterly just received, the
Journal of Mental Science , of which Dr. Maudsley is now co¬
editor.
The new therapeutical journal called the Practitioner has
made its appearance as an elegantly got-up 8vo. We have
previously announced it, and need therefore only say the first
number is equal to promise. The exigencies of our space per¬
mit no more at present.
Registered for Transmission Abroad.
The Medical Press and Circular is published
simultaneously in London , Edinburgh , and, Dublin ,
every Wednesday morning . Price bd. Stamped 6d.
By Post to Annual Subscribers , £l 2 6
,, If paid in advance , 118
Post-Office Orders and Cheques to be drawn in favour of
Charles Cooper, 3, Lincoln-place, Dublin.
Maclachlan & Stewart, South Bridge, Edinburgh.
A. A. Tindall, 20, King William-street, Strand, London.
©be gptol IJresfi mib (Omilur.
“SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, JULY 15, 1868.
SENT TO COVENTRY.
It is nut often that we have to comment on any practical
and detennined exhibition of unauimity in a large portion
of our profession in any locality. Still less frequently do
we have to express approval of a proceeding, at once so un¬
usual and so severe, as placing a medical man outside the
pale of professional recognition. Events have, however,
lately occurred, which demand attention at our hands,
and which we commend to our readers as of the utmost im¬
portance; for they indicate a determination to uphold the
honour and dignity of our calling that has too often been
found wanting ; they show, too, an activity on matters of
professional concern, and a readiness to sacrifice personal
pecuniary interests for the good of the general body, that
we are happy to make widely known.
1 Education and Training considered as a 8ubject for Legislation. By
a Physician. London : J. Churchill and Sons.
'I Half-yearly Abstract of the Medical Sciences. Vol. 47—Jan. to
June, l&GS. London : J. Churchill and Sons.
The Retrospect of Medicine. Edited by W. Brnithwaitc, M.D., and
James Braitb Waite, M.D. Vol. 57—Jan. to June, lbti*. London : Sim-
jem, Marshall, and Co.
It will be remembered that some months ago an attempt
was made in South Staffordshire, East Worcestershire, and
other parts, to place club practice on a better footing.
Meetings were convened, evils discussed, remedies pro-'
posed, resolutions adopted. There was not, indeed, per¬
fect unanimity on every point, but there was a general
agreement as to principles. The medical men of Oldbury,
for example, adopted 5s. as the minimum annual con¬
tribution of members of Friendly Societies to the medical
attendant. Some other parts fixed tht minimum at 4s.:—
The following important documents give full informa¬
tion, and are otherwise worthy of quotation:—
“ resolutions passed at a general meeting of the medical
PRACTITIONERS OF 80UTH STAFFORDSHIRE AND EA8T WOR¬
CESTERSHIRE, AT THE DARTMOUTH HOTEL, WEDNE8BURT, ON
the 19th of febrvary, 1868 :—
“ 1. That we pledge ourselves not to accept any fresh ap¬
pointment as surgeon to a dub, at less payment than five
shillings per head per annum, and we further bind ourselves
from the date of this document not to become candidates for or
allow ourselves to be elected to the office of surgeon to any
society that may become vacant owing to the resignation or
dismissal of the surgeon on the question of remuneration, at
the above rate, or on any other question, under the space of
six months after the rise has taken place.
“ 2. We pledge ourselves that between the present time and
Christmas we will raise the annual payment of club members to
five shillings, and we also agree not to attend any club whose
rate of payment is less than five shillings per member per
annum.
“ 3. That it is derogatory to the interest of the profession to
admit children into sick societies except upon the same terms
as Adults.
“ 4. That no person be admitted as a member (to receive
medical aid) *of any club who has not been examined by the
medical attendant and considered eligible, both as regards
health and social position.
“ 5. That no medical man return more than five per cent,
commission on receipt of money, nor pay any premium on
election in money or kind.
“ 6. That the foregoing resolutions be printed and circulated
among the profession of the district, with a request that every
medical man will attach his signature to each resolution, with
any reservation he may think fit to make, and return it to the
secretary. The resolutions, with their reservations, will then
be submitted to a general meeting specially convened.
“John Manley, Hon. Sec., West Bromwich.”
“We, the undersigned medical practitioners of wednxs-
BURY, DARLASTON, AND HILL TOP, UNANIMOUSLY AGREE TO THE
FOLLOWING RESOLUTIONS:—
“ 1.—That we will not accept any new appointment to a sick
club originating from this date at a less sum than 5s. per head
per annum.
“ 2.—That we undertake to issue notices to all sick societies
to which we are now appointed, for a fee of 4s. per head per
annum, from the entering on a new year, half-year, or quarter,
as the case may be; each notice to terminate at Christmas at
the outside.
“ 3.—That we further undertake not to accept any appoint¬
ment, at any price, where the surgeon has been dismissed on
the question of remuneration.
“ 4.—That we accept no appointment for six months after
termination of notice on any other grounds.
“ 5.—That we undertake to return no commission, drink-
money, nor stewards* fees, nor to become members, honorary
or otherwise, to any society.
“ 6.—That we admit no member of any dub to receive
medical aid who has not been examined, Si c.
“ 7.—That in future all salaries be paid at the surgeries of
the respective medical attendants.
W. C. Carman, Thomas Sansomjl
Charles Webb Iliffe. John Manley, Hill Top,
J. C. Carman, Thomas Blackwitod,
Ransome and Latham, Norris Wm. Best,
G. E. Ho witt, Wilson Moore,
H. F. Handy, Samuel Partridge.”
J. Johnson,
A movement of this kind, accepted unanimously by the
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$be Medital Ptmb and Circular.
NOTES ON CURRENT TOPICS.
July 15,1868. 59
resident practitioners, and supported by the voice of the
whole profession, might be supposed capable of overwhelm¬
ing all opposition, and preventing any further attempt to
grind down club doctors to a scale of pay unworthy of
skilled workmen. Such, unhappily, has not been the case.
Three persons have, it seems, been found ready to accept
contracts repudiated by the whole profession, and have
been introduced by the sick-club members to the districts
for the express purpose of accepting these terras. We are
not surprised that the practitioners of the districts have
taken the extreme step with regard to these three persons,
as will be seen from the following, to which we give due
prominence:—
“ At a meeting of the medical profession of South Stafford¬
shire and East Worcestershire, held at the Dartmouth Hotel,
Wednesbury, July 2nd, 1868, it was resolved
M That taking into consideration the introduction of medi¬
cal men into portions of these districts, who are acting con¬
trary to the u n ani m ous resolution of the profession, we pledge
ourselves neither to meet them professionally nor socially; and
we further pledge ourselves not to consent to meet in consul¬
tation any physician or surgeon who recognises them.
M That a copy of the foregoing resolution be forwarded to
the consulting physicians and surgeons of Birmingham and
Wolverhampton, and to The Medical Press and Circular,
Lancet, and Medical Times.’'
We confess that our sympathies are entirely with the
gentlemen who have passed the above resolutions. The
persons affected are unknown to us, but we cannot imagine
any justification for their conduct. Unless the voice of
the profession is to be entitled to respect and obedience
on a question like this, nothing can save it from the
greatest degradation. We have no fear of honest compe¬
tition, we have never been great sticklers for artificial
rules of professional etiquette, but we see that unless in a
question like this, the profession acts thus decisively, there
is no hope whatever for the elevation of its poorer mem¬
bers. Whatever the sacrifice they have made, and no
doubt it is considerable in a monetary sense, our northern
friends have made it for the sake of their brothers in club-
bondage throughout the kingdom, and when their action
became nullified by the introduction of strangers into the
district, who defied them and their professional brethren
throughout the land, nothing was left for them to do but
to take the extreme step they have done. This step,
though it may not enforce their views, was the only one
left, and will undoubtedly obtain for those who have taken
it the approval of the united profession.
NOTES ON THE
DEBATES OF THE MEDICAL COUNCIL.
The sittings of our General Council having been concluded,
we gather up here the fragments of its debates, in continu¬
ation of our former remarks.
Those interested by them will turn to the reports for de¬
tailed information.
PRELIMINARY EDUCATION.
The backward state of the education of the young gentle¬
men who enter the profession, has been strongly illustrated,
"lany are rejected at the preliminary examination for
lAtm, though the knowledge of that language exacted is
only elementary. Then a very large proportion of students
are rejected for ignorance of their mother tongue. Well
might the Council hesitate to demand more. Less could
not be accepted. We look forward to the time when no
one will be suffered to enter the profession until he has
given satisfactory proof of a liberal education.
FORENSIC MEDICINE.
The London College of Surgeons does not accept the re¬
commendation of the Council to add this subject to the list
of lectures to be attended. That College has always been
ready to resist any suggested improvement, and as the
Council has, after discussion, decided on certain subjects,
we are not surprised to find the College object. Does that
corporation wish to undersell all others still ? Some im¬
provements it has, indeed, carried out lately, but its conces¬
sions to public opinion were very tardy. It is a pity the
Council nas not laid down one scheme and compelled all
the corporations to adopt it.
SECONDARY EDUCATION.
Why should the Council petition Parliament on this
subject ? The idea out of doors is that the Council would
do better to confine its attention strictly to the education
of medical men, and enforce such preliminary examina¬
tions as had its confidence.
A REAL POINT.
On Monday afternoon the Council spent a weary time
in drawing up a resolution. The words having at length
been decided upon, some further time was spent in dis¬
cussing the proper position of a comma in one of the
phrases.
Verily the Council can make a point of a small point*
We, like most journalists, frequently leave punctuation
to the printer. That may and does sometimes give rise to
curious mistakes, and occasionally to annoyance, but then
it is not so costly as the time of the 24 talented men who
form the Council at five guineas a day each.
THE FRANCHISE OF THE CORPORATIONS.
This subject is attracting wider attention than ever out
of doors. Dr. Paget's speech has produced great sensa¬
tion, and it is thought that in another year he may have
so far matured his views as to tempt him to take action.
It will be remembered that he related how large was the
constituency that had the right to vote in his own case
(University of Cambridge). Dr. Bennett announced that
the Fellows of the London College of Physicians could
take part in his election, though he acknowledged that
practically his election was the act of the Council. The
Edinburgh Royal Colleges allow the resident Fellows a
vote if they chose to exercise it. These facts are the
thin end of the wedge, and upon them the weight of pro¬
fessional opinion must be exercised. A little firm expres¬
sion and this great reform of the Council must be ac¬
complished. Then although its representation may be said
to be indirect, the profession will be very fully repre¬
sented in the Council which it pays. Extension of the
Franchise of the Corporations means, too, more than this.
PHARMACY.
, The progress of pharmacy—the state of pharmacy-—
how much attention did not these phrases excite. Then
the Pharmacy Bill too ! That is a fine bone of conten¬
tion. That the present condition of the practitioner of
pharmacy is not satisfactory every one seems to see, but
now to remedy it puzzles a good many. Should pharmacy
be kept as a distinct calling, as is the case in most
foreign countries ? |That, in our opinion, is the most impor¬
tant question to be settled about pharmacy.
- 4 -
IJjote sir ftmtat
Royal College of Surgeons of England.
The annual elections came off on the 9th instant. Mr.
Quain takes the president's chair, and Mr. Cock and Mr.
Solly are vice-presidents for the year. Mr. Partridge, ac¬
cording to our prediction, is the new examiner in dental
surgery.
The council has re-elected Mr. Huxley and Mr. Le Gros
Digitized by L-.oogle
60 The Medical Press and Circuit.
NOTES ON CURRENT TOPICS.
July 15,1851.
Clark to their professorships, and appointed Mr. Hulke to
the new lectureship on anatomy and physiology.
These appointments seem to have given general satisfac¬
tion. —
University of Edinburgh.
The Principalship has passed to Sir A. Grant. The cura¬
tors have been deterred from giving it to Sir James Y.
Simpson, by a protest of some of the other professors.
Those who love Auld Reekie best will most regret to see
the claims of Sir J. Y. Simpson thus set aside. What those
claims are we have pointed out, and they have been
endorsed by upwards of 800 graduates, who signed a
counter memorial to that of the ten or twelve jealous pro¬
fessors who so unhandsomely interposed. The incident,
however, demonstrates the absurdity of allowing so small a
body as the curators to appoint the Principal. Surely the
General Council will shortly demand a voice in the election.
This is a reform for which the graduates are entitled to
ask.
The only other thing that strikes us as worthy of men¬
tion—for the conduct of the professors we consider unworthy
of our notice— is, that Mr. A. Black seems determined
to disappoint the liberals who have trusted him out of
Parliament as completely as he did those who had faith in
his Liberalism when he went into the House.
The Abyssinian Medical Service.
The Abyssinian Army has received a vote of thanks from
Parliament. No mention was made of the Medical Ser¬
vice. Many are indignant. Our contemporaries write
long effusions. But this will always be the case until the
profession makes its power felt in politics. How veiy few
heartily support our too few medical politicians ! If prac¬
tical men ignore politics let them not grumble that the
profession is ignored. A few doctors in the House of
Commons would change all that.
once saw one of his Lordship’s predecessors thrown out
from the slippery state of the streets, after which he
noticed that they were regularly gravelled.
We wish evil to none, and a little gravel might surely
be granted without risking the life of a Lord Mayor.
Evils of Bad Cooking.
A correspondent of the Nashville Journal of Medicine
and Surgery, writing from Paris, thus expresses himself:
“ I have spoken of the denizens of this gay, voluptuous
capital as being less cleanly than becomes good taste or
sound principles of hygiene, but I will do them the justice
to say they are masters in the culinary art; and I will add
that since I came to their capital I have known one invete¬
rate case of dyspepsia cured by French cooking, and the
disuse of tobacco. Such is my appreciation of this art, as
one of the great means of promoting health, that I would?
have all our girls taught that, next to being amiable and
unselfish, the great aim of a woman’s life should be to be¬
come a good cook. I verily believe that bad cooking is the
cause of much of the wickedness that is in the world, and
the source of more than half of the domestic infelicity.
Bad cooking, I am convinced, killed more Confederate
soldiers than were killed by the Yankees. I aiu not sure
that habitual bad cooking ought not, by law, to be made a
sufficient cause for divorce, as, I believe, habitual drunken¬
ness is in some of the States. If young women would
study cooking as much as they study music, and spend
half as much time in their kitchens as they grve to their
pianos, there would be more harmony in their houses if
less music. The millennium cannot come, of course, until
sin ceases in the world, but sin can never disappear while
the brains and nerves of men are tortured by unwholesome
blood, the result of bad cooking ; and so I conclude that
the man who improves the cookeiy of his country is one of
its true benefactors—certainly the peer of him who makes
1 two blades of grass to grow where one grew before.’ ”
Chloroform.
Amonost the deaths recorded from the use, or rather mis¬
use, of this an Aesthetic is that of the wife of an American
officer, who, according to The Pacific Journal, placed a
handkerchief containing a few drops of chloroform to her
mouth, in the hopes thereby of getting relief by sleep from
the pain she was then suffering. Unfortunately for the
poor victim, it took effect in the way she so much desired.
It soothed her to sleep ; but it was to a sleep from which
she never awoke. The morning found her a corpse.
Cases of a similar kind, where chloroform is sold indis¬
criminately by chemists to the general public, without any
inquiry being made, or caution as to its effects being given,
constantly come under our notice. And we hope that
some prohibition will be extended to this—in unpractised
hands—dangerous article, in the “Pharmacy Bill” now
before the legislature.
Glazing the Streets.
London people complain bitterly of the slippery nature of
the streets. When the water-carts have done their duty
the pasty, agglutinous . mud renders it next to impossible
for horses to keep their legs. The city authorities are pre¬
eminently neglectful. In driving through the city last
week we witnessed the fall of several fine horses, and our
coachmen told us that his friends heartily wished the Lord
Mayor might be pitched out of his carriage. He said he
Muzzling Dogs.
The protest raised on behalf of our canine friends is a
just one. As a dog perspires through the mucous mem¬
brane of his mouth, by forcibly keeping it closed we pre¬
vent him cooling himself. The large wire muzzles that
leave the dog the opportunity of drinking, are less cruel
than the simple strap closing the mouth, and should be
preferred by all humane masters while the police edict is
in force.
Dust-bins.
We have again and again called attention to the family
dust-bin as a focus of disease. In fact, for years past we
have at intervals urged our readers to draw the attention
of their patients to this subject. The obstinacy and blind¬
ness of servants, to say nothing of their idleness, disposes
them to make the dust-bin the general receptacle of filth.
Hence it becomes not only a nuisance but a source of great
danger.
We are glad to find that some Medical Officers of Health
have become more alive to the subject, and that our con¬
temporaries are ready to enforce the necessity of doing so.
Foremost of all, as it ever has been on this and allied topics,
is the Builder, which continues its valuable services in
sanitary matters.
At the monthly meeting of the Royal Society of Great
Britain, Sir H. Holland, Bart., in the chair, the managers
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announced that, in conformity with the deed of endow¬
ment, they had appointed William Odling, Esq., M.B.,
F.R.S., Fullerian Professor of Chemistry, in the room of
the late Professor Faraday.
Last week, a petition from a number of ladies, members
of a body termed the Female Medical Society, presented a
petition to the Council of the Farringdon Dispensary and
Lying-in Charity, praying that they might be admitted to
the practice of the dispensary. After a somewhat noisy
discussion, a resolution proposed by Dr. Palfrey and
seconded by Mr. Figgins—“ that the petitiou be not
acceded to”—was carried by a large majority. We believe
we are correct in stating that this is the second time during
the past year that the committee have refused their sanc¬
tion to the introduction of females to the practice of the
charity. -
Mr. Bailey, M.R.C.S., Is a candidate for the representa¬
tion of Athlone in the next Parliament. Mr. Baxter
Langley, M.R.C.S., has issued an address to the electors of
Greenwich. There are rumours of some other medical |
candidates, but they are as yet only rumours. We cer¬
tainly need more medical M.P.’s, and sincerely hope that
the profession will support its own candidates.
Amongst the medical men whose names have been men¬
tioned as candidates for Parliamentary honours under the
the new Reform Act, is that of Dr. Forbes Winslow, the
well-known author of “ The Incubation of Insanity,” and
various writings connected with Diseases of the Brain. This
gentleman had been solicited, and had allowed himself to
be nominated for the joint Universities of Glasgow and
Aberdeen, from the latter of which he obtained the degree
of M.D. in 1849. As soon as he became acquainted with
the fact that the Lord Advocate intended to contest the
constituency, and had already received many promises of
support, Dr. Winslow withdrew from the candidature, being
unwilling to divide the Conservative chance of success.
We have been requested to inform our readers that the
Council of the Metropolitan Poor-law Medical Officers’
Association have resolved to recommend at the annual
meeting a change of name, and to extend the Association
to the Provinces. It is proposed to drop the word Metro"
polit&n. We have always urged this plan.
A patient having lately committed suicide by throwing
himself from a hospital window is a warning that such
institutions might very well have bars so constructed as to
render such tragedies impossible.
The portrait of Sir Thomas Watson is engraved. The
FeUows of the College of Physicians propose, with that
condescension which they occasionally exercise when money
is concerned, to permit such of the members as may feel
inclined to assist them to pay for it, by purchasing such
copies as may remain after the Fellows have selected theirs.
No doubt some members will rush to obtain the leavings
of the FeUows.
Dr. Charles Hood has been knighted by the Queen.
New Fellow.— At a meeting of the Council of
the Royal College of Surgeons on the 9th inst., Mr. Thomas
Watkin Williams, Newholl-Btreet, Birmingham, diploma of
Me m b er shi p, dated April 3,1840, was admitted a Fellow of
thaOsfiegsT
GENERAL COUNCIL OF MEDICAL EDUCATION
AND REGISTRATION.
Friday, July 4.
(Continued from page 45.)
After the report containing the recommendations of the
committee on Preliminary Education had been read—
Dr. Alexander Wood, as chairman of the committee,
moved—“ That it be recommended to the licensing boards not
to accept the certificate of proficiency in general (preliminary)
education from any of the bodies, the names of which are con¬
tained in the list annually circulated, unless such certificate
testify that the student to whom it has been granted has been
examined in—1. English language, including grammar and
composition. 2. Arithmetic, including vulgar and decimal
fractions. Algebra, including simple equations. 3. Geometry:
First two books of Euclid. 4. Latin, including translation and
grammar.”
Dr. Apjohn considered it perfectly useless to attempt an
enforcement of the subjects proposed by the Committee; the
matter had, he thought, been long since settled, and he felt
persuaded that the University he represented would not con¬
sent to be hampered by such minutiae.
Dr. Parkes thought the list could scarcely be objected to
on the score of severity. It had been considered by some
members of the Council to be not severe enough; but he
thought anybody reading it carefully would see there was
nothing in it that might not reasonably be required from
young men of 17, and there ought to be no hesitation on the
part of the Counsel in recommending the licensing bodies to
require that extent of education at least.
Dr. Paget did not understand Dr. Apjohn to object to the
list as being too severe, but rather that there might be
examinations far above the mininum prescribed by the Council,
but which nevertheless might not include clearly and distinctly
all the subjects—such, for instance, as English Grammar. If
it were possible so to word the resolution as not to encounter
that difficulty, it would be an advantage, because otherwise
the Council might come into collision with bodies that were
really doing more than the resolution asked, simply because
they did not conform literally to all its recommendations.
Dr. Alexander Wood said this was the original standard
which had been laid down by the Council, and approved year
after year. The Committee, having sat upon the question,
found in point of fact that obedience was not accorded to the
recommendations of the Council, and they now suggested how
those recommendations should be enforced. The only thing to
be done was, if the examinations did not conform to the re¬
quirements of the Council, they must not be recognised. The
Council must insist upon conformity with the list drawn up by
the Committee as the minimum, because if they agreed to what
Dr. Paget suggested—to allow laxity in one subject because
the examination was high in another—who was to be the
judge ? It would be, in point of fact, better for the Council to
give up its educational supervision altogether than to admit
such a principle.
Dr. Andrew Wood said the Council had issued certain
recommendations to all the licensing bodies of the kingdom—
to the Colleges of Physicians and Surgeons, and various others;
and they had been, most satisfactorily, doing all in their power
to comply with those recommendations, until they had raised
their standard up to that recommended by the Council. He
was not, then, prepared to admit that bodies, over whom they
had no power of visitation, should be allowed to say—Because
we examine upon so and so, therefore we consider that an
equivalent for something else.
Dr. Paget : That is not what I suggested.
Dr. Andrew Wood : It is equivalent to what you sug¬
gested. It would never do to open the meshes of tne net in
that way, because if they did it to one they would be required
to do it to all, and would be retrograding instead of advancing
in Medical Education. If those bodies whom they had
hitherto recognised did not choose to come up to the standard
laid down by the Council, they must disfranchise themselves.
He therefore trusted that Dr. Alexander Wood would per¬
severe, and that there should be no vacillation and uncertainty
with regard to the matter.
Mr. Cooper could speak of the Apothecaries’ Hall as a body
who carried out most strictly the recommendations of the
Council; and the consequence was that in the examination of
January last forty-one gentlemen applied to be examined, but
only thirty-five were admitted, of whom eighteen passed, arid
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GENERAL MEDICAL COUNCIL.
July 15, m
seventeen were rejected; and of the latter, eight had been
previously rejected. With such facts before them, he thought
they should not increase the severity of the preliminary ex¬
aminations. Above all, however, every student should have a
positive knowledge of his mother tongue, a knowledge of
Latin, and he could wish a knowledge of Greek, in order to
enable him to understand the technical terms of science; but
he very much doubted whether the secondary education in the
kingdom was such as would warrant the Council in requiring
too severe a curriculum.
Mr. CjsSar Hawkins questioned whether it was wise to lay
down minute rules for such bodies as Oxford, Cambridge, and
Dublin, whdse standard must be higher than the minimum
required by the Council.
Mr. Hargrave differed from Dr. Apjohn that the Univer¬
sity of Dublin would not agree to the terms of the Council—
he believed they would comply at once.
Dr. Storrar called attention to resolutions already passed
by the Council in reference to this matter, and added that Dr.
Farkes had not used too strong an expression when he said
that those were solemn decisions of the Council come to up¬
wards of two years ago. Fair notice had been given to all
educational bodies of this determination of the Council, and
now, because those bodies had not chosen to put themselves
in a proper position with regard to the Council, it was
attempted to be said that the recommendations of the Council
should be altered for their convenience. If they yielded one
inch upon this question, they might as well throw up their
duties altogether.
Dr. Paget moved what would properly come as a rider to
the resolution, for the purpose of taking the opportunity of ex¬
plaining what he meant (which seemed to have been entirely
misunderstood) by the objection he took to the resolution. It
was not an examination in English that he objected to at all ;
but it was that bodies like the ancient universities of England
should be obliged to conform to all the minutiae pointed out in
the resolution. He would therefore move to rescind the resolu¬
tion of the Council of June 6, 1867—
“ That the General Medical Council will not consider any
examination in English sufficient that does not fully test the
ability of the candidate—1st. To write a few sentences in cor¬
rect English on a given theme, attention being paid to spelling
and punctuation, as well as to composition. 2nd. To write a
portion of an English author to dictation. 3rd. To explain
the grammatical construction of one or two sentences. 4th.
To point out the grammatical errors in a sentence ungram¬
matically composed, and to explain the nature. 5th. To give
the derivation and definition of a few English words in com¬
mon use.’ 1
And, in conclusion, he would ask Dr. Storrar whether, in the
University of London, students were required to write a por¬
tion of an English author from dictation.
Dr. Storrar : Yes.
Dr. Paget : Well, I must confess I doubt whether my uni¬
versity would think it a necessary thing.
The debate was then adjourned.
Saturday, July 4.
The adjourned debate on the report on Preliminary Exami¬
nation was continued by
Dr. Paget, who said that in cases where there was an ex¬
amination more extensive and more difficult than the minimum
proposed by the Council, such examination should stand as a
substitute for the minimum required by the Council—in other
words, that the major should include the minor. The curious
effect of the resolution of Dr. Alex. Wood, coupled with the
previous resolution of the Council last year as to the mode of
conducting examinations, would be this—that graduates of
Cambridge, and he believed of the other ancient universities,
would not be able to receive certificates of having passed the
examination now required by the Council. Because such a
test as writing from an English author from dictation was not
applied at Cambridge, therefore a man might have taken the
highest honours in classics, mathematics^ and natural science,
he might be, and ordinarily would be, 23 years of age, he
might be as well able to write good English as any member
sitting on the Council; yet, after all, that he would not be
allowed to begin his medical studies. True, he might have
passed his examination in writing from dictation from an Eng¬
lish author when he was a boy of 12 or 14 ; but, inasmuch as
the university did not apply that test, it could not give the
certificate that would be required.
Dr. Alexan der Wood said that laws were not made for the
good, but for the bad, and that it was known as a positive fact
there were men seeking to enter the Medical Profession every
day who, whatever might be their knowledge of Latin, Greek,
or mathematics, were utterly ignorant of their mother tongue.
In order to remove all difficulty, he was content to modify the
resolution by inserting the words, “Provided also that the
Branch Council may accept any examination which seems to
them equally to secure on the part of those passing it a suffi¬
cient grammatical knowledge of English.”
The debate was continued by Dr. Andrew Wood, Dr. Thom¬
son, Mr. C. Hawkins, Sir Dominic Corrigan, Mr. Hargrave,
Dr. Apjohn, and others, and the resolution was finally adopted
in the following form :—“ That, in reissuing the regulation re¬
garding the examination in English adopted last year, the fol¬
lowing be added—‘ Provided always that an examination may
be accepted as satisfactory that secures on the part of the can¬
didate passing it, a sufficient grammatical knowledge of Eng¬
lish.* ”
THE SUPERVISION OF PRELIMINARY EXAMINATIONS.
Dr. Alexander Wood, in introducing the second paragraph
of the report, said the Committee had to consider “ whether
any plan could be devised by which the Council could better
supervise the preliminary examinations.’* He would move,
“ That the Branch Councils be requested to make arrange¬
ments for visiting and reporting on such preliminary examina¬
tions as have not already been visited, and regarding which it
may appear to them desirable to procure information. That
the reports made on these examinations be transmitted in the
i usual manner to the Executive Committee for the considera¬
tion of the General Council at their next session.**
After a few remarks from Sir Dominic Corrigan, Dr. Apjohn,
Dr. Storrar, and Mr. Hargrave, the paragraph was agreed to.
GENERAL EDUCATION.
Dr. Alexander Wood said the Committee, having taken
this matter into consideration, he begged to move the follow¬
ing resolution:—“ That the Executive Committee be in¬
structed to watch over any Bill on general education with a
view to such arrangements as will enable the various boards to
secure the due preliminary education of Medical students.**
Dr. Storrar seconded the motion, and it was carried nan
con.
centralisation of examining boards on preliminary
education.
Dr. Fleming, in introducing this subject, mftved—“ That it be
remitted to the Branch Councils to consider and report how far
it would conduce to a more efficient and satisfactory system of
conducting the examination of students in preliminary educa¬
tion if a board was appointed by each Branch Council to
arrange and conduct, under their supervision, these examina¬
tions ; and that should the Branch Councils approve of such a
system, they be requested to indicate the method by which they
would propose to carry it out.” At one period he had been of
opinion that it would be better to withdraw these examina¬
tions from licensing boards altogether and place them entirely
in the hands of the National Education Boards ; but from
what he had seen and heard jt was his belief that confidence
could not be placed in them, and that if the Council could
organise some central plan, it would be both a great facility for
students and also an advantage to the profession at large.
Taking London, for instance, he would suggest that the Exe¬
cutive Council should appoint a committee of five examiners,
who should prepare a list of questions which, upon being
printed, should be sent down to the various licensing bodies.
The students would then write their answers to those ques¬
tions, and they would be returned to the examiners, who
would judge upon them and decide whether the candidates de¬
served to pass or to be rejected. In regard to the expense, it
could be met if a fee of ten shillings were exacted from every
student coming up for his preliminary examination. One of,
the 'principal recommendations of this scheme was that it
would prevent—what was too common at the present time—
students saying, “ I will go to this board or to that, and see if
they will pass me, and if I am rejected I will go to the.
Apothecaries or some other body and try them.” He knew
that that was done in Scotland, and he had no doubt the same
thing occurred in the other divisions of the kingdom.
Sir Dominic Corrigan thought this was a step in the
right direction, because it would ensure that yotmg men en¬
tering the profession had a sufficient preliminary education,
which was not secured under the present system, and he be*
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GENERAL MEDICAL COUNCIL.
July 15,1808. 63
lieved never would be, while they had something like twenty-
two or twenty-three bodies entitled to issue certificates for
preliminary education, over which bodies the Council had but
little control. It was their fatal lukewarmness with regard to
general education that produced such scenes as that described
by one of the daily papers, which he, as having taken place in
the House of Commons, would read for their instruction :—
“Non-combatants in Mounted Corps.—Captain Vivian asked
why non-combatant officers were appointed to mounted corps
and compelled to pay ration, although they received no mounted
pay ? Sir J. Pakington said it was impossible to deny that,
especially as regards medical officers, there was an inconsis¬
tency in the system, but, notwithstanding this, medical officers
are always found anxious to obtain employment in cavalry
regiments.” He would like to know would Sir John Paking¬
ton say the same thing of his own office—namely, that if the
salary was only £100 a-year it should not be increased because
there were to be found many persons ready to take it at that
rate ! The reason medical men were treated in that way was
quite in accordance with the well-known axiom of political
economy—namely, that in proportion to the abundance of the
supply the price of the article would be depreciated. By
narrowing the door of preliminary education they would remedy
this evil, and, at the same time, raise the status of the whole
profession. If, next year, all the licensing bodies rejected 70
per cent., instead of 25 per cent., neither society in general
nor the medical profession in particular would sustain a very
great loss from the absence of the Other fifty who were declared
unfit to enter the profession. He was, moreover, of opinion
that society would go on very well, and perhaps a good deal
better, without any doctors at all than with bad ones.
Dr. A. Smith expressed his entire concordance with the mo¬
tion of Dr. Fleming.
Dr. Storrar said, anxious as he was to see it realised, there
was no power to do what was suggested without an Act of
Parliament. They could only recommend it to the various
bodies. He would offer a word of encouragement to those
bodies which had courage enough to honestly raise their
standard : that it had the effect of increasing the number of
candidates. For whatever might be said about their being
a body of students who were anxious to get through their
examination on the easiest terms, there was a very large pro¬
portion who would never be satisfied unless they got the “ best
thing going.” He mentioned as an illustration that three
years ago there had been a very merciless rejection at the
matriculation examination of the University of London ; but
notwithstanding that, the number of students in the succeed¬
ing years had very largely increased ; and this year in parti¬
cular they had a very large addition to boast of ; he therefore
contended that those schools who insisted upon a high stan¬
dard would receive the greatest number of those men who
would not fail to pass with credit to themselves, and honour
to the body accredited with their education.
Dr. Paget would move that the resolution be amended os
follows:—“ That it be remitted to the Branch Councils to
consider and report how far it would conduce to a more effi¬
cient and satisfactory system of conducting the examination of
students in preliminary education, if boards were appointed by
the General Medical Council, or by the Branch Councils re¬
spectively, to arrange and conduct, under their supervision,
these examinations ; that should the Branch Councils approve
of such a system, they be requested to state the method by
which they would propose to carry it out, or any difficulties
which may stand in the way of doing so ; and that these reports
be transmitted to the Executive Committee at least onemonth
before the next session of the Council.'’
The President, while agreeing with much that had been
said, thought it should be publicly known, for the defence of
the Council, that although they were one and a11 most anxious
to raise the education of the profession, both preliminary and
professional, they must always bear in mind that their regula¬
tions were not intended for men who were aiming at the
highest honours of their profession. He thought the hon. and
learned baronet and others had rather gone beyond what was
just, in making a comparison between the requirements of the
Council and those of such a body as the University of London.
TlpseyWho came under the latter went of their own free will,
and for the purpose of obtaining a very distinguished degree,
but it was totally different with the students for whom they
were called upon to legislate.
having expressed himself in favour of the
the same was then adopted.
THE STUDY OF GREEK.
Dr. Alexander Wood proposed :—
“ That the Medical Council, while unwilling to come to any
resolution that will have the appearance of lowering the
standard of preliminary education, is of opinion that the year
1870 will be too soon to transfer Greek from the optional to
the compulsory subjects.”
Dr. Embleton seconded the motion.
Sir D. J. Corrigan totally dissented from the resolution,
and it was the paragraph in the report which made him say
the tone of the document was retrogressive. In Ireland the
term grammar schools simply meant charity schools, the edu¬
cation of which was totally insufficient for any one intending
to enter the medical profession.
Mr. Hargrave thought it would have the effect of post¬
poning the study of Greek not only to the year 1870, but to
the Greek Kalends.
Dr. A. Smith was quite convinced that if the Council re¬
quired Greek from the candidates they would obtain it. He
was quite prepared to undertake the responsibility on behalf
of the college he represented, and he hoped the Council
would insist upon the subject being required.
Dr. Storrar thought that for the sake of thoroughness it
was well to postpone the subject of Greek for the time Btated,
because he thought sufficient notice had scarcely been given.
For that reason, and for that reason only, he would support
the resolution.
Dr. Acland supported the motion on the ground stated by
Dr. Storrar. He would admit that Greek was very essential in
the higher branches of professional knowledge, but there
was a general inclination gaining ground in the country to
substitute foreign languages as an alternative for Greek ; it
would therefore be better to defer it.
After a few remarks the motion was put to the meeting and
carried by a large majority.
THE STUDY OF LOGIC.
A resolution upon this subject:—“That the Branch Councils
be instructed to consider and report bow far it be desirable to
add some knowledge of the elements of logic to the preliminary
examination of the medical student, and, if considered desir¬
able, how it could best be carried out,” moved by Dr. Alex-'
ander Wood and seconded by Dr. Rumsey, was passed unani¬
mously.
A resolution endorsing paragraph eight of the report was
also carried nem. con.
The Council then adjourned.
[The report of the Pharmacy Committee and the interesting
debate thereon are unavoidably postponed till our next issue.]
REPORTS OF THE VISITORS OF EXAMINATIONS.
( 1867 - 68 .)
1. ENGLISH UNIVERSITIES AND LICENSING BODIES.
University of Durham.
The Committee have already noticed the addition of Euclid
and Algebra to the subjects of examination for the Registra¬
tion of medical students. The Reporters state that “in all the
papers the questions are good, though rather easy. If a high
standard of answering be enforced, such an examination may
serve well for the present as a minimum test of general educa¬
tion.”
With respect to visitation of other examinations in England,
see resolution of English Branch Council, Minutes of General
Medical Council, June 27, 1868.
2. SCOTTISH UNIVERSITIES AND LICENSING BODIES.
University of Edinburgh.
Preliminary Examination. —The Suggestions made by the
Reporters last year for the improvement of the examination in
English have this year been fully carried out.
University of A herdeen.
Examination on Clinical Medicine and Surgery for the Medi-
cal Degree. —The Report states that the Examination is quite
satisfactory.
University of Glasgow.
Preliminary Examination in General Education .—It appears,
from the Report that this Examination is not, in all respects,
satisfactory. “The extensive alterations in it proposed by
the University show that they themselves are not satisfied with,
it,” and therp can be no doubt “ that under the new regime it
will be greatly improved.”
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GENERAL MEDICAL COUNCIL.
July 15, 1868.
Examination in Botany and Chemistry for the Medical
Degree. —A very satisfactory Examination.
Clinical Examinations in Medicine for the Degree in Medicine.
—The Examination is thorough and complete. A detailed
account of it is given by the Reporters.
University of St. Andrews.
Examination for Degree of M.D. —All the candidates were
registered Medical Practitioners above the age of forty years.
The Examination was both written and oral, and the plan
pursued was “judicious and well-arranged but there is no
mention of any Practical or Clinical Examination.
Royal College of Physicians of Edinburgh.
Examination of candidates who already possess a qualification.
—This is exclusively oral. The Reporter states that it “ is in
every respect highly creditable to the College.” There is no
mention of any clinical Examination.
Royal College of Surgeons of Edinburgh.
Examination in Clinical Surgery. —“A thorough and fair
teBt of the practical knowledge possessed by the candidates.”
Faculty of Physicians and Surgeons of Glasgow.
Preliminary Examinations. —“ On the whole, this is a satis¬
factory examination, and creditable to the Body by which it
has been instituted.”
Clinical Examinations in Medicine and Surgerif. —These
Clinical Examinations have been introduced since last year.
The Reporters state that they are conducted satisfactorily.
Double Qualification of the Royal Collee/es of Physicians and
Surgeons of Edinburgh.
Preliminary Examination. —Some of the candidates had
passed on several subjects previously. Of the five subjects of
Examination, three only were compulsory, viz., English, Latin,
and Arithmetic : the other two were allowed to be selected at
the option of the candidate. This option would enable a
student to avoid Examination in Geometry and Algebra.
First Professional'Examination. —Reported to be “fair and
judicious but in Chemistry, no analysis or testing was re¬
quired.
Final Examination. —Reported to be “ sufficiently extensive,
varied, and searching, ani yet not unduly difficult.”
Double Qualification of the Royal College of Physicians of Edin¬
burgh and the Faculty of Physicians and Surgeons of Glasgow.
“ No practical or analytical test was applied to the candidate
during his Chemical Examination.”
3. THE IRISH UNIVERSITIES AND LICENSING BODIES.
University of Dublin.
The accuracy of this report having been questioned by the
representative of the University, the Committee have con¬
ferred with the Reporter, and have ascertained that on one
point there has been misapprehension. The report disapproves
of the supposed practice of the University of announcing
publicly the failure of a candidate. The Committee have
ascertained that such is not the custom.
Moreover, the statement that the Examiners are the Pro¬
fessors seems to require some qualification, or at least explana¬
tion. Two of the Examiners are not Professors, and two of
the Examiners, though Professors, are not Teachers.
The Report of last year referred to the Surgical Clinical
Examinations as excellent. At the visitation now reported
there seems to have been no clinical Examination either in
Surgery or Medicine.
After a few remarks on the foregoing report by Dr. Wood
and others,
Dr. Apjohn stated, that the publication of the report of the
committee on the visitation of examinations, has been attended
with much inconvenience, and been productive of considerable
injustice. It professes to present a complete view of the
nature and extent of the examinations of the different licens¬
ing bodies, and then comments upon their supposed relative
degrees of merit or demerit. Unfortunately, however, some
of the condemnatory statements are not founded on facts, and
hence an undeserved obloquy has been cast on certain of the
licensing bodies. The part, for example, of the report which
relates to the University of Dublin, is specially obnoxious to
this criticism, for it alleges that “ the mode of carrying on the
oral examination (examining in class) is peculiar to this
University.” This is quite incorrect, for the very same
method of examination is adopted at the King and Queen’s
College of Physicians in Ireland. In the report of the com¬
mittee to which I' am referring, the opinion is also expressed
that such method of examination “ cannot be so efficient as the
ordinary plan of examining each candidate apart.” I do not
know the grounds of opinion here expressed by the chairman
of the committee, but, I presume, it has been founded on a
report by Dr. Leet of a visitation of an examination, held last
October in the University of Dublin. Dr. Leet was the
visitor, and the following is the passage to which I allude :—
“ The questions (Dr.JLeet reports) were judiciously selected,
and appeared to be well qualified to test the candidates 1 know¬
ledge ; but in consequence of the r ird voce questions being
passed round the class, the answers did not tell to advantage,
and I was not able to form a correct judgment of their value.”
Now, all this is quite possible, and, indeed, much of it is, I am
sure, quite correct, but I do not see that examination in doss is
in the slightest degree damaged or even impugned by these re¬
marks, for though the answers did not tell upon Dr. Leet, and
that he was unable to judge of their value, he does not allege,
and, I am sure, did not mean to convey, that the candidates or
the examiners were in the same predicament as himself. In¬
deed, I am not without hope that on reflection, Dr. Leet will
concur with me in thinking it would be very unreasonable in a
visitor to pronounce an examination insufficient, merely be¬
cause he found himself unable to follow the questions of which
it consisted. I now, sir, turn to the suggestions in the report
of Dr. Leet, the first of which is couched in the following
words :—
“ That no medical or surgical qualification be conferred upon
any person who has not graduated in arts, and that the uni¬
versity should discontinue to grant licenses in medicine and
surgery.”
Now, Mr. President, this is a proposition which appears tome
—not to use a harsher term—irrelevant in the highest degree.
Such is the view which has been taken of it by the chairman
of the committee, Dr. Andrew Wood, who judged it to have
no relation whatever with the duty imposed on the visitors of
examinations. It is not very easy to conceive what Dr. Leet’s
object could be, except that of giving gratuitous offence, for
his recommendation is altogether impracticable—in fact, in¬
capable of being carried out except through the intervention of
an Act of Parliament. I may observe, too, that it comes with
very little weight indeed from the representative of a trading
company, whose acquaintance with university practice and
privilege is necessarily very limited, and whose counsel, there¬
fore, on the important questions of which he has so flippantly
disposed, is altogether valueless.
Shortly after, at a particular stage in the reading of his
report by Dr. Paget,
Dr. Apjohn drew attention to several erroneous statements
by Dr. Hargrave in relation to the medic&l and surgical exa¬
minations held in the University of Dublin. It was not true
that, as alleged by Dr. Hargrave, at the close of the examina¬
tions the names of the unsuccessful candidates, as well as the
names of those whose answering had been satisfactory, were
read out by the Regius Professor. It was not true that the
teachers in the school of physic were the only examiners; and
it was equally untrue to say that the candidates were not tested
in the writing or dictating of prescriptions. These mis-state¬
ments were, he (Dr. Apjohn) knew, noticed in the report now
under consideration; but, as the representative on the Medical
Council of the University of Dublin, he was anxious to give
them a direct and public contradiction.
Queen's University in Ireland.
Examination in J natomy, Physiology , Chemistry , Botany , and
Materia Medico. —The Reporter states that the oral Examina¬
tion “ was conducted practically in the case of all the subjects
specified, with the exceptions of Chemistry and Pharmacy ;
and a longer time was given to the examination of each candi¬
date than on the occasion of my former visit ; each being sub¬
jected to a sufficient test of proficiency in the several subjects
of examination, with the two exceptions referred to.
“Three Professors conjointly carried on the Anatomical
Examination, and one Professor, singly, conducted each of the
others.”
King and Queen's College of Physicians in Ireland.
“ Should a candidate fail at an examination he can be re¬
examined, but not until two months have at least elapsed since
the time of his rejection.”
“ All the Fellows and Licentiates of the College may be
present at the examinations.”
“The College will, as heretofore, permit the student to
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The Medical Pres and Circular.
GENERAL MEDICAL COUNCIL.
Juljr 18,1868. 65
qualify in Arts at any time within the first two years of pro¬
fessional study.’*
The Committee draw the attention of the Council to this
fact.
At this visitation “seven gentlemen presented themselves
as candidates, all of whom were Licentiates of the Royal
College of Surgeons, Ireland, and were therefore, by a Bye¬
law of the College, relieved from examination in Anatomy,
Physiology, Practical Anatomy, Chemistry, and Practical
Chemistry, and interrogated solely in the senior or more prac¬
tical portion of the Medical curriculum. The candidates were
seated on one side of a table, and opposite to them were the
four Examiners, two on each side of the President. Of these,
two examined in the Practice of Medicine, one in Midwifery,
and the fourth in Materia Medica ; but there was no Examiner
in Medical Jurisprudence, though the latter is one of the sub¬
jects which is placed by the regulations of the College in the
second or practical part of the examination for the Licence.
The examination commenced at ten minutes past 4 o’clock, the
questions being proposed in turn to the several candidates, and
when missed by one, passed to the next, and so on in succession ;
and it concluded at forty minutes past five o’clock, so that its
duration was one hour and a half. The number of questions
given by each Examiner was about eight, and the time occu¬
pied by each Examiner about thirty minutes.”
The paper on Materia Medica contains some questions on
Toxicology, but none on other parts of Medical Jurisprudence.
The time (one hour) allowed to candidates for writing their
answers seems far too short.
In case of a difference of opinion among the Examiners,
“ the admission or rejection of the candidate would not be left
to the Examiners, but would be determined by a majority of
the votes of all the Fellows present, who might choose to
exercise a voice in the matter,” who (as the Committee under¬
stand) may, or may not, have been present at the entire
Examinations, and may never have seen the written answers.
At a second visitation of these Examinations, the Reporter
“was informed that there were no written questions, and that
such were only proposed at the Quarterly Examinations.”
There is no mention of any Clinical Examination.
The following suggestions are made by the Reporter :—“ In
the first place, I would recommend that the Bye law which
places Medical Jurisprudence among the subjects which con¬
stitute the second or senior part of the Examination for the
Licence be strictly complied with, and fully carried out. It is
an important practical branch of medical education, and there
can be no difficulty in providing a suitable Examiner, seeing
that the Professor in this department attached to the School
of Physic is appointed by the College. If this courso be not
taken, it will at least be necessary to remove Medical Juris¬
prudence from among the subjects on which, as is announced
at present, Candidates for the Licence will be examined.
“ In the second place, it appears to me that the practice of
varying the Examinations so as sometimes to have paper along
with rica voce questions, and sometimes only viva voce ques¬
tions, is very objectionable, and ought to be abandoned. No
examination can be considered sufficient, in which the know¬
ledge of the candidate iB not tested by paper questions.
“ Lastly, the College should insist upon the Examiners com¬
plying strictly with its printed rules in relation to the manner of
conducting the Examinations, and the adoption of a numerical
method of recording the answering of the candidates.”
The Committee entirely agree with these remarks.
Royal College of Surgeons in Ireland.
Preliminary Examination. —“ The constitution of the Board
of Examiners is a very sufficient guarantee of their fitness for
their duty.”
The subjects of Examination were Arithmetic, English, Latin
and Greek.
The results of the Examination were judged thus:—“A
nought in any one of the subjects of examination insured the
rejection of the Candidate.” “ About thirty-three per cent, was
considered sufficient for ‘ pass.* ”
“ The Examination in the Greek and Latin languages waB
well conducted to test the acquirements of the Candidates, but
many of them possessed a very imperfect knowledge of Latin
Grammar ; and in several instances it appeared that, although
tin Candidates could read and translate Greek, they did not
know the oorrect pronunciation, or the Greek names of the
fetal*
States that he cannot give any opinion re¬
specting the proficiency in Arithmetic and English, as he did
not see the answers sent in by the Candidates.
The number of Candidates was 42. The Reporter was in¬
formed that 8 were rejected. “One of the Candidates admitted
that he was only fourteen years old, and two that they were only
fifteen; four or five others appeared to be about the same age.
The Reporter observes that—“ The fact of admitting boys of
the ages of fourteen and fifteen years to pass a preliminary
examination preparatory to becoming Registered Medical
Students is one which deserves the attention of the General
Medical Council, more particularly because the Council has
recommended that no Medical or Surgical qualification should
be conferred on any candidate who had not attained the age
of twenty-one years.”
The Committee are of the same opinion*
Examinations for Licence to Practise Surgery. —These exami¬
nations are generally defective; the defects which were noticed
last year remain uncorrected. There is neither Practical nor
Clinical Examination.
Apothecaries' Hall of Ireland.
The Report includes an Examination in Arts, and the first
and final Professional Examinations.
Rejection in. the first (Professional) Examination hardly
ever takes place.
“ The Examinations in Chemistry, Inorganic and Organic, in
Botany, General and Medical, Materia Medica, and General
and Practical Pharmacy, embraced a great number of ques¬
tions, which were admirably put, and must be considered as a
searching test of the knowledge of the candidates in these de¬
partments.
“ Those in Anatomy and Physiology, on the other hand,
were of the most elementary description.”
The Reporter states, “ As to the Professional Examination,
which includes the Principles and Practice of Medicine,
Surgery, Pathology, and Therapeutics, Midwifery, Forensic
Medicipe, Hygiene, and Toxicology, I cannot give any report,
except from one instance. On the occasion of my first attend¬
ance the Examination was confined to its first part, and on
that of my second, there was but one of the candidates who
had to undergo the second or Professional Examination. This
candidate was a Surgeon. He was well examined in Thera¬
peutics ; but in Medicine and Pathology the Examination was
extremely limited, and could hardly be taken as a test of suffi¬
cient medical knowledge.”
In making the foregoing extracts from the Reports of Visi¬
tations of Examinations, the Committee have had in mind
rather to point out defects than to record acknowledged merits.
They have had solely in view the means of further improve¬
ment and perfecting of the Examinations; but they desire to
add their conviction that there has already been a general and
very great improvement in the Medical Examinations through¬
out the United Kingdom during the short period since the
Medical Council directed its attention more particularly to this
subject.
The Committee are confident that this general progress of
improvement in the Examinations must lead, and is already
leading, to improvement in the acquirements of Medical Prac¬
titioners.
In conclusion, the Committee would suggest the adoption of
the following Resolution:—
That the General Medical Council are of opinion—
I.—That it is desirable that the different Licensing Bodies
should combine their Examinations, when this is practicable,
so as to secure that the knowledge of every practitioner, whose
name appears on the Register, shall have been tested in all the
subjects of Professional Education which the Council has de¬
termined to be essential, viz.:—1. Anatomy. 2. General
Anatomy. 8. Physiology. 4. Chemistry. 5. Materia Medica.
6. Practical Pharmacy. 7. Medicine. 8. Surgery. 9. Mid¬
wifery. 10. Forensic Medicine.
H.—As to the Method op Conducting the Examinations.
1. That they should be both oral and in writing.
2. That not less than two Examiners, or one Examiner
with an Assessor, should be present at every oral
Examination.
3. That the oral Examinations should be so far public as
to be open at least to the Medical and Surgical Gra¬
duates, or Members of the Examining Body.
4. That the questions to be answered in writing should be
so numerous, and embrace such a variety of the de¬
tails of each subject, as may adequately test the pro¬
ficiency of the candidate; and that they should be
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66 Hie Medical Press and Circular.
GENERAL MEDICAL COUNCIL.
July IS, IMS.
submitted to the whole body of Examiners for con¬
sideration and revision, if desirable, before being pro¬
posed to the candidates.
5. That the written answers should be submitted to more
than one of the Examiners.
6. That Practical Examinations should be held in all the
subjects in which they can be employed.
7. That excellence in one or more subjects should not be
allowed to compensate for failure in others.
8. That if a candidate be rejected for failure in any one
subject, he should be re-examined in all.
III. That Examiners should only be elected for definite
periods, with power of re-appointment.
G. E. Paget, Chairman.
The report was received and entered on the minutes.
After a considerable discussion upon various questions con¬
tained in the report, the following resolutions founded upon it
were adopted:—“ That the General Medical Council are of
opinion—1. That it is desirable that the different licensing
bodies should combine their examinations, when this is practic¬
able, so as to seenre that the knowledge of every practitioner
whose name appears on the register shall have been tested in
all the subjects of professional education which the Council has
determined to be essential—viz. : 1. Anatomy. 2. General
Anatomy. 3. Physiology. 4. Chemistry. 5. Materia Medica.
6. Practical Pharmacy. 7. Medicine. 8. Surgery. 9. Mid¬
wifery. 10. Forensic Medicine.” Upon the second resolution
—“ As to the method of conducting examinations”—the fol¬
lowing recommendations were discussed seriatim : —“ 1. That
they should be both oral and in writing. 2. That not less
than two examiners, or one examiner with an assessor, should
be present at every oral examination. 3. That the oral exa¬
minations should be so far public as to be open, as far as prac¬
ticable, to the medical and surgical graduates, or members of the
examining body. 4. That the questions to be answered in
writing should be so numerous, and embrace such a variety of
the details of each subject, as may adequately test the pro¬
ficiency of the candidate ; and that they should be submitted
to the body of examiners or governing body for consideration
and for revision, if desirable, before being proposed to the
candidates. 5. That the written answers should be submitted
to more than one of the examiners. 6. That practical examina¬
tions should be held in all the subjects in which they can be
employed. 7. That excellence in one or more subjects should
not be allowed to compensate for failure in others. 8. That
if a candidate be rejected for failure in any one subject he
should be re-examined in all.”
The third resolution, amended on the suggestion of Sir D.
J. Corrigan — ** That examiners Bhould only be elected for
definite periods, and be eligible for re-election,” was then
agreed to, and the Registrar was directed to forward these re¬
commendations to the various licensing bodies.
Dr. Alexander Wood moved “ That the Registrar be
directed to draw up, in the usual form, the recommendations
and opinions of the General Medical Council with regard
both to the preliminary and professional examinations; and
that copies be issued to the various licensing bodies.”
This motion was seconded by Dr. Andrew Wood, and
carried without discussion.
On the motion of Dr. Paget, seconded by Dr. Fleming, it
was unanimously resolved—“ That copies of the (1) Observa¬
tions of the Licensing Bodies upon the Report of the Com¬
mittee, 1867, of the Medical Council on the Visitations of
Examinations ; (2) the Reports of Visitations of Examinations
which have been made since the last session of the Medical
Council; and (3) the Report of the Committee thereon, en¬
tered in this day's Minutes, be sent to the various licensing
bodies, together with the Resolutions of the Medical Council
thereon.”
' The report of the Committee of last year upon the same
subjects was, on the motion of Dr. Fleming, seconded by Dr.
Alexander Wood, dropped.
The last subject brought under the consideration of the
Council was the report of the Committee on returns from the
licensing bodies of Professional examinations and their results,
and on the registration of students for the year 1867.
1. The Committee beg -leave to present a table, compiled
from the returns, according to Recommendation 6, sec. v. of
the Recommendations of the Council, 1866 (vol. iv. p. 311)—
viz., that returns from the licensing bodies in Schedule (A) be
made annually, on January 1, to the General Medical Council,
stating the number and names of the candidates who have
passed their first as well as their second examinations, and the
number of those who have been rejected at the first and
second examinations respectively:—
Table for 1867.
No. Rejected.
LicenaiDg Bodies.
R. Col. Phys. Lond. .
R. Col. Barg. Eag.
Soc. Apoth. Lond.
Univ. of Oxford |
„ Cambridge j
,, Durham J
„ London
R. Col. Phys. Ed in.
R. Col. Phys. & R. Col.
Surg. Edinburgh ..
R. Col. Surg. Edin. .i
R. Col. Phys. Edin. &
Fac. Phys. Sur. Glas.
Fac. Phys. Burg. Ojas.
Univ. of Aberdeen
,, Edinburgh .
,, Glasgow
„ St. Andrews
K. Q. Col. Phys. Ire. j
R. Col. Burg. „ J ,
Apoth. Hall „ .
Univ. of Dublin
Queen’s Univ. of Ire. J
Qualifications.
Licence .
Membership .
Licence .
MB.
M.D.
M.B.
M C
L. U. and M.C.*
M. C. and M.D.
M.B.
Lieence .
Licence in Med. \
and Surg. . t
Licence .
Licence in Med. 1
and Surg. )
Licence .
M.B.
M.B. & M.C., M.D.
M.B. & M.C., M.D.
M.D.
Licence in Med.
Ditto in Midwifery j
Licence in Surgery .;
Ditto in Midwifery
licence .
MB.
M.C.
M.D.
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*
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122
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254 ...
43
301
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2®| 18
1604j 148
379
17
* Three of this number were examined in Physiology only.
The Council will observe with satisfaction that this year the
table comprises returns from the whole of the nineteen licens¬
ing bodies without exception, and the Committee are not
aware that any person has entered upon the study of the
Profession without having been previously registered as a
student in Medicine.
2. The number of students registered during the year 1867
is as follows:—
In England
. 457
In Scotland
. 258
In Ireland •
. 212
Total .
. 927
According to the Medical Students' Register, every person
registered during the year 1867 has passed the required
preliminary examination (No. 2 of Recommendations on Regis¬
tration of Medical Students), hut your Committee have been
informed that in Ireland a good many students have been
allowed to enter upon Medical study on condition of their
passing an examination in general education before the end of
their second year of Medical study.
The following five paragraphs show the present state of
things in reference to this point:—
The King and Queen's College of Physicians of Ireland
holds no preliminary examination themselves, every candidate
for their qualifications, with very rare exceptions, having
already passed elsewhere an examination in preliminary edu¬
cation.
With the Royal College of Surgeons of Ireland the rule is
to require candidates to pass a preliminary examination before
commencing Medical study; the exceptions to this rule are
very few.
The Apothecaries’ Hall requires in all cases the preliminary
examination to be passed before Medical study is begun.
With regard to the University of Dublin, it appears that
the Act of Parliament which sanctions the matriculation of
Medical students without any previous examination in Arts,
is practically a compulsion on the University to admit to the
advantages of the Medical school students who do not intend
to enter on the ordinary studies in Arts. This provision of
the Act is not approved of by the University, but cannot be
said to affect any persons who take degrees in Medicine, as
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5 he lie&cal Press and Ctocnlar.
GENERAL MEDICAL COUNCIL.
Svij 15,1868. 67
such degrees are conferred on those students only who have
previously graduated in Arts.
The Queen’s University in Ireland does not require the pre¬
liminary examination as an antecedent to the commencement
of Medical Study.
The Committee would suggest to the Council that the
Registrar be requested to address a letter to those licensing
bodies in Ireland which do not require the preliminary exami¬
nation to be passed before Medical study is begun, represent¬
ing that throughout England and Scotland a complete uni¬
formity has been brought about by the adhesion of the licens¬
ing bodies to the recommendation of the General Medical
Council in this respect, and that it is highly desirable that
students in all the three divisions of the kingdom should be
placed on the same footing, making a rule absolute requiring
preliminary education and examination to be really prelimi¬
nary to Medical study.
3. In regard to the resolution of the Medical Teachers’
Association referred to the Committee—viz., “That in the
opinion of the Association, the registration of the metropolitan
students of Medicine should be performed at one office only ”
—the Committee beg leave to say that the Council has only
one office of registration for metropolitan students—viz,, that
at No 32, Soho-square—and to this no student is obliged to
go, as the object can be entirely effected by correspondence.
The registration is of two facts only—viz., that a pupil has
passed his preliminary examination and has commenced his
Professional study. The Medical Council have no authority
over the licensing bodies as to the registration of students,
and the internal regulations frequently include many more
facts than the above, and some of these are registered at dif¬
ferent periods of Professional study.
4. The Committee have had before them and considered the
letter of Dr. Edwards Crisp “ on the increase of half-qualified
Practitioners since the passing of the Medical Act.’’ They
think it may be advantageous to have an official analysis, under
the care of the Registrar of the General Medical Council, of
the Medical Register , such as that made by Dr. Crisp, and
which should appear on the Minutes of the Council. They are
of opinion that the Council has no power under the Medical
Act to interfere with the number and kind of qualifications
that Practitioners choose to obtain, and that the consideration
of Dr. Crisp’s “ Representative Faculty of Medicine” does not
come within the scope of duty of this Committee.
5. The Committee have to recommend to the Council that
to the list of preliminary examinations, recognised by the
General Medical Council, be appended the names of those
examinations which, by the Branch Councils, have as special
exceptions been admitted. (No. 9. —Regulations as to Regis¬
tration of Medical Students.)
Dr. Embleton, in reading the report, said there were several
inaccuracies, which it would be necessary to correct before it
was entered on the minutes.
On the motion of Dr. Embleton, seconded by Dr. Wood, it
was unanimously resolved that this report be received and
entered on the minutes.
Dr. Embleton then moved—“ That the registrar be re¬
quested to address a letter to those licensing bodies in Ireland
which do not require the preliminary examination to be passed
before fnedical study is begun, representing that throughout
England and Scotland a complete uniformity has been brought
about by the adhesion of the licensing bodies to the recom¬
mendation of the General Medical Council in this respect, and
that [it is highly desirable that students in all the three divi¬
sions of the kingdom should be placed on the same footing by
the Irish licensing bodies using every means to obtain the
necessary powers to enable them to require that preliminary
education and examination shall be really preliminary to medi¬
cal study.”
The motion was seconded by Dr. Alexander Wood.
& D. J. Corrigan said he must object to consider any
resolution founded upon a report which was a tissue of errors
from be ginning to end, and which the Council had had no
opportunity of considering in its existing form, Dr. Embleton
bavingjnade various important alterations and additions not
contained in the printed copy, and proceeded to criticise the
varipBafnaccuracies of the report, and urged that at the present
bt4W(aix o'clock), it was necessary the entire matter should
•tlt&nfcr faU discussion next year.
sfasyitmr' Wood most say that Sir D. Corrigan’s
yrtSijyMpty Rati* upon the motion ; and it reminded him
m Mfttttyto which, when closely pursued, were said to
wBiakfiqtdd to conceal themselves. In the same way
Sir D. J. Corrigan, when he found the body he represented
was closely pressed, had ejected a considerable amount of irre¬
levant matter to hide its imperfections. The Council was asked
not to adopt the report, but to convey the expression of opinion
contained in the motion to the licensing bodies, and he chal¬
lenged Sir Dominic Corrigan and all the Irish professors, with
all their talents, to educate properly a medical student whose
mind had not been previously prepared by preliminary exami¬
nation.
FIRST REPORT OF THE COMMITTEE ON STATE MEDICINE.
The following interim report was read :—
“ The Committee on State Medicine beg leave to report to*
the Council that, having carefully considered the resolution of
the Council by which the committee was appointed on June
27, 1868, they have decided with a view to presenting a more
complete report at the next session of the Council, on taking
evidence from various persons having special knowledge of the
subject referred to the committee.”
Replies were then ordered to be sent to the secretaries of the
Medical Teachers’ Association and Dr. Edwards Crisp in the
following terms :—
“ That a letter be addressed by the Registrar to the secre¬
taries of the Medical Teachers’ Association to the effect that
the Council has only one office of registration for metropolitan
students—viz., that at No. 32, Soho-square—and to this no
student is obliged to go, as the object can be entirely effected
by correspondence. The registration is of two facts only—
viz., that a pupil has passed his preliminary examination and
has commenced his profsssional study. The Medical Council
have no authority over the licensing bodies as to registration
of students, and the internal regulations of those bodies fre¬
quently include many more facts than the above, and some of
these are registered at different periods of professional study.
“ That a letter be addressed by the Registrar in answer to-
Dr. Edwards Crisp’s letter * On the increase of half-qualified’
Practitioners since the passing of the Medical Act,’ to the
following effect—viz., that it may be advantageous to have
an official analysis, under the care of the Registrar of the
General Medical Council, of the Medical Registrar, such a »
that made by Dr. Crisp. That the Council has no power
under the Medical Act to interfere with the number ana kind
of qualifications that practitioners choose ; and that the consi¬
deration of Dr. Crisp’s ‘ Representative Faculty of Medicine'
does not come within the scope of duty of this committee.”
Votes of thanks were then unanimously accorded to the
Treasurers of the Royal College of Physicians (with a gratuity
of twenty guineas to the resident officials), Dr. Andrew Wood
(Chairman of the Business Committee), and the President.
The President, in acknowledging the vote, said: I beg to
thank the Council for this compliment that is now offered;
me. I wish my services had been more efficient than they*
have been, but I have done my best, faithfully and impartially,,
to execute the duties entrusted to me. I feel extremely grate*
ful for the manner in which every member of the Council ha*
received my services. At the commencement of this session £
ventured to suggest to the Council that my term of office waif
coming to a conclusion, and that I was very anxious that the
members of the Council should confer together as to the time
when it would be most convenient that I should vacate my
office, and also as to who might be the best person to succeed
me. I am very glad to learn that the Council has had a
private conference, and from the Chairman of that private
conference I learn that it will be for the convenience of the
members of the Council, and for the good of the conduct of
the business of this Council, that I should offer my resignation
at the termination of this session, as I propose to do. From
a communication that has been made to me by the chairman
of that private conference, I find another circumstance has
been mentioned, which is, of course, most highly flattering to
me, and most gratifying to my feelings—namely, that if I resign
my office into your hands, the Council might be disposed to
re-elect me to such a distinguished honour. Gentlemen, I
assure you I almost hesitate even to allow my name to be pro¬
posed again to fulfil the arduous and responsible duties of the
President of this Council. For I do assure you, that although
I occupy what I consider a post of honour, and one which I
highly value, yet, at the same time, my position is by no
means always a bed of roses. I find very great difficulty in
performing my duties here to my own satisfaction] and of
course they must be very often imperfectly and unsatis¬
factorily performed -to yourselves. But it is not during
the. session, alone, that I feel my duties arduous and re¬
sponsible; it is much more during the intervals between the
Digitized by VjiOOQ LC
' 6d The Medifcd Press and Circular.
CORRESPONDENCE.
Mr 15, tatt.
sessions, when a great deal of responsibility devolves upon me
personally. It is true that from time to time I have the great
advantage of conferring and consulting with the eminent
men whom you have elected upon your Executive Committee;
but that can only be twice or thrice in the year, and in the
intervals between the meetings of the Executive Council I am
left very much to my own resources, and am obliged to assume
a very considerable amount of personal responsibility. It is
then that I feel my greatest difficulty, and I should be wrong
—I should not be doing that which is agreeable to my own
feelings—if, before quitting this chair, I did not say that I
really could hardly have supported those responsibilities, or
performed my duties to my own satisfaction in those intervals,
unless Ihad had the great advantage and comfort of being able to
rely upon the wisdom and the knowledge of business and the
power and perfect independence of spirit of a friend who was
once associated with me os treasurer here, and who still
occupies that important office. There is another duty which
devolves upon me as President which must necessarily fall
upon any other President—that is to say, a great deal of cor¬
respondence devolves upon me in the intervals between our
sessions. I do not think any gentlemen sitting round this
table is aware of the amount of correspondence which falls
upon your President, both with the Government, the Medical
bodies, the colonies, and private individuals. A great many
of those letters, in reply, require consideration, care, thought,
delicacy, and careful wording : and here I should be sorry to
quit the chair without acknowledging my great obligations to
the amiable and accomplished gentleman who fills the office of
Registrar. His support, advice, and assistance in these
matters of correspondence are really most valuable, and I am
greatly indebted to him for his services. Gentlemen, I have
nothing more to say but to renew my acknowledgment for the
past, and to say that, should your choice fall upon me for the
future, I will endeavour to perform my duties to the best of
my ability. But should it fall upon me again to be elected to
this dignified office, I wish it to be distinctly understood that
I cannot undertake the duties for the five years, and that I
only accept them until such time as you can among yourselves
find a successor whom you think worthy to occupy this chair.
With these observations I retire from you, and wish you God¬
speed for another year.
The President then retired from the Council, when he was
re-elected unanimously amidst loud and prolonged cheering,
and the Council concluded the session of 1863, soon after seven
P.M., having sat this day more than seven hours.
MEDICAL REFORM.
TO THE EDITOR OF THE MEDICAL PRESS ASD CIRCULAR.
Sir, —The battle of medical reform has now been fairly begun.
The Medical Council has refused to accede to the wishes of the
profession so far as even “ to consider the propriety of attempt¬
ing to obtain a change of constitution.” No other result was
to be expected—nor, to my mind, even to be desired. No
Urging of the question by the Medico-Political or British
Medical Associations could so effectually arouse the attention
of the profession to their own interests in this matter as will
be done by this refusal of the Medical Council to entertain the
subject. Let us not fear the battle, the result cannot be
doubtful; without a battle, we might have an ignominious
treaty, we could not secure a splendid victory. The Counci],
have, however, very distinctly indicated to us what our next
step in the matter must be, namely, an application to Parlia¬
ment, based upon the interests of the public ; for a low class
of practitioners evidently injure the public by their practice
even more than they injure us by their competition.
Such an appeal to Parliament we must bring forward as
soon as we have a practical organisation in working order to
carry it out.
Sir Dominic Corrigan has nobly redeemed his promise given
to the Medico-Political Association, that he would support this
question when it should come before the Council. The pro¬
fession ought to use every endeavour to place him in Parlia¬
ment as the advocate of their interests, when this measure may
be brought befose the House. Nobody ever supposed that the
Council could alter its own constitution ; the question was
would they, in the intsreeto of the profession end of the public,
eeebfrtmi Perikmect each an efreietkm as the profes*e» in¬
dicated as necessary. This, they have refused to do for us;
we must now do it for ourselves. But their refusal will have
no other effect than to arouse the attention of the profession
and the public to the question, and to give time and opportu¬
nity for the “ education” of both as to their true interests m the
matter.
It has been urged in the Council that our representatives
would neglect higher questions, In order to complain of the
insufficient remuneration of the profession; the best answer
to this is the fact that the profession has already grasped the
idea that its insufficient remuneration is to be effectually
remedied only by going back to the highest question of all—
namely, its own representation on the Council. And hence,
we may fairly argue that our representatives when seated
there, would bear in mind that they were sent there to deal
with principle* — ie. t with the higher questions, and not with
details, and that hence they would strike boldly at the root of
the evil, which the Council at present handle so tenderly, but
which we instinctively recognise as excessive competition,
caused by a low standard of qualifications both preliminary
and professional, which again is owing to the rivalry of
the corporations for licensing fees, and the inability of one
to raise its standard for fear of sending three-fourth’s of
its candidates elsewhere. This is the root of the evil, and
I have elsewhere proposed to deal with it by making the
emoluments of the colleges quite independent of the number
of candidates passed by them. My views on this point, and
on the representation of the registered practitioner, the
Council of the College of Surgeons have pronounced “ Utopian,
and in advance of the age,” it remains to be seen whether the
profession and the public, in whose interest they were pro¬
posed, will regard them in the same light. One thing is
certain, that unless the root of the evil is dealt with in some
such manner as this, our remuneration and status will remain
what they are at present. Why does Dr. J. C. Reid, in the
Morpeth Union, get only £10 a-year, as reported in your last,
for attending to a population of 3000 ? Why does Dr. Gill,
in the same county, get only £6 for a district of 21,000 acres ?
Why is a similar scale the rule all through Northumberland ?
Because there are several other men ready to come forward at
the same tariff, and take their private practice from them if
they refuse such a scale. How were the committee of the
Ashford dispensary district, near Wicklow, able the other day
to reduce their salary from £100, which their late officer was
paid, to £85 ? Because even at £85 there were several men
to apply for the post. This excessive competition in the pro¬
fession must be put an end to, and the only legitimate way to
do it is by enforcing a really high standard of preliminary Mid
professional education. This is the “ higher question” with
which our representatives must boldly deal, when we shal l have
won our first battle of representation in the Council, Mid thus
obtained a standing ground for our next move.
The profession seems to have been strangely hoodwinked by
Dr. Paget’s statement that his constituency numbered 5400
electors. Why, these are all non-profmional elector s, mere
Masters of Arts of Cambridge University ; the total number
of graduate* in medicine of Cambridge University in 1867 was
only 142. Should these wish to give a vote adverse to the
choice of the senate, the latter body can, it is true, overpower
them by influencing the votes of the non-professional 5258;
but these latter electors take.no further interest in us, or our
concerns. Such a fallacy as this cannot be Allowed to pass
unnoticed.—I am, dear sir, yours truly,
Isaac Ashe, M.B., T.C.D.,
Gen. Sec. for Ireland, Medico-Political Association.
Warrenpoint, July, 1868.
THE PHARMACY BILL.
TO THE EDITOR OF THE MEDICAL PRESS AMD CIRCULAR.
Sir, —In your report this week of the discussion on the above
bill, in reference to its extension to Ireland, in answer to Dr.
Leet’s concise and able protest, Dr. Aquilla Smith stated
that, since the year 1855, Pharmacy has greatly Regenerated
in Ireland, and since the passing of the Medical Act in 18hc,
it has become so low that a physician would have great aiffi*
culty in getting a prescription made np by an apothecary in
Ireland. Does Dr. Smith mean that they are too proud to
engage in pharmacy, being general medical practitioners, or
that they are incompetent to perform the duty for which they
prepared for years ? In regard to their unwillingness, I will
merely refer Dr. Smith to'the daily advertisements uW
lipedical halls both in Dublin atod the provincial te*n* «
Digitized by Google
MEDICAL NEWS.
July is, iMj. 6d
they are incompetent, which I am far from allowing, I don’t
thinlr that Dr. Smith*8 remedy—allowing'drnggiats to compound
(for, in that class, chemist is only a name)—would lessen the
difficulty. The accidental poisoning statistics of England,
compared with that of Ireland, are, I think, suggestive enough.
Apologising for trespassing so much on your valuable space,
I am, sir, yours respectfully,
George P. Atkins.
Dublin, July 9,1868.
IODIDE OP SULPHUR IN THE TREATMENT
OF “ PORRIGO FAVOSA.”
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—I have submitted the following cases for publication in
your valuable journal, thinking that they might prove of in¬
terest, by illustrating the beneficial action of iodide of sulphur
in the treatment of a most inveterate skin disease, viz.,
Pvtrigo Favoia, commonly known as scall head.
John Riley, at. 18 years, William Riley, set. 7 years, and
Patrick Riley, et. 6 years, three brothers, were admitted into
the Skibbereen Workhouse Hospital, February 27th, 1868,
suffering from porrigo favosa in its most aggravated form. The
eldest had been affected for eight years—the second for six
years, and the youngest for about twelve months ; their heads
were covered with the mouldy-looking honey-combed crusts
peculiar to this disease. In some places where the crusts had
fallen off, the integument presented a red-glazed looking
appearance, studded here and there with yellow pustules, and
totally devoid of hair; their general health was good, and
neither of them any indication of a scrofulous diathesis.
During two months succeeding their admission into hospital
various plans of treatment were adopted, such as the use of
sulphur and citrine ointments, corrosive sublimate and nitras
argent solutions, and also painting the diseased surface from
time to time with tinct. iodine. Temporary relief was occa¬
sionally afforded, but the disease invariably returned in as bad
a form as ever. On the 21st May, the following treatment
was adopted, and produced quite unexpectedly a speedy and
permanent cure. After softening and detaching the crusts by
the application of linseed-meal poultices, an ointment composed
of ioaide of sulphur, 3i-, adeps. gisa., intimately mixed together,
was ordered to be well rubbed into the diseased patches night
and morning. This treatment was continued regularly, and on
June 10th, a fortnight after it had been first adopted, a marked
improvement had taken place ; the formation of fresh scabs was
arrested, the red patches pf skin had almost disappeared, and
hair began to grow from several portions of the scalp which
were previously bald.
The three patients were discharged cured from hospital,
June 30th, as there were no indication whatever of a return
of the disease, and their heads were uniformly covered with
hair.
If the iodide of sulphur treatment should prove equally
beneficial in most other cases of porrigo, it would supply a
very simple means of arresting this disease, instead of having
recourse to the internal use of arsenic and iodine, and the
application of caustic and poisonous lotions to the skin : the
use of which remedies in the case of children, is attended
with considerable risk, especially in country districts where
one must often rely upon ignorant and careless people to ad¬
minister them, and therefore must be very guarded how he
entrusts to the] hands of such persons medicines that might
prove fatal, if not carefully given in the prescribed dose, or
not used as otherwise directed.
It is not many years ago, before the true nature of porrigo
was discovered, when the barbarous plan of applying pitch
caps to the scalp was adopted on the Continent, and in some
parte of Ireland where the disease was tolerably prevalent.
These pitch caps consisted of strips of stout calico, spread
with Burgundy pitch, or some other adhesive material, and
after being firmly applied to the scalp, they were forcibly torn
off in a direction contrary to the growth of the hair, bo as to
tear the hairs out from their roots; this plan was adopted
under the erroneous impression that the disease originated in a
morbid condition of the hair bulbs, and not unfrequently
either scalped the victim or produced death. In this case, as
in others, microscopic and chemical research have come
'tyjhq-eni of medicine. The microscope has determined that
’ jjprin'jfcvosa depends on the formation of low vegetable
a fungous nature (achorion schbnleinii) in the
afc the epidermis and upon the surface of the
ther baif follicles, and causing alopwcia in
most cases. Chemical researches have discovered that sulphur¬
ous add in a fluid or gaseous form, and the sulphites? esped-
ally the hyposulphite of soda, and the compound resulting
from the union of iodine and sulphur, have a sort of specuS
capacity for destroying the vitality of such vegetable organ¬
isms when they come in contact with them, and we thus have
a rationale to follow out, when applying these remedies to the
treatment of porrigo favosa, instead of having recourse to hap¬
hazard modes of treatment which generally produce more
harm than good, and invariably aggravate the sufferings of
those who are the victims of the disease under considera¬
tion.—Your obedient servant,
Daniel Donovan, Jun., M.D.
Skibbereen, Co. Cork,
3rd July, 1868.
gpbical ffeftrs.
The Public Health.—W e extract the following
from the weekly returns of the Registrar-General:—“ In the
week that ended on Saturday, July 4, 4620 births and 3180
deaths were registered in London and in thirteen other large
towns of the United Kingdom. The annual rate of mortality
was 25 per 1000 persons living. The annual rate of mortality
last week was 25 per 1000 in London, 25 in Edinburgh, and
17 in Dublin, 20 in Bristol, 22 in Birmingham, 26 in Liverpool,
33 in Manchester,25 in Salford, 35 in Sheffield, 24 in Bradford,
25 in Leeds, 25 in Hull, 26 in Newcastle-upon-Tyne, and 26 in
Glasgow. The mortality from diarrhoea, principally infantile,
showed a considerable increase in most of the large towns last
week. Of the death rates from all causes, 6 per 1000 resulted
from this cause in Manchester, 5 per 1000 in London and Sal¬
ford, and 2 per 1000 in Liverpool. The excessive rate in
Sheffield was due to 15 more deaths from small-pox, in addition
to a considerable mortality from measles and diarrhoea.
The deaths registered in London during the week were
1516. It was the twenty-seventh week of the year, and the
average number of deaths for that week is, with a correction
for increase of population, 1315. The deaths in the present re¬
turn exceed by 201 the estimated amount, and are more by 62
than the number recorded in the preceding week. The deaths
from zymotic diseases were 577, the corrected average number
being 395. Nine deaths from small pox, 55 from measles, 36
from scarlatina, 11 from diphtheria, 49 from whooping-cough,
46 from fever, 286 from diarrhoea, and 19 from cholera or
choleraic diarrhoea were registered. The mortality from diar¬
rhoea exhibits a considerable increase. In the week which
ended the 6th of June, the deaths from diarrhoea were 27, in
the three following weeks 31, 66, and 171 persons died, and
last week the deaths recorded were 286. The deaths from
fever were at the annual rate on 10,000 living of 4 in West
London, 7 in North London, 9 in Central London, 18 in East
London, and 5 in South London. In calculating these results
the deaths in the London Fever Hospital have been referred to
the districts from whioh the patients were hrought. At the
Royal Observatory, Greenwich, the mean height of the baro¬
meter in the week was 30‘023 in. The barometrical reading
increased from 30*05in. on Sunday, the 28th of June, to 30‘2lin.
by 9 a.m. on Monday, the 29th of June ; decreased to 29*81
by 3 p.m. on Friday, the 3rd of July, and was 29*88in. by the
end of the week. The mean temperature of the air in the week
was 61*6 deg., which is 0*4 deg. above the average of the same
week in 50 years (as determined by Mr. Glaisher). The
highest day temperature was 84‘3 deg. on Friday, July 3rd.
The lowest night temperature was 47*8 deg. on Tuesday,
June 30. The entire range of temperature in the week was,
therefore, 36*5 deg. The mean of the highest temperatures
of the water of the Thames was 66*7 deg. ; that of the lowest
was 65*4 deg. The difference between the mean dew point
temperature and air temperature was 10*6 deg. The
mean degree of humidity of the air was 68, complete saturation
being represented by 100. Rain fell on Saturday, July 4, to the
amount of O Olin. The general direction of the wind was N.
and N.N.E. Ozone was observable on four days of the week.
Since Friday, the 29th of May, when rain fell to the amount
of 1 08in., to Saturday, the 4th of July, rain has .fallen on only
six days, amounting in the aggregate to 0‘47in. in 86 days.
According to a return furnished by the engineer of the Metro¬
politan Board of Works the daily average quantity of/sewage
pumpedfntothe River Thames at the Souther* GutfUk Works,
Digitized by v joogle
?6 Th4M«u a upr M .ttdCTr CT itt NOTICES TO CORRESPONDENTS.
July 16,1868.
Croeanass, w m 39,700,733 gallons, or 180,379 cubic metres,
equivalent to about as many tans by weight. 1 ’
University of Cambridge.—Natural Science
Scholarship. —Mr. C. Fox has been elected to the Natural
Science Scholarship (value £60 a-year), at St. Peter’s College.
Mr. Fox is a student at University College. The examination
was in Botany, Comparative Anatomy, and Chemistry.
Registration in Scotland.—T he medical pro¬
fession of Scotland are protesting against what is an un¬
doubted grievance. When the Registration of Births, Deaths,
and Marriages Act was passed in England in 1836, the medi¬
cal men of England were solicited to render their services
gratuitously for State purposes, and for behoof of the public,
by forwarding to the registrars certificates of the causes of
death in cases which had come under their professional notice.
As a matter of course this is always done, but it is not done
compulsorily, but as a certain courtesy which the doctors pay
to the nation. In 1854 a similar Act came into operation in
Scotland, but for some unaccountable reason (for the English
Act has always worked without any hitch) power was given
by it to compel the practitioners to grant professional certifi¬
cates of the causes of death, under the threat of the infliction
of serious penalties, recoverable at the instance of the criminal
officers of the Crown. The distinction is a very invidious
one, and utterly uncalled for. The medical gentlemen of Scot¬
land have never objected to give their services gratuitously
for the public interest; but what they object to is the exac-
tion of such services compulsorily, or under penalties for non-
fulfilment. It is justly regarded as a slight cast upon the
profession in Scotland, and the present time, when medical
votes are of some value to university candidates, is, with con¬
siderable sagacity, thought to be a seasonable one for getting
it removed. Some years ago, when Mr. Moncreiff held the
office of Lord Advocate, an attempt to this end was made by
means of a clause in a bill which was under the charge of ’ Sir
William Dunbar, but the medical applicants were not success-
ful in convincing the official gentlemen of the hardship under
which they laboured. The effort has been renewed wi thin the
last few days under better auspices. At a meeting of the
faculty in Glasgow, a memorial was drawn up to the Lord
Advocate, pressing the matter upon his attention. To this a
favourable answer has been received, but Mr. Gordon is com¬
pelled to confess that legislation to give effect to it is impos¬
sible this session. We may tender a word of advice on the
subject to that portion of the profession in Scotland who are
members of the united constituency of Aberdeen and Glas¬
gow Universities They have as candidates for their suffrages
the present Lord Advocate, and the gentleman who, in the
event of a change of government, is certain to be his succes¬
sor. Let them make assurance doubly sure, by exacting a
pledge from both candidates that each will make it his busi¬
ness to abolish with all speed this humbling distinction —
London Scotsman .
Sewage Experiments at Tottenham.—L ast week
experiments on the purification of sewage by means of a par¬
ticular preparation of alum, according to Mr. Lenk’s process
were made at the sewage works of the Tottenham Local Board of
^ length by 20 in breadth,
was filled with 26,000 gallons of sewage, very black in appear¬
ance, and extremely offensive in smell. Forty-six gallons of the
purifying essence” were then sprinkled over the surface of
the fluid by means of a hydropult, and afterwards stirred in
by the aid ofa wooden apparatus roughly improvised for the
purpose. The fluid was then allowed to settle, and the
action of the essence was seen in the precipitates. In about
ten minutes, and at intervals afterwards, bottles were plunged
into the deepest portion of the fluid, and on being brought to
tho surface arid examined, the contents were fluid, though
slightly blue. In half an hour the whole body of the sewage was
mu ll yMjp d. I he cost of this process is said to be trifling.
n.< nts were also made to contrast the alum process with
that in which lime is employed. The subject will receive
Hither ,.hi(„hitum by rigid chemical tests. It is hoped that
tli- solid portion will prove a valuable manure, while the fluid
'Mil Iu> such as may be safelydischaigedintoopenstreams.
On Sunday morning the body of a retired farmer
in I h von w as found lying in an orchard fearfully mutilated.
The deceased placed the muttle of the gun to his ear, and by
Mie use of the string had di charged it, thereby causing ins tan-
\neous death. -
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in Eogland on or before Friday morning are
expected to be returned to the Editor, at the office, 90, Wfag
William-street, Strand, W.C., before five p.m., on Friday afternoon.
Froofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two r.x. on Saturday, which &
an early dosing day. Duplicate proofs are sent to authors, in
order that they may correct and return one copy, and keep the
other for private use. Contributions should be legibly written, on
one side of the paper only.
Mr. A. Drew, Brighton.—We have still a few copies of February
19th on hand. The two previous numbers are out of print. The
annual subscription is 91s. 8d., post free, in advance.
Dr. T. 8.—You will find the subject mentioned in another part of
the paper.
Dr. Kirby is thanked for his note.
Mr. J. T., Manchester.—The back numbers from January 1st, with
the exception of two “out of print,” will be forwarded to New York,
as requested, in the course of the present week. You will please re*
member, that the poetage to the United States has recently been
doubled. The postage per copy is now 2d.
Mr. W. Carsick, Crofts.—Your request has been attended to.
BIRTH.
WA T^“r J '. 24 ^ a * Wes^een, Tottenham, the wife of William
Tyndale Watson, M.D., of a son.
NOTI CE TO ADVERTI SERS.
gpirial ffms anir Circular
OFFERS UNUSUAL ADVANTAGES
Tj^OR the Insertion of announcements from its extensive
A- and largely increasing circulation in each of the three
£ £ f v he TT Umt f d i and tb© Colonies. Being also
SwSf P b ™ ne8 ’ *>« foundla most
valuable medium for Advertisements of Books, Vacancies aftd
The scale of charges is as follows
Sevenlines and under. £0 8s fld
Per line afterwards. 0 0s* 6d
One-quarter page.. 1 go*. Od!
f£i f »» .. » 6s. Od.
The average of words pet line is twelve.
Queen Anne-street, Cavendish-sqnare, London.—
^ A vei 7 desirable Professional residence, having 4 good
reception rooms; 8 bed-rooms; Rood office, and capital stabling, com¬
pletely furnished; all in excellent condition—held at a verv low
rental-to be sold on meet advantageous term, pAeSZs <5
Hoteff aa< ^ C uaT18 » lamgbam-pl.ee (next the Langham
THE MEDICAL PROFESSION.
THE ALBERT LIFE ASSURANCE COMPANY
r" E st *blUhed 1838— Annual Income £350,000, accepting
healthy and invalid lives, is prepared to enter into special and liberal
7? th member * of the Medical Profession acting as private
Agent8of theCompamr.—Apply to the Secretary, FR/
at the Chief Office, 7 Waterloo-place, Fall-Mail, Lo ndon
CONVERTIBLE OTTOMANS FOE CENTRE
OF ROOMS,
To form two Settees and two Easy Chain, a great improvement on the
ordinary Ottoman. Only of . —
FILMEB ABD SOB*,
UPHOLSTERERS,
81 A 89, Bemers-street, Oxford-street, London, W.
Factory—84 A 86, Charles-street.
An Illustrated Catalogue poet free.
RUPTURES.-M0RPIE, Patent Trim Makar
18, Hawkins-street, Dublin.. Established 100 Years.
Suspensory Bandages, Belts, Ac., Ac,
“ SALUS POPtTLI SUPREMA LEX.”
WEDNESDAY, JULY 22, 1 868.
CONTENTS.
ORIGINAL COMMUNICATIONS.
A Cue of Compound Fracture of Frontal
Bones, with Fracture of Clavicle and
Acromion. Under the care of Mr.
Roberta, Surgeon. paob 71
Urea and Uric Acid : Their Relation to
Health and Disease. By B. Kelly,
HJ>., LX.a.C.P.L. 72
HOSPITAL REPORTS.
CiTTor Dublut Hospital—
Hanoi* of Large Size: Operation:
Sueoeaaful Result.—Hare-Up: Opera¬
tion, Leaving scarcely a Trace of De¬
formity. Cases under the care of Mr.
(holy.
Bichxovd Sueoical Hospital—
. Strangulated Inguiuo-scrotal Hernia;
Duration of Strangulation Five Days;
Herniotomy; Sac Opened; Unfavour¬
able Termination of the case. Under
the cate of Mr. William Stokes.
Da. SmvBvs* Hospital—
Retention of Urine, with Puncture of
Bladder.—Large Malignant Tumour of
Breast: Removal: Recovery. Under
the care of Mr. Oolles..
LITERATURE.
Treatment of Typhus Fever. By Prof.
Mosler. 79
LEADING ARTICLES.
The Medical Department op tiib Abys¬
sinian Expiditiox . 80
Tbs Elzction at thb Dublin Oollbob
of Physicians . 80
Notbs ON THB Abyminians. No. IV. 81
NOTES ON CURRENT TOPICS.
Royal College of Physicians of London.—
Medical Department of the Privy
Council. — Medical Candidates for
Parliament.—Aneurism in the Army.—
The Lothians’ Medical Association... 82-3
SUMMARY OF 8CIBNOB.
Dr. Cram Brown’s Papers on Chemical
Constitution and its Relation to Phy¬
siological Action.—Analysis of Potable
Water. — Black Varnish. — Carbolic
Add.—Solubility of Oxide of Iron.—
Gamgee’s Experiments upon Blood.
By C. R. C. Tichbome, F.C. 8 .,
F.R.G. 8 .I., Ac. 86
CORRESPONDENCE. v
Williams on Reform in the Medical
Council. 88
Crisp on the Carmichael Prize Essays. S®
MISCELLANEA.
General Council of Medical Education
and Registration. 76
Over-population and Public Health........ 84
Guy’s Hospital, London. 80
Rejections at the London College of
Surgeons. 80
Medical News.89-90
Original
A CASE 0/ COMPOUND FRACTURE OF
FRONTAL BONES, WITH FRACTURE
OF CLAVICLE AND ACROMION.
Under the cabe of Mb. ROBERTS, Surgeon.
(Communicated by Hbnrt B. Dow, M.D.)
Tom Richards, aged 14, engaged as farm-labourer, was,
on September 25th, 1867, driving some horses into a field,
and happening to strike one with his stick, it immediately
kicked, one hoof striking him on the right shoulder, frac¬
turing clavicle and acromion, the other falling edgewise on
the forehead, fracturing both tables and exposing dura
mater. On my arrival, two hours after the accident, found
him partially insensible and extremely weak, the loss of
blood having been excessive, the supra orbital artery being
wounded. A piece of bone, rather larger than a sixpence,
had been forced on to the dura mater, causing slight com¬
pression of the brain. I immediately secured the artery,
and with the aid of forceps and elevator removed the de¬
pressed. bone, cleansed the wound, and applied simple
water dressing. The nervous irritability was so great as to
preclude the reduction of the fractured clavicle and acro¬
mion, the limb was placed in a comfortable position, and
evaporating lotions applied. A gentle apenent was ad¬
ministered.
. September 26th.—Passed a tolerable night but is very
ftveosh, wound looking healthy ; their is great intoler-
aQOAuCJighfcand noise. Effervescing salines administered,
■nd the lotion continued to the shoulder.
. 27th.—-Doing tolerably well, had some refreshing sleep,
and took a little nourishment; fleshy part of wound
commencing to slough slightly, water dressing still applied.
Kervoucmtem stiff too much disturbed to admit of re-
dnt^ieftorJhe fractared bones, so the limb was slightly
abiftod to prevent union, and evaporating lotion con¬
tinued*
j28tb.~lmproving.
<29tLr-^iuch fjrar, wound sloughing and discharging
ntbsahhj rnn mixed with ipiculve of bone; poultices to
take the of water dressing, effervescing salines to be
iinlhraed, and perfect rest and quiet enjoined, the intoler-
*a* pf^^andiioiae being present in a marked degree.
. tlOt htl ttWe symptoms diminishing, and there is
wound discharging freely. There 1
is great swelling and discolouration of shoulder, but little
pain ; it was again shifted, it being still not thought advis¬
able to attempt reduction.
October 1st.—Still improving.
2nd.—Allowed to be conveyed home, about two miles.
3rd.—No bad symptom has arisen from his removal.
Wound still discharging unhealthy pus, and symptoms of
necrosis of surrounding bone becoming apparent.
4th.—General health improving, febrile symptoms hav¬
ing almost entirely disappeared. Considered that I was
now justified in attempting reduction of the fractured
bones, which was satisfactorily accomplished in the ordi¬
nary manner, with but little pain or inconvenience to
patient.
6th.—Pieces of bone of various sizes are now being dis¬
charged with pus, which is excessive, and there is every
indication of a large surface of surrounding bone becoming
detached. To have good nourishing diet and wine.
8th.—Wound above and below the more serious injury
commencing to heal.
8th to 25th.—Doing well; no bad Symptoms ; general
health improving, but several pieces of bone of various
sizes have exfoliated; satisfactory union of fractured clavicle
and acromion has taken place.
October 28th to November 7th.—Complains of head¬
ache; health not so good, there is dullness and loss of Ap¬
petite. On examining wound, which has not been seen for
a day or two, a large amount of fungus is seen to have
sprung up, which, on removal, exposed a piece of bone,
which, taking into consideration the altered state of health
and head symptoms, I decided on removing, and did so
with the aid of forceps and elevator. It was about one and
a quarter inches in length, and two-thirds of an inch in
breadth, and beneath it the dura mater was exposed to
that extent. Cold Water dressing applied, perfect rest and
quiet enjoined, and a brisk aperient administered.
November 8th.—Again improving.
9th.—The removal of the necrosed bone is attended
with marked success, the head symptoms have entirety
disappeared, and general health rapidly improving. The
splints and bandages removed from the shoulder, which
has resumed its former shape and power in every respect.
November 9th to December 9th.—During this time the
progress is very satisfactory; less discharge and more
healthy; all the diseased bone appears to have come away,
and the wound commencing to fill up, whilst his general
health is good.
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72 The Medical Press and Circular. KELLY ONUREA AND URlC AClJ).
July «, m
December 9th to January 9th, 1868.—Wound steadily
and gradually healing ; nitrate of silver has been applied
freely with great benefit, the granulations having been
excessive.
January 15.—Wound nearly closed.
20th.—Patient discharged quite well. There is a de¬
pression over the inner angle of the right orbit large
enough to admit the end of the finger. The amount of
bone which exfoliated altogether measures about two inches
square. The injured shoulder has completely resumed its
former power and use.
UREA AND URIC ACID :
THEIR RELATION TO HEALTH AND DISEASE.
Bt B. KELLY, M.D., L.K.Q.C.P.I.
When we take into consideration the great importance of
the urine as an excrementitious liquid, and the part it has
played from time immemorial in the pathology of numerous
diseases, we may be somewhat surprised why its chemical
composition and morbid qualities should have so little
occupied, until a comparatively recent period, the attention
of medical men. But if these portions of its study have
been ignored and neglected, its reputed value as a polychrest ,
or useful remedy in sickness, has been recognized from a
very remote antiquity.
Aristotle observed that when urine was retained unduly
long in the bladder it emitted a stronger and more offen¬
sive odour after expulsion than when voided after the
usual interval—a change which he justly attributed to the
gross and viscid properties it thus acquired.
That the practice of autouroposis must have originated
at an early period of the world either through the injunc¬
tions of physicians, or (which is not improbable) through
the impulse and dictates of morbid imaginations, there
cannot be a serious doubt; and yet disgusting and un¬
natural as the habit may have been, it was far exceeded in
this respect by the internal use of album grascum, meconium ,
and the sulphur occidentals of Paracelsus. Celsus records
the death of a favourite of King Autigonus, who died from
the effects of drinking his own urine. This personage,
‘ according to the assertion of the great Roman physician,
was notoriously intemperate. Pliny states that the sup¬
pressed menses are restored by the patients inhaling the
warm fumes of fresh urine excreted by males under the
age of puberty. The same author also believed, that as
fullers were never troubled with the gout, and as stale
urine was the liquid used by them in his tiine for scouring
woollen fabrics and other articles of clothing, it must,
therefore, be an appropriate, if not an effectual, remedy for
the disease in question. But indeed there was scarcely a
malady in the entire nosological catalogue against which
the internal and external use of urine, fresh or stale, had
not been deemed a sovereign specific from the d^s of
Celsus and Pliny down to a century or two ago. The
autouroposis of the ancients bids fair to be revived under
a modified and less disgusting form by the modem appli¬
cation of certain saline constituents of the urine to the
treatment of disease. Even in our own day, the besotted
inhabitants of Kampschatka, who eat the Amanita Mus-
caria for the sake of its exhilarating influence upon the
animal spirits, are wont, when the supply of the fungus is
exhausted, to prolong its intoxicating effects by drinking
freely of the urine they excrete after its use.
The first physician I find, in looking back through the
long vista of time, who seemed to have had any definite
knowledge of the chemical composition of the urine, is
the renowned Dr. Willis. In his Treatise on the several
kinds of urine, he gives a rough, but rather comprehensive,
analysis of this liquid. According to him, it consists of a
large quantity of serum, a less amount of salt, sulphur and
earthy matter, and a small proportion of spirit. Van
Helmont, the Flemish physician and chemist, who was
a cotemporary of Willis’, bestowed considerable attention
on the physical characters of the urine. That, passed on
rising in the morning, he called urina sanguinis , in con¬
tradistinction to the urina potHs , or that resulting from
beverages.
It is quite unnecessary to allude here to the long and
illustrious list of physicians of our own times who have
rendered themselves immortal by their researches in the
domain of urinary pathology, as their works and achieve¬
ments are fortunately well-known to the Profession. But,
as the subject is far from being exhausted, I have deemed
it not unworthy or profitless to devote a few pages to the
consideration of urea and uric acid, as two of the most
important proximate principles of the urine, whether in a
physiological or morbid point of view, and the relation
they bear to the system in health and disease.
Urea .—This substance, which results from an oxydation,
or species of slow combustion of the constituent elements
of tne tissues, is constantly found in the blood, urine, and
other organic liquids of the economy, but more especially
in the lymph and vitreous humor. It is excreted from tli
system exclusively by the kidneys and skin in a state of
health; but in Bright’s disease and other organic affections
of the kidneys, the gastro-intestinal mucous membrane
vicariously discharges the function of the disordered glands,
and effects the removal of a large share of the noxious
principle from the blood. Hence the vomiting and diar¬
rhoea which not unfrequently accompany the more advanoed
and serious cases of albuminuria. These accidents, being
in a measure critical of the disease, and curative in their
tendency, ought never to be incautiously interfered with
or suddenly checked.
Whether urea be obtained as a constant and natural pro¬
duct of the living body, or is fabricated in the laboratory
of the chemist, its physical charactev and elementary
constitution are always the same. Dry urea contains no
water of crystallization, and, being a quartern ary com¬
pound, possesses all the well-known chemical instability of
such substances. Whether hydrated or anhydrous, it is
readily converted by stale or t putrid mucus, or by any
agents capable of acting as ferments, into carbonate of
ammonia. It is dimorphous, that is to Say, capable of
assuming two distinct crystalline forms according as it is
slowly or rapidly evaporated.
Urea is in its origin and essence purely excrementitious;
and where, from any cause, it is suffered to accumulate in
the blood, it invariably gives rise to alarming nervous
accidents, as amaurosis, convulsions, paralysis, &c., which,
if neglected, usually terminates speedily in death. It aid)
occasionally enters as an active element into the pathogeny
of serous inflammations.
The first liquid of the body which contains urea in largest
proportion is the lymph. The lymphatic vessels, indeed,
may be said to be purposely set apart for the special
absorption and accommodation of this substance, in the
same manner as the lac teals are for the imbibition and
reception of the chyle. The more abundant the lymph,
the more abundant, all other things being equal, will be
the'quantity of urea contained in it; and as tne quantity
of lymph increases up to a certain point in a state of
abstinence, and as the individual, in such circumstances,
feeds, so to speak, and subsists upon his own tissues, the
proportion of urea necessarily increases, thus demonstrating
the large amount of animal matter that was necessary to
be consumed to supply the want of the customary food,
and to keep the living machine in active motion. When
abstinence, however, is prolonged to an extreme degree, so
as to approach starvation, not only the serum of tiie
lymph greatly diminishes, but its solid constituents, and
notably the urea, decrease, yet not to the same extent as
the watery portion of the humor.
The venous blood always contains a greater or less
quantity of this substance in solution, wbich not duly
varies from one vein to another, but according is the
subject of the experiment is in a state of repletion or cue
of abstinence. The amount of urea contained in the
venous Wood in the former case is relatively amalli'fbrthe
reason that the vessels are filled to tupgidity and Iiti
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The Medical Pieee and Circular. KELLY ON UREA AND- URIC ACID.
July 33(1968. 73
barely power to support the column of blood circulating in
them; while in the latter, the veins are comparatively
empty and flaccid, and endosmosis of liquids with their
. soluble contents readily takes place through their walls.
The left vena inndminata contains a greater proportion of
urea than all the veins of the body, from the fact that the
greater thoracic duct empties its contents into the left sub¬
clavian previous to its junction with the internal jugular
of the same side; next to this vessel, the brachiocephalic
of the right side contains the greatest amount of urea,
more especially when the lesser thoracic duct enters it.
The renal veins, for obvious reasons, contain the smallest
share, and yet they are never entirely free from it either in
a diseased or healthy state of the kidneys.
As a greater or less quantity of urea is always found in
. the blood of the renal veins, it becomes a question to
„ decide from what source it may be derived. There are
. only two points to which we can legitimately trace its
origin; either it must have escaped the filtering process in
- the kidneys, and thus directly entered the capillaries of the
. renal veins; or it may have penetrated the coats of the
latter from the substance of the glands in which it had
been formed as an effete product of nutrition. The former
view in all probability is the more correct, especially in
presence of the anatomical fact that the organs in question
, are duly supplied with lymphatics, not very abundantly,
it is true, but yet sufficiently so to effect the removal of
the urea as rapidly as generated. In Bright’s disease,
however, and in acute nephritis, the quantity of urea carried
eff by the renal veins is almost as great as that contained
, in the renal arteries.
The arterial system always contains a larger share of
- urea both in health and disease than the veinous. When
we take into consideration that, with the exception of the
small quantity removed from the renal arteries, the entire
mass of the urea centres here, we may well be surprised
why an element so excrementttious in its nature, and so
deleterious to the healthy functions of the economy when,
from any cause, it has accumulated to excess in the blood,
should circulate so freely in the arteries without producing
any serious disturbance or perceptible change in the process
of nutrition.
- The existence of urea in large quantity in the vitreous
• humor was first , verified by Millon, and has ever since
puazled scientific men to account for its presence in a
secretion which is so very dissimilar to the urine both in
.t physical and chemical characters. I have ventured to
approach the vexed question, and to offer an explanation
v thereon, leaving it to others to judge of its correctness.
We know that the vitreous humpr being a permanent,
; reerementitial product of secretion is never absorbed, at
least in no appreciable quantity, in the healthy state, but
- remains hermetically enclosed in the cavity of the eyeball.
t Possessing great viscidity and consistence, its endosmotic
- property is also very considerable. But as urea is formed
- in all the tissues of the body wherever blood-vessels and
j■, lymphatics are found ; and as it is dissolved by the fluids
which bathe and permeate these tissues, it must necessarily
enter the vitreous humor; and as it cannot possibly escape
nnleBs the humor has undergone liquefaction, it must
increase by gradual and constant accessions. How far its
accumulation may be instrumental in producing or aggra-
: rating certain farms-of blindness and impaired vision may
become a fruitful subject of inquixy in future experimental
i researoh.
Uric Acid .—This substance resembles urea in being an
: organic product of nutrition, and in elementary constitution,
but is entirely unlike it in its chemical affinities and
i Motions, as well as in physical characters. It 4s also unlike
; ltm.net being ever formed outside of the living system by
artificial means. Besides forming stable compounds with
- soda, lime, potash, magnesia and, ammonia by converting
o thflU, jwithe case may be, into alkaline, neutral, or acid
. ip ohanged into alloxan and allontoin—the
fi-fcjgbet! degrees, possibly, of oxydation, if we except allox-
Irona and parabanio aqid, to which this principle is capable
of being raised—the former by nitric acid, the latter by
the peroxide of lead.
Uric acid, which in the human subject is always a
morbid product when it exists in excess in the blood and
urine, is a normal, excrementitious principle of tissue-
metamorphosis in insects, birds, and reptiles. As the
nitrogenous elements abound in the systems of these
animals, and very little of the fatty or carbonaceous, we
can reasonably account for the enormous quantity of uric
acid and urates, and the extremely small proportion of
water and carbonates excreted by them. In herbivorous
mammalia, on the contrary, uric acid and the urates are
never found qs constituent elements of their urine in its
normal condition; whereas urea, the alkaline carbonates
and phosphates,are abundantly formed as natural products
in their systems, and are copiously discharged in their
urine. When, however, such animals are kept in a state
of abstinence for a time varying from twenty-four to
forty-eight hours, the alkalinity of their urine disappears,
and, with it, its usual turbidity; the excreted liquid
becomes limpid, and exhibits a decided acid reaction,
owing to the presence of uric acid, and acid urates ana
phosphates contained in it. Claude Bernard accounts for
this remarkable change in the physical characters and
chemical constitution of the unne of herbivora during
abstinence, by referring to a counterchange which ensues
in the nature of their aliments—the animals, in such
circumstances, living upon their proper tissues, thus
becoming, for the time being, to all intents and purposes,
carnivorous.
It is known that cold-blooded animals, as reptiles, whose
respiration is very slow, abundantly excrete uric acid,
either free, or in combination with alkaline bases, especially
ammonia. From this it has been inferred that the forma¬
tion of uric acid, whenever it occurs in the human subject,
results from a deficient oxydation of the nitrogenous
elements of the food and tissues. Cl. Bernard, however,
warns us earnestly against accepting this theory, and cites,
as an illustration, the example of birds, in whose systems
uric acid is freely generated, notwithstanding that their
respiration is extremely rapid. Here, truly, is a dilemma—
how to reconcile a uniform and constant effect with con¬
ditions and causes so diametrically opposed. For my own
part, I think that the conditions in question are not so
conflicting as they seem. The respiration of reptiles, it is
true, is very slow; but their circulation, also, is equally torpid;
there is consequently an equilibrium established between
both functions. In birds the contrary of this obtains;
their respiration is very active, as is, also, their circulation;
their blood, too, is extremely plastic from its great richness
in coagulable principles, especially fibrine. ’Hie generation
of uric acid takes‘place, as we know, with equal uniformity
in both cases under apparently different circumstances.
We cannot attribute its formation exclusively to an active
respiration, nor yet to a slow, we must, therefore, look to
other conditions and causes than those mentioned in order
to solve, with any degree of satisfaction, so perplexing a
problem.
I have already stated that the nitrogenous elements
abound in the systems of insects, birds and reptiles, and
that the carbonaceous or fatty matters are greatly deficient,
or only exist as secondary, or accessory constituents.
Hence the great quantity of uric acid and urates (all
azotized products) normally formed and eliminated by
them; whereas water and the carbonates are so extremely
scant as only to amount to mere traces in their excrements.
Let us look again to the* sheep and ox, for instance, in
whose bodies are usually hoarded up such great masses of
fat, and what do we find? Neither uric acid nor urates
are ever discharged by them as normal excrementitious
products, while tne alkaline carbonates and earthy phos¬
phates are so abundantly excreted by their kidneys, that
I their urine may be well considered a saturated solution of
I these substances.
I. Like all other herbivorous mammalia, these animals ore
heated more by the combustion of their fat than by the
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74 The Medical Press and Circular.
HOSPITAL REPORTS.
July IS, 1888.
oxydation of the nitrogenous principles of their compact
tissues. The reverse of this obtains in birds and reptiles;
not being furnished with the so-called calorifacient sub¬
stances, or only so to a very limited degree, combustion of
their solid structures, and, as a consequence, oxydation of
their constituent elements, take place; and hence the
marked disparity in the nature of their excrementitious
products as compared with those of the above-named ani¬
mals.
Uric acid being very sparingly soluble, requiring, as it
does, 10,000 parts of water at 60° for its solution, it be¬
comes an important question to decide why it should
remain soluble in the blood and urine, not being sponta¬
neously precipitated from the latter for many hours after
emission, even when it exists in abnormal quantity, as in
cases of gout and rheumatism. Heat, we know, is
favourable to its solubility, but when once crystallized, ele¬
vation of temperature may be carried almost to the point
of decomposing it without effecting anything more than its
partial solution, unless the quantity of liquid employed
bears an exaggerated proportion to the amount of acid to
be dissolved. It is quite possible, however, that as fer¬
mentation rapidly takes place after expulsion of the urine,
under certain morbid conditions, the more soluble urates
become decomposed through the agency of new-formed
acids (the lactic and acetic), the substance in question is
precipitated, the liberated bases being converted into lac¬
tates and acetates.
The chloride of sodium, which always exists in greater
or less quantity in the blood and urine, assists materially
in keeping the urate of ammonia soluble in these liquids;
but I am not aware that it exerts a similar influence over
uric acid.
The urates, also, are remarkable for their slight solu¬
bility in water and the urine, and may be distinguished
by this character from other saline substances with which
they are usually associated, and with which, as a conse¬
quence, they might readily be confounded. They become
more soluble by heat, and by the addition of alkaline car¬
bonates and phosphates, which, without decomposing them,
convert them from acid salts into neutral or alkaline
urates.
Urea is a natural and constant product of nutrition in
the human subject so long as the functions of the organ¬
ism are performed with regularity and health; but when
from any cause these are deranged, the urea ceases to be
formed in normal quantity, and its place becomes occupied
by uric acid and its compounds. Hence we find these
substances in great abundance in remittent, intermittent,
typhoid and other fevers, in rheumatism, gout, and in all
acute and many chronic inflammations. According to Cl.
Bernard, the urea also diminishes in the urine towards the
last stage of inanition. This may be explained by keeping
in view the well-established fact that in the early stage of
abstinenoe the lymph and urea are increased in absolute
and relative quantity, the system as yet being vigorous and
hot suffering from the depressing effects of actual starva¬
tion, the animal meanwhile feeding upon his own tissues.
All this is changed when he has fallen into that state of
utter debility consequent upon long-continued fasting. The
circulation becomes slow and languid, and in this manner
keeps pace with the retarded respiration; the surface is
dry and rigid, the tissues in general grow atrophied, all the
organic liquids of the body—blood, lymph, urine, &c.,
with their constituent proximate principles—are reduced
to the lowest possible ebb, and evince a strong tendency
to putrefaction, as well in situ as when withdrawn from
the system.
Frerichs and Wohler have found that when urate of
potash had been taken into the stomach, the normal quan¬
tity of urea contained in the urine had increased. From
this observation they were led to believe that the excess of
urea was due to an oxydation of uric acid, which they
therefore considered to be the mere exponent of the first
step in the oxydation of azotized substances. M. Gallois,
who repeated the same experiment, was unable to verify
the result obtained by the German physiologists. On the
contrary, he found that the quantity of urea usually voided
in the twenty-four hours had sensibly diminished.
If oxydation is to be measured by the degree of heat
evolved in the human system as in external -combustible
substances, we are forced to admit that the elements enter¬
ing into the constitution of uric acid undergo a higher oxy-
dising process than those of urea in the diseases mentioned.
Chemical analysis of both these products confirms, I be¬
lieve, the correctness of this deduction. The atomic com¬
position of urea is thus represented:—C« H 4 N 2 O*; and
that of uric acid—H 4 N 4 0* We here see that uric
acid contains oxygen in the proportion of 6 to 18, or one-
third of the other equivalents; whereas urea only contains
the same gas in the ratio of 2 to 8, or one-quarter of the
whole. I myself have for a long time adhered to the doc¬
trine still accepted by continental and by most, if not all,
American physicians, which maintains that the formation
of uric acia is the result of a lower degree of oxydation of
the elements that compose it than that of the same ele¬
ments constituting urea. I have renounced it, however,
from conviction, but am prepared to acknowledge my error
when proved to be wrong.
(To be continued.)
CITY OF DUBLIN HOSPITAL.
Cases under the care of Mr. CROLY.
Case 1.—RANULA OF LARGE SIZE—OPERATION—SUC¬
CESSFUL RESULT.
F. M., aged 63 years, residing in the county of
Louth, was admitted into the surgical wards of the City
of Dublin Hospital, suffering from a tumour under his
tongue. •
History . —The growth commenced about thirteen months
previously to his admission, and increased gradually in size;
it caused the patient much annoyance latterly by interfering
with speech and deglutition; the saliva was constantly
flowing from his mouth ; on one occasion he experienced a
most distressing sense, of suffocation. On examination, a
large Ranula was observed occupying the entire right side
of the cavity of the mouth; the tongue was displaced
backwards, and to the left side ; when the patient was told
to put out his tongue, the tip appeared behind the
tumour. The saliva poured from his mouth, and his speech
was so inarticulate that it was difficult to understand what
he said.
The tumour was hard at the base, and had a fluctuating
feel on the anterior surface. The patient said he lost fleshy
which he attributed to the waste of saliva.
Operation .—The patient having been seated in a chair,
Mr. Croly raised the anterior wall of the cyst with *
tenaculum, and cut a circular piece out, the size of a
shilling, by means of a sharp-pointed scissors. The cyst
contained, near the surface, the characteristic glairy fluid,
like white of egg, but thesac was chiefly filled with solid mat¬
ter, which was removed with the handle of thescalpeL These
was very little haemorrhage; the cavity was filled with
lint; the interior of the cyst was subsequently touched
freely with nitrate of silver, and the part healed by
granulation.
The patient was discharged from hospital perfectly cured.
Mr. Croly gave a brief clinical lecture on this disease.
He mentioned the various causes assigned for this affection^
amongst which he alluded to obstruction of the salivary
duct and the development of a special cyst. He aho cm
mer&ted different modes of treatment—the most successful
being that adopted in this case, viz.:—the removal of m.
portion of the cyst, emptying out the contents, and finally
touching with nitrate of stiver; the seton or drainage-
tube being only suitable for cases of Ranula with fluid con¬
tents.
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HOSPITAL REPORTS.
7011 23,1869. 75
Case 2.—hare-lip—operation, leaving scarcely a
TRACE OF DEFORMITY.
M. Staged two months, was admitted into hospital under
Mr. Croly’s care, for the purpose of being operated on for
hare-lip. The fissure was at the left side, and did not
extend into the nostril. There was no cleft in the palate.
The operation was performed in the following manner:-—
The child having been secured in a sheet, was held steadily
in the lap of an assistant. The lip was first freely detached
from the inside by a small scalpel, and the edges were cut
with a curved hare-lip scissors. A fine hare-lip pin was
next introduced near the red margin, and at a distance of
at least a quarter of an inch from the edge of the fissure.
It was passed down as far as the mucous membrane, and
through the opposite side in a similar manner.
A twisted silk suture was applied with moderate tight¬
ness, and a second pin, with twisted suture, was introduced
shove. The edges came into perfect apposition, and strips
of adhesive plaster were applied from one cheek to the
other, to keep off all strain from the sutures.
The child was not allowed to suck for some hours.
The pins were removed in seventy-two hours; the lip
was found to have united most accurately, leaving scarcely
a trace of deformity.
Mr. Croly observed on the advantages of early operation
for hare-lip, and dwelt specially upon the importance of
detaching the lip from the inside before paring the edges.
He recommended the use of the curved scissors, and showed
Borne drawings of cases operated upon by him with that
instrument, which were most satisfactory.
The manner of introducing the pins, and the application
of the twisted suture, was also dwelt upon.
RICHMOND SURGICAL HOSPITAL.
Cases under the care of Mr. WILLIAM STOKES.
(Reported by Mr. .Tames A Ross.)
STRANGULATED INGUINO-SCROTAL HERNIA—DURATION
OP STRANGULATION FIVE DAYS—HERNIOTOMY—SAC
OPENED—UNFAVOURABLE TERMINATION OF THE CASE.
It has been truly remarked that almost every case of
strangulated hernia is characterized by some unusual and
peculiar feature. The following case, which was recently
under observation in Mr. Stokes’ wards, in the Richmond
Hospital, and which presented some peculiarities which
rendered its exact diagnosis a matter of considerable diffi¬
culty, is strikingly illustrative of the truth of this observa¬
tion.
John Wade, aged 21, was admitted into the Richmond
Hospital on the 29th of June, having been recommended
tp Mr. Stokes by Mr. Charles Gray. The patient stated
that about twelve months ago, he got a fall from a horse,
in consequence of which the right testicle was injured, and
became very much inflamed and swelled. This, after a
time, subsided, and then, shortly after this, the patient ob¬
served a small tumour in the scrotum, which he never
could reduce fully, but, without doubt, to a certain extent.
On the night of the 24th ult., without any assignable
cause, the tumour became somewhat larger, and this was
accompanied by an attack of vomiting. The following
day, the vomiting having subsided, he was able to go to
his employment, but on the evening of that day—the 25th
—the tumour became larger and much more tense, and
vomiting again sot in, and the patient continued in this
condition, vomiting at intervals, and with his bowels con¬
fined until the 29th—the day of his admission into hospi¬
tal. Owing to the strangely contradictory statements the
patient made, whose intellect, owing probably to his great
suffering, was in a perfectly distracted condition, it>was a
matter of extreme difficulty to elicit even these few par-
tfealars of his case.
Qmtfc* patient’s admission into hospital, a small tumour
sheutlhasixe of a hen’s egg, was found in the scrotum.
hk the situation of the coni, a little external to the ex¬
ternal abdominal ring, the tenderness and pain were ex*
trenie. This was not the case in the scrotal tumour, which
was free from tension, pain, and impulse on coughing,
The tumour was somewhat pyriform in shape, and tn*
scrotal portion of it felt not unlike a varicocele ; this, as
was subsequently ascertained, was caused by this portion
of the tumour being made up of omentum. The epididymis
could be distinctly felt, and the testicle easily isolated*
On percussing the tumour, the sounds were absolutely dull,
and there was no translucency. Since Thursday, the 25th
ult., five days previous to his admission, the bowels ha4
not acted. His face was pale and anxious-looking, and he
was perspiring profusely. The pulse was very weak,
quick, and compressible, being 120 ; vomiting continued
during the day. In the evening the bowel—probably the
portion only below the strangulation—was cleared by
an enema. There was considerable fulness, pain, and
tympany over the abdomen.
Taking into consideration the want of tension in the
tumour, the absence of impulse on coughing, the fulness,
pain, and tension being localized solely in the cord, the
question to determine was whether the case was one of
strangulated inguino-scrotal hernia, or an omental hernia
combined with acute inflammation in the cord. This con¬
dition, though very rare, has occasionally misled the most
accurate observers. The practice Mr. Stokes determined
on was, in the first instance, to observe the effects of local
depletion and stuping, &c., for a short time, and that then,
should the symptoms of strangulation persist, to cut down
in the situation of the external ring, and return the tumour
should it prove hernial. Several leeches were applied,
followed by hot stuping, and at 9 p.m., Mr. Stokes finding
that the symptoms had not ameliorated, and that the
patient was obviously becoming weaker, determined on
performing the ordinary operation for strangulated inguinal
hernia.
On dividing, carefully, the structures in front of the tu¬
mour, the latter was found to be hernial, the greater propor¬
tion of which was found to consist of omentum, not by any
means gangrenous, but in an extreme state of congestion.
At the upper portion of the tumour, a small knuckle of in¬
testine was found, and of a dark chocolate colour. The
protruded intestine was completely surrounded by omentum.
There was no difficulty, after dividing the stricture, in re¬
turning the intestine into the abdomen, but the reduction
of the omental portion of the tumour was, owing to ex¬
tensive adhesions, attended with very great difficulty. The
hernial tumour, however, was, after some time, completely
reduced. After the operation the patient got a powerful
anodyne draught, containing opium, Hoffmann’s anodyne,
and hydrocyanic acid. During the night, he slept for some
hours; the pulse became stronger and fuller, but still com-*
pressible; his face lost its anxious look, and its colour im¬
proved.
June 30th.—The vomiting continues ; there is scarcely
so much pain over the abdomen; bowels not moved; pulse
120, stronger and better ; he complains of much thirst, and
perspires freely. He was then ordered one grain of calomel
every hour, leeches to the abdomen, mercurial inunction in
the axilla and over the abdomen, and, internally, opium and
iced brandy, with dilute hydrocyanic acid. As the day ad¬
vanced he became very restless ; the vomiting continued;
the forehead was covered with large drops of perspiration,
and the feet and hands grew clammy and cold ; the great
thirst remained throughout the day quite unrelieved. The
pulse rose until, at midnight, it was over 150, and at two
o’clock a.m., twenty-nine hours after the operation, the
patient sank.
The autopsy revealed a state of things which would
render recovery under such circumstances quite hopeless. -
The intestines were very vascular from the extensive
and violent peritoneal inflammation, and lymph was ex¬
tensively thrown out all over them, in fact, glueing them
all firmly together. They were also greatly inflated above
the seat of the stricture. The omentum was carried down
in a strong band, and had contracted adhesions with the
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GENERAL MEDICAL COUNCIL.
76 The Medloal Press and Circular.
sac in the scrotum. The portion of the small intestine
about the constriction, which was near the ilio-ccecal valve,
was approaching a state of gangrene, and the portion of in¬
testine below this was contracted.
In some clinical remarks to the class on this and other
cases of strangulated hernia, which have recently been
under observation in the Richmond Hospital, Mr. Stokes
mentioned the leading peculiarities and features of each.
He also drew attention to the general principles of treat¬
ment for all such cases, both before and after operation.
Special mention was made as to the use of opium in such
cases, and it Was pointed out how its inconsiderate use
before operation may, by causing the subsidence of vomit¬
ing, one of the most important and characteristic symptoms
of strangulation, mislead the incautious surgeon, who in
consequence of the apparent amelioration in the patient’s
symptoms, may either defer the operation to too late a
period, or, labouring under the erroneous belief that
strangulation no longer existed, abandon it altogether.
The great advantages of opium after operation were then
dwelt on, and Mr. Stokes mentioned that the chief reason
for its administration after operation is analogous to that
for which atropine is principally given in cases of acute
Iritis; in both cases the great object of the surgeon being
to bring the muscular structures in the one case of the
intestine, and in the other of the Iris, into a state of
quiescence or repose, these objects being attained respec¬
tively by opium and by atropine. In the case of Iritis, frequent
use of atropine is much more important in bringing about
absolute rest of its muscular fibres, than for diminishing
the chances of posterior synechim by keeping the iris
dilated, or, as it undoubtedly does, acting as a local
narcotic.
DR. STEEVENS' HOSPITAL.
0a8E8 under the care of Mr. COLLES.
RETENTION OF URINE, WITH PUNCTURE OF BLADDER.
Daniel Conollt, set. 21, was admitted into hospital on
Sunday, June 21, under the following circumstances -He
had, on previous occasions contracted gonorrhoea, and was
then labouring under that disease. The night before he
had indulged to a large amount in drink, principally porter
and whisky, and found himself in the morning unable to
pass urine. On examination, the bladder was enormously
distended, its outline distinct on the abdomen. He was
evidently suffering severe pain, although partially stupid
from intoxication, and making violent straining efforts to
pass water. All attempts to pass a catheter were unavail¬
ing, the extreme congestion of the urethra being denoted
by the occurrence of haemorrhage on the gentlest trial of
the instrument. The warm bath, and all other general
methods that could be devised for affording relief, were
successively adopted, but without success. The symptoms
of distension being very urgent, it was at length determined
to evacuate the bladder by puncture, which was done
through the rectum. Nearly 70 ozs. of urine, by measure,
were drawn away. The canula was retained in the bladder
by means of tapes.
22nd.—The urine has passed freely through the opening
in the rectum ; the canula has slipped out. A catheter of
the railroad kind, used by the late Dr. Hutton, was passed
into the bladder through the urethra. Over the fine cat¬
gut director an instrument was introduced without much
difficulty, and retained in the bladder.
23rd.—The instrument was withdrawn ; the urine has
ceased to pass through the artificial opening.
29th.—The man has left hospital to-day, passing water
freely through the urethra. There is some gonorrhoeal
discharge, for the treatment of which he has been directed
to eome to the hospital dispensary.
This case seems to show very definitely that the class of
strictures, usually known by the term sp;tsmodic, are more
dependent on a congested state of the mucous lining of the
urethra, which condition may be sufficient as well to cause
complete retention, as to create a formidable difficulty in
ordinary catheterism. The small amount of inconvenience
resulting from the puncture, and rapid recovery, are worthy *
of notice.
LARGE MALIGNANT TUMOUR OF BREAST : REMOVAL :
RECOVERY.
R. Smith, set. 49, was admitted into hospital in March
1868. He had the aspect of rude health, naving a florid
complexion and cheerful expression of countenance, and
was remarkably large, weighing 322 lbs. He was suffering
from a large tumour in his right breast, which had been
growing about fourteen months ; it had at that time
attained the dimensions of a child’s head, and had ulcerated
in one place, from which he had some severe attacks of
haemorrhage. After remaining in hospital about a week,
the tumour was removed by an oval incision—it weighed
three and a-half lbs., and on microscopic examination was
found to be distinctly cancerous in its nature. The wound
healed rapidly, and the man left hospital three weeks after
the operation. This case has some interest in showing that
the possession of a robust frame and plethoric habit of
body confers no immunity from the development of malig¬
nant disease. Many instances have recently occurred m
this institution, where cancer has made its appearance
in individuals apparently of the strongest and most healthy,
constitution.
-» — ■ - ■ -
GENERAL COUNCIL OP MEDICAL EDUCATION
AND REGISTRATION.
PHARMACY.
The following is the report of the Pharmacy Bill Committee,;
which we promised, owing to its importance to the profession
at large, to give in exlenao :—
The Committee appointed to consider and report on the Bill
for the regulation of pharmacy now before Parliament, beg to
submit the following report to the General Medioal Council ;•
and they desire to state that, in considering the matter, they
have had the advantage of the presence of Mr. Sandford, Pre¬
sident, and of Mr. Bremridge, Secretary of the Pharmaceutical
Society.
The course adopted was, in the first instance, to read the,
recommendations, in order, of the Committee of the General
Medical Council on the pharmacy question in 1865, and to aslf
the President and the Secretary of the Pharmaceutical Society
for information as to the reasons of the promoters of the Bill
for not adopting the suggestions of that Committee. Mr,
Sandford and Mr. Bremridge most kindly and most frankly,
met all the questions. The following are the questions and
replies, divided under the two heads, “ Pharmacy,” and “ Sale
of Poisons.”
PHARMACY.
Suggestion No. 1.—Why was this suggestion, proposing to
extend the Bill to Ireland not adopted ?
Reply.—1st. That the Pharmacy Bill of 1852 did not extend*
to Ireland.
2nd. That the promoters were informed that the dispensing
chemists of Ireland were a superior class of men to those in
England.
3rd. That the promoters do not now object to the extension
of the provisions of the Bill to Ireland.
Suggestion No. 2.—Why was it not rendered imperative on
all chemists and druggists to follow the formularies of tie
British Pharmacopoeia in compounding prescriptions I
Reply.—It was considered that such compulsion wee not
within their jurisdiction, but belonged wholly to higher author
rities. The promoters do not object to the insertion'of sneh
provision.
Suggestion No. 8.—Why are persons admitted on what ap- •
pear to be too easy terms, and why are the privileges proposed
in 1865 to be given only to those then in business, now ex¬
tended by the present Bill to a wider class of unqualified
persons! - — -- - -
Reply.—That such extension was given by Parliament iaf •
protection of vested interests; that a committee of . the HoUSe
of Commons.in, 1865 recommended such extension, and t ha t
without such extension the Bill would have no chance of pan¬
ting through Parliament.
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fhs Medial £re« sad Ctrcnlsr.
general medical COUNCIL.
JnlyM, 1868. 77
to
. Bn&eetiaD. No. 4. —Why is some provision not inserted to
prohibit dispensing chemists from practising any branch of
Medicine or Sorcery ?
Reply.—-1st. That the power to prevent nnqualified persons
from practising Medicine or Surgery rested, in their opinion,
with a higher authority.
2nd. That they object as strongly as any others to dispens-
obemists practising Medicine or Surgery, and that Sect.
IL of the Pharmacy Act of 1852, which remains in force by
this Bill, strictly excludes any examination in Medicine, Sur¬
gery, and Midwifery from the examinations.
SALE OF POISONS.
Suggestion No. 1.—Why are not the provisions of the
Arsenic Act extended to the sale of all the more fatal poisons 1
Reply.—That the provisions of the Arsenic Act remain a
dead letter.
Suggestion No. 2.—What restrictions as to sale of poisons
are to be imposed upon registered chemists ?
Reply.—There was no restriction in the original draft,
bat Clause No. 1, as amended in the House of Lords, provides
that all chemists shall “ conform to such regulations as to
keeping and selling of such poisons as may be prescribed by
the Pharmaceutical Society, with the consent of the Privy
Council.”
The promoters of the Bill consider this restriction quite
sufficient.
Suggestion No. 8.—Why does not the list of poisons in
Schedule (A) include opium ?
Reply .—-Opium was included in the first draft of the Bill,
but the promoters of the Bill received such strong representa¬
tions from chemists residing principally in Cambridgeshire,
Lincolnshire, and Norfolk, against interfering with their busi¬
ness—opium, as they stated, being one of their chief articles of
trade—that the promoters felt compelled to strike opium out
of Schedule A ; but that clause 2 of the Bill provides for the
addition, from time to time, of any article deemed a poison to
Schedule (A), with the consent of the Privy Council, and that,
at any time, it and any other poisons might be so inserted.
Your Committee now beg to report their own conclusions,
and they would here recommend the introduction of the
single word “ pharmacist,” for the several terms now used,
“•chemist and druggist,” ** compounding chemist,” " pharma¬
ceutical chemist,” Ac.
PHARMACY.
. Your Committee desire, in the first place, to correct a mis¬
take in the information conveyed to the promoters of the Bill
—viz.: “ That the dispensing chemists of Ireland are a
superior class of men to those in England.” The fact is, that
there are no such persons in Ireland as compounding chemists,
while there are more than 6000 compounding chemists in Eng¬
land and Wales. The only persons permitted to compound
nfcdiriinea in Ireland are licentiates of the Apothecaries* Hall of
Iceland, any other person opening a shop for compounding
medicines in Ireland being liable to a fine of £20 for every
offence of compounding a prescription, at the prosecution of
the Apothecaries* Hall of Ireland, and to obtain such licence
it is required by the Apothecaries* Hall of Ireland that the
candidate should have gone through a four years' course of
study joi anatomy, surgery, medicine, and midwifery.
Your Committee are of opinion that some provision should
bp introduced into the Bill by which pharmacists, duly exam-
insd-aoaordinff to the provisions of the Pharmacy Act of 1852,
and registered under the proposed Act, shall be permitted to
open shop in like manner in Ireland, as in England, without
being liable to prosecution or infliction of penalty ; and that
if* there be any obstacle in the Apothecaries* Act of Ireland
te prevent the licensing by the Apothecaries* Hall of Ireland
of pharmacists in Ireland, that that obstacle should be re¬
moved, giving reciprocity of practising pharmacy throughout
tbs. United Kingdom.
£n rcferenoe to the introduction of a clause rendering it
cempnlscty on pharmacists to follow the formulary of the
Britm ^harniacoporia, the Committee observe that the obU-
gllta to compound according to the formulary of the British
rVginifinpcnii is provided for to some extent by sections 2
afeftfrd Act 2fi and 26 Viet. c. xci., which are as follows
Sect. IL— “ The exclusive right of publishing, printing, and
Nibg^tlM lflftd Pharmacopoeia shall rest in the said general
CoomQ, Subject to this proviso : that it shall be lawful for the
~ i of * the Treasury from time to time tor fix the
of the said work are to be sold to the
Sect. III.—“The British Pharmacopoeia, when published,
shall for all purposes be deemed to be substituted throughout
Great Britain and Ireland for the several above-mentioned
Pharmacopoeias, and any Act of Parliament, order in Council,
or custom relating to any such last-mentioned Pharmacopoeias
shall be deemed, after the publication of the British Pharma¬
copoeia, to refer to such Pharmacopoeia.’*
Your Committee regret that this Act of Parliament, or the
above sections, were not printed in the last edition of the-
Pharmacopoeia, as they were in the first, and suggest to the
Council the propriety of giving them publicity.
Your Committee are, however, of opinion that the above
sections are not* sufficient to enforce the desired object, and
recommend that a provision should be introduced into the
Bill to render it imperative on all registered pharmacists to
dispense medicine in strict accordance with the British Phar- *
macopoei unless, when otherwise specially directed in written
prescriptions.
Your Committee beg to call particular attention to the
provisions of this Bill, which would register indiscriminately
every person who may be at the present time engaged even.
partially in the business of chemist and druggist. The pro¬
posal in this Bill goes farther than the corresponding proposal
in the Bill of 1865, inasmuch as it would qualify for registra¬
tion every assistant and every apprentice of two years* stand¬
ing. To such extensions your Committee strongly object.
In a measure which constitutes a registered body, to which
would be committed the power and responsibility of dispensing
medicines which may be poisonous, or injurious, or worthless,
if not properly prepared and from pure materials, some better
plea for indiscriminate registration should be adduced than
the protection of vested interests. The health and safety of
the community are surely of more consideration than the *
vested interests of traders. Your Committee therefore re¬
commend that the legalised right to dispense medicine should
be confined to members of the Pharmaceutical Society, and to
such other existing chemists and druggists as the Council of
that Society may recommend for the privilege of registration.
On the question of inserting a stringent clause in the Phar¬
macy Bill to prevent pharmacists from practising any branch
of Medicine or Surgery, your Committee observe that they
would be liable, in common with all other unqualified persons,
to the penalties provided in the Medical Act of 1858, but
your Committee are of opinion that such provision is not suffi- .
cient, and that a provision of a similar kind to that recom¬
mended by the Committee of 1865 should be added to Clause
16 of the present Bill, after the words “ Medical Practitioner,”
viz.:—“ or entitle any person registered under this Act to
practise Medicine or Surgery, or any branch of Medicine or
Surgery.”
SALE OF POISONS.
Your Committee, as already stated, are informed that the
provisions of the Arsenic Act have become a dead letter; and
if such be the case, they would not recommend that the pro¬
visions of the said Act should be embodied in this Bill.
Your Committee are of opinion that Clause No. 1 of the
present Bill would sufficiently provide for the regulation of the *
sale of poisons, if the same power were extended to the General •
Medical Council as to the Pharmaceutical Society, viz.:—to
represent to the Privy Council what in their opinion should be
inserted in Schedule A as poisons, and, from time to time, to
make such other representations to the Privy Council for the
protection of the public as may seem advisable.
With regard to the omission of opium from the list, your Com¬
mittee are of opinion that opium should be inserted either at
once, or under the provisions of Clause 1 ; and that the reasons
which have been put before this Committee! viz.that re¬
gulations as to the sale of opium would interfere with the trade
profits of druggists in certain parts of England—constitute, in
the opinion of your Committee, the strongest ground? fer in- *
serting opium in the list of poisons.
With regard to the sale of opium and other poisons la Ire¬
land, there is already in force in Ireland an Act, 81 Geo. III.,
cap. 84, applying to the sale of arsenic, &c.; and it may be
advisable, in the next session of Parliament, to consider the *
expediency of extending the provisions of that Act, or Of the
present Bill, to that part of the United Kingdom.
Dr. Rumsey said he regretted the Committee had only^had
the opportunity of conferring with the representatives of one -
of the bodies which were promoting this Bill—namely, the'
Pharmaceutical Society; the other large body—the chemists *
and druggists of ths ©ountry^tfcey had not yet been abteto
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W The Medial Pnm and Circnlar. GENERAL MEDICAL COUNCIL.
communicate with. He also regretted that it did not appear
practicable to adopt the Pharmaceutical Society under the
Act of 1852 as a basis of legislation. It would then have been
necessary merely to prohibit the use of the title of pharma¬
ceutist by those who were not on the register, dealing with them
just in the same way as unregistered Practitioners of Medicine
were dealt with by the Medical Registrar—not prohibiting
such as were now in business to continue their occupation, but
not allowing them to be on the Register, which would give
them a sort of legally established position in the country.
The number of chemists in the country was very much larger
than it was stated to be by the Pharmaceutical Society, who
put the number at between €000 and 7000, whereas, taking
the census of 1861, there were found to be not less than
16,000 males entered as belonging to the occupation. No
doubt many of them would be assistants, but still the differ¬
ence between 6000 and 16,000 was rather astonishing. The
Committee were unanimous in desiring not to interfere, further
than was necessary for the public health and safety, with
chemists and druggists now in business. The Apothecaries’
Act of 1815 had been quoted on behalf of existing interests,
but that did not apply to the present proposal, because it did
not create a registration of members, but merely protected
existing members from any interference.
Mr. Cooper said there was a register kept at the Apothe¬
caries’ Hall for the purpose.
Dr. Rumsey was sorry the great principle of supervision
had been omitted in the present report. Perhaps it was pru¬
dently done, but he was bound to say it was a principle which
the Council had already laid down in a report adopted by
them. Add to that the fact that England was the only country
in the civilised world where pharmaceutical chemists were not j
subject to control, and he thought he sufficiently justified him- I
self in calling the attention of the Council to the matter. With
regard to Mr. Sandford’s statement that the provisions of the
Arsenic Act had become a dead letter, after having the advan¬
tage of hearing a statement of Mr. Simon upon the subject, he
could not admit the truth of the assertion. He believed that
those provisions had exercised a most salutary effect in cur¬
tailing the unlimited sale of so frightful a poison as arsenic,
and he would have liked to see in the report a recommendation
for applying similar safeguards to the sale of other poisons.
He was sorry to say that the Pharmacy Bill now under dis¬
cussion did not give that power. It gave power solely to the
Pharmaceutical Society, with the consent of the Privy Council ,
thus leaving the initiative with the Pharmaceutical Society.
With regard to the sale of opium, the reply received from the
Pharmaceutical Society was most curious and instructive—
namely, it 44 was included in the first draft of the Bill, but the
promoters of the Bill received such strong representations from
chemists residing' principally in Cambridgeshire, Lincolnshire,
and Norfolk against interfering with their business—opium, as
they stated, being one of their chief articles of trade—that the
promoters felt compelled to strike opium out of Schedule A.”
It was a very remarkable thing that those three counties the
Medical Officers of the Privy Council had shown to be dis¬
tinguished for the highest rate of infant mortality in the king¬
dom, and they attributed this mortality and the degeneration
of race that was going on in those counties to the enormous
consumption of opium—-yet, with that frightful fact before the
community, the promoters of the Bill struck out the word
opium in deference to the traders in those counties. He now
moved that the report be adopted by the Council, following
upon which some resolutions would be moved by Sir D. Corrigan
on the subject.
Dr. Quain thought the report should be discussed para¬
graph by paragraph, because to some parts of it he felt bound
to offer considerable opposition. For example, it was most de¬
sirable that the Act should extend to Ireland, but, on the
other hand, that all chemists should adopt the British Pharma¬
copeia was most inconvenient. No one had greater desire to
extend the Pharmacopoeia than he had, but to adopt it indis¬
criminately and by force of law in that way would lead to very
For example, many were in the habit of
made up ; a chemist in such case
nd judgment; but under the
s he understood it, a chemist had no
r but to use the British Pharma-
s of the principal chemists and
said it would be a most
indiscriminate and corn-
resolution
founded upon the report— 44 That the term pharmacist be in¬
troduced into the wording of the Act as synonymous with the
;erms compounding chemist, pharmaceutic chemist^ chemist or
druggist”—-said the word 44 pharmacist” had been chosen by
the Committee as more in accordance with the usage on the
Continent, and also as a term which it was thought would in
time supersede the variety of terms at present in use.
The resolution was seconded by Dr. Storrar, and unani-
nously adopted.
( Sir Dominic Corrigan, in moving the second resolution—
* That, from and after the passing of this Act, 4 pharmacists,*
or 4 dispensing chemists,* or 4 druggists,* duly qualified to open
hops or establishments in England for the compounding of
■ uedicines, shall in like manner be duly qualified to open like
hops or establishments in Ireland, and shall not be liable to
penalty. or fine for so doing, and that in like manner persons
licensed in pharmacy, and registered by the Apothecaries* Hall
of Ireland, shall not be liable to penalty or fine for so doing in
Great Britain'*—said that, whereas the Bill provided certain
j o iso ns should not be sold by such and such persons unless
they conformed to such regulations as to the sale of them as
might be prescribed by the Pharmaceutical Society with the
consent of the Privy Council, the Committee proposed to ill-
t roduce the words 44 or by the General Medical Council,** thus
giving them power to initiate any steps they might think
necessary.
Dr. Andrew Wood was pleased that a new class of dis-
ensing chemists (who would not assume the power of pre¬
scribing) would, by this resolution, be introduced into Ireland.
In moving the third resolution— 44 That in clause 1 of the
Pharmacy Bill, after the words 4 may be prescribed * should
be inserted the words 4 by the General Medical Council or/
and that in clause 2, line 3, similar words should be inserted
after the word 4 and,* and again after the word 4 thereupon *
in line 7 *’—
Sir D. J. Corrigan said the object was to give power to the
General Medical Council as well as the Pharmaceutical Society
to suggest to the Privy Council such questions as this— that
certain dangerous drugs should be put into' S c h ed u le A con*
t tuning poisons dangerous to human life a-nd health.
Mr. Hargrave seconded the resolution, and after discussion
the resolution was put to the vote and negatived, as was also
an amendment by Dr. Rumsey that the words 44 the Pharma*
ratical Society with the consent of’* be omitted from the Bill
-thus-leaving the initiative with the Privy Council.
THE BALE OP OPIUM.
Sir D. J. Corrigan, upon this subject, moved 44 That 4 opium*
should be inserted in Schedule A.** This was unanimously
adopted.
DRUGGISTS* ASSISTANTS AND APPRENTICES.
The following resolution, moved by Sir D. J. CORRIGAN, and
s econded by Dr. Andrew Wood, also received the assent of
the Council: 44 That clauses 3 and 4 be so amended as to limit
the registration of 4 pharmacists * or chemists and druggists to
members of the Pharmaceutical Society, and to such other ex¬
iting chemists and druggists as the Council of that Society
may recommend as fit to be placed on the registry.’*
THE NEW PHARMACOPOEIA.
Sir D. J. Corrigan moved 44 That all pharmacists shall be
required to compound medicines according to the formularies
the British Pharmacopoeia, unless otherwise specially
directed in the written prescriptions.”
Dr. Quain objected as before to such a clause, in cons©-
! icnce of the hardship and inconvenience which he was con¬
vinced from practical knowledge it would impose upon phar¬
maceutical chemists. It was a well-known fact that certain
1 ' i edical men did not use the British Pharmacopoeia, and at the
same time did not indicate that fact upon their prescriptions.
1 hemists at present knew, from the quarter whence the pre¬
scription came, that it was intended to be made up under the
London Pharmacopoeia. But unless this was distinctly stated,
wider the proposed clause, they would be compelled by law to
dispense under the British Pharmacopoeia ana no other; and
the responsibility of any mishap would be thrown back upon thS
medical man.
This resolution was also carried, and the next and last fcesoln*
ti<jn on the subject was agreed to-*- i-
THE PRACTICE OP MEDICINE BY PHARMACISTS.
u That there shall be a clause introduced, prov idi ng that
registration under this Act shall not entitle any penm so
le
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literature.
July M r 1868. 79
registered to practise medicine or surgery, or any branch of
Medicine or Surgery.”
It was then moved, “That a deputation consisting of the
President, Sir Dominic Corrigan, Dr. Rumsey, Dr. Leet, and
Dr. Alexander Wood, be requested to place, without delay,
before the Home Secretary, the resolutions of the General
Medical Council in reference to a report of the Pharmacy Bill
Committee this day considered by the General Council, placing
in his hands both the report of Committee, and the resolutions
adopted by the Council.’’
The deputation, as proposed, thereupon left the Council for
the purpose stated, and returned at a subsequent period of the
meeting, Sir Dominic Corrigan, in the absence of Dr. Rumsey,
Chairman of the Committee on Pharmacy, reporting to the
Council that the deputation had had an interview with Sir
James Fergusson, Bart., Under-Secretary of State for the Home
Department, and had handed to him the resolution of the
General Medical Council previously agreed to, and that Sir
James Fergusson had promised to give the resolutions and
report of the Committee his best attention in the progress of
thfe BUI through the House.
The Council having expressed themselves satisfied with the
result of the deputation, the subject dropped.
iituatirr*.
FBOFESSOR MOBLEB ON THE TREATMENT OF TYPHUS FEVER. 1
A work on such an important subject as the treatment of
typhus fever undoubtedly is, written by a teacher of clinical
medicine at one of the largest schools in Germany, has a just
claim on our immediate attention. On Professor Mosler’s
ability to treat bis subject in such a manner as to make it
profitable both to science and the practitioner, we need not
dwell. But it may just be mentioned, that the author’s re¬
searches on entozon and mykology have placed him in the
foremost position amongst the authors of this department.
The work is divided in six parts, treating on the following
subjects:—
1. Prophylactic measures, by means of which an epidemic
im tiie district of Fransburg has been kept within its original
hmito, and soon quenched.
8. Statistics of cases of typhus fever treated in the Hospi¬
tal of Stralsund.
8. Experiments on the contagiousness of typhus fever, and
eortiieprophylactic measures derived thereform.
^ Description of barracks of the Greifswald University
Hospital, and the results obtained therein, during winter, in
typhus and other diseases.
5. Statistics of cases of typhus fever, treated in the Uni-
vem ty Hospital of Greifswald, during 1866-1867.
6. General remarks.
To treat on all parts separately and in such a manner as
they deserve, would imply a reproduction of nearly the whole
bosk. That being impossible, we must confine ourselves to
two parts which we consider of the utmost importance, and
leave with the reader the perusal of the book itself, if they
feel more deeply interested in the subject.
The first of the two points concerns the experiments in
respect to the contagiousness of typhus fqver.
Professor Mosler maintains, acknowledging the correctness
of PasteuFs researches, according to which fermentation and
putrefaction are induced and conducted by vegetable or ani.
mal or ganisms of a lower order, that by influence of the same
minute beings, animal and human substances may become in¬
fectious. This applied to typhus fever, our whole-eare must
tend.towards the prevention of the secretions and excretions
of the patients, undergoing decomposition, by means of the
products of. which contagiousness is principally engendered.
most simple and the most convenient way of arriving at
tw feM end, is the immediate removal of the secretions
and kXcxetiOns from the wards, and the cleanliness of the
by putting them often into a bath. The whole pro-
as adopted in the treatment of fyphus, by means of
Wtt» r «aoo*rding to hydro-therapeutical principles, frequent
cfcanfer'cl Hnen, keeping clean all parts of the patient’s
1 R r f s hrnn gSP fiber die Behandlung des Typhus exanthematius mit
BdUnfc hUittsg dabel erf or derlicher prophylakticher Maassregeln,
Will tie nisi Usaltfitatircuiitn mltgetheilt von Dr. Fr. Mosler, ordent-
Mi nifiioi fliT Medidn. Director der Medidnischen Kilinck an der
OcaSwald, )ut. l, Tafel Greifswald, Akademische
1869 .
body, prevents the development of a nest of contagion imme¬
diately around the patient.
Professor Mosler has experimentally shown the part played
by lower organisms in decomposing secretions and excretions
from patients labouring under typhus fever, to be really great,
and that their origin and multiplication must by all means be
prevented.
1st Experiment .—On 8th April, 65 C. cent, of blood from a
patient suffering from typhus fever, whose morning tempera¬
ture on about the sixth day of his illness was 40*3 C. in
the axilla, were defibrinised and injected into the right jugular
vein of a dog, after having emitted from the same vessel a
quantity of blood, equal to that injected. Immediately after
transfusion the animal became infirm on its legs, but gradu¬
ally recovered, exhibiting only during the day of injection a
higher temperature, thirst, and passed urine somewhat mixed'
with blood. On the next day, the dog was perfectly well, and
continued so.
2nd Experiment .—A patient, whose temperature on the
seventh day of illness was 40*5 C. at five in the afternoon, whose
pulse was 130 in a minute, who exhibited numerous petechise and
all other symptoms of typhus fever, was bled, and about 90
C. cent, of blood was drawn, at once defibrinised, and still
warm, about 40 C. cent of it injected into the left jugular
vein of a dog; no abnormal appearances could be observed,
and the animal continued in perfect health.
3rd Experiment .—On the 8th of April, a quantity of blood
was taken from the right ventricle of a patient, who died from
typhus fever. It remained twenty-four hours in the vessel,
and contained after that time a very large number of Bactriss.
It was filtered, raised to a temperature of 31 R. and 60 C.
cent., injected into the right jugular vein of a healthy dog.
Immediately after injection, no perceptible alteration of the
animal, but a few hours afterwards vomiting, intense fever,
profuse diarrhoea set in, the animal collapsed rapidly and died
after twenty-two hours. On post-mortem examination, the
sinuses of the brain were found filled with blood, the same
in the envelopements of the brain, the latter exhibiting some
small extravasations. No catarrh in the lungs; on the surface
of the anterior rim of the left lung, a few small extravasa¬
tions were visible. A small hemorrhagic infaret, which, how¬
ever, could not be shown dependent on embolism. Heart
normal, liver normal, spleen voluminous, containing much
blood, but soft. Kidneys congested. Bladder filled with fluid
of a reddish yellow colour, containing albumen. Bowels re¬
markably altered, being thoroughly filled with a "dark bloody
mass ; mucous membrane swelled, nyperaemic containing extra¬
vasations, even the stomach was filled with the same dark
bloody mass as the bowels.
Small as the number of experiments is, and negative as are
the results of the two first experiments, yet they sufficiently
show the blood of a typhus-patient, when immediately trans¬
fused into an animal, does not under all circumstances produce
typhus, but only acts as blood of any other patient suffering
from some kind of fever, and experiments recently made by
Frese have even shown that larger quantities of healthy blood
produce fever symptoms, if a venesection has preceded infu¬
sion, from which fact Frese considers increased reception of
products from physiological decay into the blood, as the cause
of raise of temperature after bleeding, and after transfusions
following such bleedings.
From the positive results of the third experiment, Prof. Mosler
concludes, that the blood, as well as the secretions and excre¬
tions from typhus-patients, assume deleterious properties, when
some time under the influence of the atmosphere, and
when decomposed by lower vegetable or animal organisms.
In fresh typhus-blood Bactriae could not be discovered.
Some feeding experiments made with dejections from patients
suffering from typhoid fever, are of great interest, and may
briefly be mentioned.
4th Experiment .—On 31st October, 200 C.C. of typhus-stool
from a patient suffering from typhoid fever, whose evening
temperature in the second week of illness was 40*2 C., morning,
temperature 39*6 C., were given by means of a funnel, to a
strong, healthy dog. No vomiting after infiltration. The
stool has been evacuated during the night from the 80th to
31st October, and infiltrated on the 31st October, at 11 o’clock
A.M. The microscope Bhowed the usual elements of typhus-
stool, but there were already numbers of vibriones. Reaction
intense alkaline.
On the first of November, temperature in the rectum .of the
dog 39 C. On the next day the animal was perfectly healthy;
no diarrhoea.
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16 n* Medial Trea md cifeuiir. ELECTION AT T&E COLLEGE 0? PHYSICIANS.
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On the third of November, 25 C.C. of typhus-stool five days
old, have been given to the same dog. The stool contained
large masses of vibriones, reaction intensely alkaline. No
symptoms perceptible during the first few days, but on the 9th
November the animal declined taking food ; had rigors, shiver-
ings, was emaciated, and died on the 14th November.
On the post-mortem examination, ulcers of the intestines
and other products were seen as are usually met with in
cases of typhoid fever.
5 th Experiment .—On the 28th November, 600 C.C. of fresh
typhoid-stool was given to a dog, and all precaution taken to
prevent the fluid being returned by vomiting.
On the 29th the animal was uneasy ; took but little food ;
was very foetid, but recovered the next day. Temperature
measured in the rectum was not raised.
MORNING TEMP.
26th November 88*8 C.
27th „ 38-6 C.
28th „ 38*9 C.
29th „ 38 6 C.
80th „ 38*6 C.
EVENING TEMP.
39-1 C.
891 C.
39*2 C.
391 C.
391 C.
No symptom of disease was afterwards observed in the dog.
While repeating the experiment on another dog with stool
which had been standing for five days, and containing large
masses of vibriones, the whole quantity was returned by vomit¬
ing. Nevertheless, the dog fell ill, but ultimately recovered,
which Prof. Mosler takes as evidence that the smallest quantity
of stool, when putrefied, may give rise to disease.
(To be continued.)
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“SALUS POPULI SUPRBMA LEX.”
WEDNESDAY, JULY 22, 1868.
THE MEDICAL DEPARTMENT OF THE
ABYSSINIAN EXPEDITION.
Medical Officers in the army complain, with good reason,
that their labours with our troops in all climates, and
under every circumstance of military service, neither obtain
for them the rewards and distinctions that are bestowed
on military men, nor those that the more successful of their
professional brethren in civil life receive. They justly
consider that they are thus in a most unfavourable position
in these respects; nor can exception be taken to the point
of view from which they consider their position.
< It is not enough to assert that in any improvements in
their social status, pay and prospects on retirement have
of late years been effected, nor to remind them that only
within the present century has the custom been established
of any notice bemg taken in “ orders” by commanders of
their services at all. These facts are not denied, although
when contrasted with the improvements effected in the
status of tHe medical practitioner in civil life, and in the
condition of the army military officer, they hesitate to be¬
lieve that, as compared to either, they have not been left
behind. Knighthood and baronetcies have been conferred
upon medical men practising in civil life; similar and far i
greater rewards upon generals employed in the different |
wars in which our troops ‘have, during the last fourteen
years, taken part. But as to the medical officer! let us
look at the Army List, and we there find there is not
among the names of those now on full-pay any distinctive'
honour beyond the Companionship of the Bath.
The omission of the Medical Officers attached to the
army in Abyssinia in the vote of thanks to all other de¬
partments connected with that force, is an illustration in
point, and has, in fact, given rise to these remarks. Under
ordinary circumstances, to omit all mention of the officer
at the head of an administration, implies censure of that
officer, and of the department under him. Dr. Currie,
fortunately for himself, had already established his reputa¬
tion as an able administrator and first-rate medical
officer, and had this not been the case the accounts given
by correspondents with the force, not to mention the re¬
cognition of his services in the despatches of Sir Robert
Napier, amply testify to the importance of the services
that, on this occasion, have been rendered by him and the
medical officers employed under his orders.
It is clear, then, that the non-recognition of those ser¬
vices, rests not with the General in command. No man
knows better than Sir Robert Napier the value of an
efficient medical department, and no man is more ready
than he to give to each the credit to which he is justly
entitled, whether he be military, medical, commissariat, or
other “ departmental” officer. How comes it, then, that
among the principals whose services were acknowledged by
Sir Robert Napier as having conduced to the success of
the expedition, Dr. Currie has alone been excluded in the
filtering process that the despatches underwent in their pro¬
gress to concentration in the Houses of Parliament ? With
whomsoever the blame rests, the omission is a grievous
mistake. The prospects of Army Medical Officers are
already small enough in all conscience. Even with open
competition there is some difficulty in u catching” a suffi¬
cient number of young men at ten shillings per day per
head to fill existing vacancies ; but, bye and bye, when the
eyes of those self-same young men shell have been opened,
when they see that they are shut out from the rewards of
civil life, and not admitted to those prized sq much in
military, they will cease to take pride or to exert them¬
selves in a position in which, whatever be their individual
merits, whatever the services rendered by them, they
meet with no other treatment than discouragement and
absolute neglect.
THE ELECTION AT THE DUBLIN COLLEGE
OF PHYSICIANS.
On Friday next, the 24th instant, the President and
Fellows of the King and Queen’s College of Physicians in
Ireland will proceed to elect a King’s Professor of the
Practice of Physic on the foundation of Sir Patrick Dun,
under the provisions of the School of Physic Act of 1800,
and of the amended statute—the School of Physic Amend¬
ment Act of 1867.
We have on more than one occasion adverted to this
matter, and as our readers are by this time tolerably well
acquainted with the facts of the case, we need not further
advert to them now. We have every confidence in the
electors, and we are>convinced that each one will vote
according to his solemn oath, and execute the trust reposed
in him to the best of his judgment, and for the honour and
dignity of our profession.
There is, however, one point in connection with this elec¬
tion to which sufficient attention has scarcely been given,
in our opinion, and it is this the important, very im-
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fee Ifatteal ires and Circular.
NOTES ON THE ABYSSINIANS.
ibly<j,lM8. 8l
port&nt, question—how long shall the Professor hold his
office?
The newly elected professor, according to the terms of
the statute, will be chosen for seven years only ; and,
herein, we think, lies a very important consideration.
Hitherto, it has been customary to re-elect the Pro¬
fessors of the School of Physic at the conclusion of their
Septennial terms, the Act empowering the electors to do
so ; but there is nothing in the terms of the Act to give
rise to the idea that these professorships are de facto ten¬
able for life.
When once a gentleman has been elected on the old cus¬
tom, mooting this question, so far as he is concerned,
would, of course, have a personal aspect; and, therefore,
we disclaim any reference to existing professors in these
remarks. Our idea is, that this election ought to be clearly
understood to be in the strict terms of the Statute, for
seven years only, and not for life ; and that, at the end
of that time, there should be a fresh bond fide election,
open to the retiring professor, as well as to all other candi¬
dates.
The advantages of this are numerous.
If the professor has been found to be a man of only or¬
dinary ability, a more able' man can be put in his place,
without any real or implied censure on him ; while, if he
has been found to be very able in the discharge of his pro¬
fessional duties, he need not fear competition.
Again, if a man be chosen because he is senior and ex-
perienced, he will, when too senior, give place to others
before he becomes a clinical bore to students ; while, if a
man be chosen because he is young and active, he will, in
time, give place to other young and active men, who will
thus be not excluded from office for a long life-time, but
will have a stimulus to exertion, and a strong motive for
preparation for such frequently occurring^vacancies.
A candidate for such a place may be too old to be chosen
for a life-time, but not too old to be chosen for seven
years; and a candidate may also be too young to be chosen
for a life time, but not too young to be chosen after the
lapse of one septennial period.
The Benchers of the King’s Inns elect their professors
for three years only, and several of the Dublin University
professorships are only for a term of years.
If a man be chosen professor, and given seven years to
make a name and position, he may, if successful, very well
give place to another, who could thus have a similar advan¬
tage. Whereas, if he did not make a name and position in
seven years, the School of Physic could well afford to sup¬
ply his place with a better man.
The Professor of the Practice of Physic should not be
a lecturer in stereotype, whose very sentences, by unceas¬
ing repetition, become butts for the wit and satire of the
student
NOTES ON THE ABYSSINIANS.
No. IY.
In our issue for the 1st instant we noted the deaths and fune¬
rals, and some of the treatment given to the sick among this
curious and ancient people. We Bhall now note some facts in
their religion and superstitions which have bearing on medicine.
By profession the great majority of the nation are Christians,
they will not eat of meat slaughtered by any but a Chris¬
tian hand. Their fasts are more numerous, perhaps, than
those of any other Christian people, more than two-thirds of
the year being assigned to more or less abstinence; In their
festmg it is not sufficient to abstain from animal food only;
during fast-time they neither eat or drink anything until late
in the afternoon, and this (observes Mr. Parkyns) “ is a severe
mortification of the flesh in a hot and enervating climate.
Many of their fasts are of long duration. The time of day
when it is lawful to eat is decided by the length of a man's
shadow, measured by his. own feet, and varies in different fasts.
Thus, the fast of Advent is during the last ten days of the
month of October, and the whole of November, and during
each day of that time till a man’s shadow measures nine and
a-half feet. Beside, there are all the other long fasts, and all
Wednesdays and Fridays, making nearly 260 days of fasting
in each year.”
On the morning of St. John’s Day the friends of persons
“ possessed of the devil,' 1 who have in vain tried all the ordi.
nary remedies, take the patients into the country, where they
are placed at a point where two cross roads meet. Then, in
each case, as instructions have been received from the wise,
“ a white or a red sheep is dragged three times round him, and
afterwards slaughtered 4 in the name of the Father, and of the
Son, and of the Holy Ghost. 1 The sign of the cross is then
marked on the patients forehead with the blood of the victim,
which is left where it was killed, and the whole party returns
homeward, being careful on no account to look back towards
the sheep, lest by so doing they should disturb the devil, who
is supposed to have left the man, and to be busy in eating the.
mutton.”
The most common diseases appear to be taenia, quinsy,
leprosy, scabies, and fevers. Even at the risk of quoting at
full length, we deem Mr. Parkyns’ remarks on these subjects
—coming as they do from a non-professional observer, too im¬
portant to be omitted.
In chap, xxxvi., p. 273, he says:—
“ Taenia, or tape-worm, is on this account certainly the first
to be considered, for the whole Abyssinian population may be
said to be afflicted with it. Out of above forty persons, male
and female, whom I had as servants at one time, only two were
exempt, and I should say that this was a rather larger propor-.
tion than would be found in a general average of the people.
The cause of this complaint has been frequently made a sub¬
ject of speculation. By many it has been assigned to the
eating of raw meat; by others again, to the great quantity of
cayenne pepper used by the Abyssinians. The natives are in
the habit of taking physic regularly once every two months to
relieve them of this malady, but as yet they have no means of
completely curing it, the head of the worm (as they say) re¬
maining as a germ, from which link after link is formed, till a ’
future dose is required. In this I believe European doctors
are in nowise superior to the natives, for they have lately
introduced into the Pharmacopoeia one of the Abyssinian medi¬
cines called kousso. This is the flower and seed of a tree which
grows abundantly in some parts of the country. In Abyssinia
a supply sufficient for a man's life may be procured for the
value of 6d., while in Europe a single dose, and that a very
small one, costs several shillings. Besides this, the Abyssinians
use the bark of another tree and the bulbous root of a small
plant which, if it be not our common wood sorrel, is very nearly
allied to it. One of these—I believe the bark—is reckoned much
more efficacious than the “ kousso,” but is seldom used, from
being supposed to be highly dangerous in its effects. The one
is called ‘ baainna,’ the other ‘ muitcha-muitcho. 1 Neither of
these, however, is nsed when the kousso can be procured. The
dried flowers are ground or pounded as fine as possible, and a
strong infusion made, of which the patient takes more than .
half a pint fasting. About noon, when it has taken the
required effect, a good quantity of beer or tedge is considered
beneficial, on which account, if the sufferer be a servant, he
begs for a supply from his master, or any friends who may be
dining with him; coming round at meals, holding in his hand
a small cross made of two bits of stick or straw, and exclaim¬
ing, 4 For the sake of Mary, for the sake of the Saviour, 1 &c.,
when a horn of liquor is usually given him.
“ Next is the complaint called 1 hannat, 1 which is a glandular .
enlargement in the throat, ultimately forming abscesses, which
increase to such a size that, if no means to cure them be taken,
the throat is completely stopped up and the patient suffocated;
this, after the tenia, is perhaps the most frequent malady of
the Abyssinians. The premonitory symptoms are violent pains
in the head, back, and legs, and much dizziness. The follow¬
ing remarks, taken from my original notes, will exemplify the
treatment adopted for it:—‘Tisphitou’ (one of my servants),
4 on his return from Mai Quollaw, was seized with the hannat;
not having any of the preventive medicine, they twice took a
good deal of blood from his head, but with no beneficial effect.
The night before last he was obliged to be carried into the hut,
being nearly senseless; the other servants urged him to ha vs
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bis throat examined, but he seemed reduced to that listless,
apathetic state of mind in which we see people who are suffer¬
ing from violent sea-sickness, for he begged to be left alone
and not bothered; on being expostulated with, and the danger
of delay pointed out to him, he merely said ‘ Oh, never mind;
let me alone.* However, a soldier who happened to be-in the
village volunteering his services, and professing to be a skilful
operator, we forced the patient’s mouth open, and held him
while the examination was going on. The throat was almost
entirely closed, and, had the man been allowed to remain till
the morrow, he would in all probability have died. The
soldier, however, made short work with it; for, thrusting in
his hand, he tore the swellings with his nail, and the patient,
having ejected a quantity of matter and blood, was pronounced
oat of danger for the time. On the advice of the operator I
gave him a good dose of jalap, and he ultimately recovered,
though he remained in a very weak state for several days.
Since his illness almost all of our people have suffered more or
less from this same complaint. The preventive medicintf which
I alluded to is a sort of root, which is chewed in an early stage
of the malady, and seems, when taken in time, to be a certain
antidote. One symptom is extreme furriness of the tongue.
The disease of which Mr. Salt {vide Valentia’s Travels, vol.
iii., p. 80) doubts the existence in Abyssinia is unfortunately
only too prevalent; I myself have treated many cases of it,
generally with much success where it was taken in time; but
occasionally I have seen some most horrible instances where it
has been neglected—living specimens, quite as fearful to behold
as any of the models in the Musle d’Anatomic at Paris. That
the Abyssinians appreciate the difference between it and the
scorbutic affection with which Mr. Salt confounds it, is evident
from their having distinct names for it. In Tigrd it is called
* fintita;’ in Amhdric, ‘ kitting;’ and in the Galla language,
* fin to.* I have already mentioned that among the native
remedies the flesh or blood of the wild boar is reckoned as one,
probably, as I said, from their having seen the lard used by
Europeans in the composition of mercurial ointment. They
have several others, but none productive of good effect. Near
Metemma, in the Nubian province of Berber, there is a sort of
whitish-coloured earth, called by the natives * toureyba,* which
is used as a medicine in these cases, and I have been assured
(even by Borne European medical men) with a good result: in
Abyssinia they possess nothing so valuable. There is an old
Armenian named Gorgorious (Gregory), who administers to
sufferers, at a considerable chaise, what he professes to be a
certain cure. This is nothing more nor less than a dozen or
two pills, containing corrosive sublimate, the recipe for which
he, no doubt, obtained from some quack in Egypt. Though
a rather dangerous medicine, this preparation of mercury might,
in many cases, if properly administered, be beneficial ; but
with our friend, who never troubles himself either to examine
his patient, or inquire how long he has been afflicted, simply
receiving his fee and desiring the sufferer to take so many per
diem till the box is finished, it is a case of 1 kill,* perhaps,
oftener than of ‘cure.’ The natives, too, are very difficult to deal
with, for they cannot be made to understand that, where one
dose will do them good, two may be injurious; nor are the
blacks worse in this respect than the Turks, Greeks, or Egyp¬
tians—of which I have had many proofs.
“ There is a sort of horrible scrofulous disease in all these
oountries, which causes the loss of the hands or feet. The
people of Sennkr call it ‘ judhm;’ I forget the Tigrfe name.
Elephantiasis is not bo common* in Abyssinia as in the low lands
to the north, nor is the Guinea worm. I have never seen any
case of the latter in this country, except in a pilgrim who was
merely passing through. In the provinces of Senn&r it is called
‘fr&ntite,* audits origin attributed to the black soil of the
country; it sometimes appears in the arms or body, but most
commonly in the lower part of the leg. The only cure is to
wind the worm gradually out, taking great care not to break
it, which accident might be productive of very dangerous con¬
sequences.
“ Scabies is very prevalent, but I am doubtful if it is the
same as that which is common with us. It generally fixes
itself on the elbows, where it forms a large sore difficult
enough to get rid of. It does not seem to depend at all on the
habits of the person or on contagion, for I have known Euro¬
peans to have it without any assignable cause.
“ The various fevers of tropical climates are tolerably abun¬
dant in Abyssinia, though principally confined to the low
marshy districts just after the cessation of the periodical rains.
The natives seem to have but one name for any fever caught
ip the jangle (* nedad*), whether it be common intermittent
ague or the fearful bilious jungle fever; while those of a low
typhoid class, which occasionally visit even the most elevated
towns, often as epidemics, are called ‘mitilt.* Local bleedings,
aperients, and emetics are administered in these; for aperients
they have certain herbs, but not an uncommon agent for pro¬
ducing both purgative and emetic effects is a large quantity of
1 ghee* (clarified butter) and honey. Dysentery, and the other
complaints of the same family, are by no means uncommon.
11118 is the disease which is most fatal to Europeans in the*,
countries: several Frenchmen have died of it in Abyssinia. The
natives chew a root, in addition to the above-named medicines,
for this class of malady. The root has a pungent taste, between
ginger and pepper, and I really believe it did me some good on
one occasion, when, not being able to have recourse to my own
drugs, I was obliged to put up with those of the country.
Small-pox is, I should say, not so uncommon here as in many
parts of the world: it has visited Abyssinia, as an epidemic,
once or twice in the last fifteen years, but, judging by the
number of those who bear its traces, I should say, not very
severely.”
■ +-
ffofcs flit famt $J0pC8.
Royal College of Physicians of London.
Before this meets the eye of our readers, the annual
meeting for the election of Fellows of this College will, in
all probability, have terminated.
Without any feeling of personal disrespect to the gentle¬
men nominated, we trust that the Fellows will, fora second
time within a brief period, remind some members of the
Council of the existence of such things as “ daylight and
fair-play,” by refusing to endorse the selection they have
made ; or, failing this always painful means of even en¬
forcing a principle, we trust that they will, at least, render
the Council powerless in the future, to inflict further in¬
jury upon their tottering institution.
Medical Department of the Privy Council.
Mr. Simon, the Medical Officer, has published his tenth
report, which forms a volume containing a variety of in¬
teresting and valuable particulars, which we can only
briefly notice. It consists of two parts or divisions. The
first relates to public vaccination, and to the causes and
extent of local outbreaks of disease, from which we leant
that the work of vaccination has been so far satisfactory,
that gratuities were given to 231 vaccinators, amounting
to A1824—the largest being £67, 7s. 4d., and the smallest
only 15s. 4d. Winterton, Guilford, and Terling, where
typhoid fever has been the prevailing disease, are the
places to which the inquiries have been principally con¬
fined. The filthy state of the locality, and the culpable
neglect of sanitary measures, were found to be the chief
cause of the epidemic, except in Guilford, where the im¬
mediate cause of the outbreak was the impurity of the
water-supply. The second part of the report details what
Mr. Simon calls the “ systematic proceedings” which have
been pursued, “with the object Of increasing our exact
knowledge of disease.” They include " An Inquiry by Dr.
Buchanan, on the Delation of Phthisis to Dampness of
Soil“ An Inquiry by Dr. Sanderson into the Innocula-
bility of so-called Tubercular Disease f and “ A Report
by Dr. Thudichum on the Chemical Researches he has
made towards obtaining a precise knowledge in those
chemical aspects of pathology, where at present there is
almost utter darkness.”
Medio&l Candidates for Parliament.
Dr. Ghadwic*, whose recent munificent donation to
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NOTES ON CURRENT TOttCS;
July **,!«£ Si
Bolton we had the pleasure of recording, is to be the Con¬
servative candidate for the borough. Our own wish to see
more medical men in the House is too well-known for us
to need to do more than announce this fact. We sincerely
hope that in* all parts the profession will be awake to its
own interests.
Besides the other names we have mentioned, it is now
stated that Dr. Walshe, of University College, London,
would be willing to contest a borough in the Liberal in¬
terest. We heartily hope some borough will at once
secure so eligible a candidate. The other candidates
talked of still make no sign.
Aneurism in the Army.
Thx late Dr. John Davy, Inspector-General, in his work
on “ Diseases of the Army” (p. 372) gives a series of statis¬
tics of aneurism, from which the following information as
to the rate of prevalence of, and deaths by, that disease,
has been prepared, both these. being recorded so as to re¬
present 1000 mean strength for one year.
The ratio of deaths by this disease is according to him—
In the Cavalry ... ... *31
In the Infantry ... ... ‘14
According to stations the rates of admissions and deaths
were as follows, namely—
Admissions.
Deaths.
Jamaica
*32
•13
Windward and Lee-)
•l l
ward Islands )
A\)
Canada...
*15
•07
Nova Sootia and New'
l -11
•A7
Brunswick
r 11
Ui
Bermudas
•26
•17
Gibraltar
•57
•39
Malta.
*83
*23
Cape of Good Hope
•32
*11
The above statistics refer to different periods j thus, as
regards Gibraltar, Malta, Bermudas, Nova Scotia, and
Canada, they embrace the period extending from 1837 to
1847 both inclusive, but as regards the Cape of Good
Rope windward and leeward islands, and Jamaica, the
period from 1818 to 1836 both inclusive.
The records available for reference do not inform us as
to the locality of the aneurism or artery affected; this
circumstance is, however, of the less moment, inasmuch as
traumatic aneurism, if affecting the limbs, is not often fatal;
while idiopathic cases of the disease, whether occurring in
the external or internal vessels, are those by which mor¬
tality is in the great majority of instances occasioned.
The aeries of departmental blue-books enable us to give
similar information with regard to the prevalence of, and
mortality by, this disease among the troops in the
United Kingdom, and in each of the three Presidencies of
India. From these we select the statistics of the five years
from 1861 to 1865 inclusive, and find the averages of ad¬
mitted and died per 1000 of mean strength per annum to
have been—
Admissions.
Deaths.
In Madras .
•51
•16
Bombay .
•47
•24
Bengal .
•39
*24
And in the United King¬
dom .
| -37
*35
.With reference to the latter, it may be mentioned that
the yearly rates of mortality during the period have varied
considerably. Thus, they were in 1861, 0*27; in 1862,
0-24; in 1603, 0*37; in 1864, 0*57; and in 1865, 0*37.
ThMfetiatioinfthe disease given b^low, as they refer
to Ceylon, China, and Australia, are obtained from the
returns of those places for the five years from 1861 to 1865
inclusive.
Following the manner of comparison already punned,
we obtain the following ratios, viz.:—
Admissions. Deaths,
Ceylon. 1*12 ... *67
China . *28 ... *22
Australia . 116 ... 1*16
. From these figures we find the somewhat unexpected
result that at the Cape of Good Hope, where diseases of
the heart are usually believed to be very prevalent, the
Tatio of deaths by aneurism is considerably lees than in the
United Kingdom, while the greatest rate of mortality from
this cause is observed at places having such very different
climates and circumstances generally, as Australia and
Ceylon.
The Lothians’ Medical Association.
We have received the second annual report of this im¬
portant association, and have great pleasure in observing
the progress it has made, and the vigorous attempt it has
inaugurated of placing the profession in a better position.
The dispensary system in Edinburgh has been thoroughly
investigated, and from the effect already produced we
augur well for the future of the Association. The Com¬
mittee seem to have felt very strongly the evils of too
much gratuitous medical aid, and they very properly urge
the objections that have frequently been pointed out, to
making whole classes of artizans dependant on charity for
medical relief in time of sickness. The improvidenoe of
the working-classes ought not to be encouraged, and un¬
doubtedly much has been done towards rendering them
paupers in spirit, by teaching them to look for medical aid
in the shape of charity. The committee report that the
abuse of charity at the Children’s Hospital is most con¬
spicuous:—
“ There the general ( well put on* appearance shows
the character of the class ; sometimes they come attended
by their servant maids, and many acknowledge that they
have regular family medical attendants. The special
character of the Institution is doubtless the cause of thisj
but there is on this very account the greater need for caw
and discrimination. No objection can be made to their
applying there, in the same way as the higher classes
would go to a consulting physician, but the same care
should be instituted in the odo case as in the other, of
trenching on general practice, and those who have, or can
afford to have, a medical attendant, should not be per¬
mitted to attend regularly, or to b.e attended at their own
homes.
“ The pauper class, it is known, are no unfrequent ap¬
plicants at the dispensaries, but as no systematic inquiries
are made, their character is only occasionally discovered.”
The removal of the Medical Club to more capacious pre¬
mises has been inaugurated by a dinner after the orthodox
English fashion.
Sir William Fergusson occupied the chair, supported
by Sir Charles M‘Grigor and Sir Banaid Martin. The
usual loyal and patriotic toasts having been duly honoured,
the Chairman gave the toast of the evening —" Success to
the Medical Club.” He remarked that although the Club
was only in the second year of its existence, it had by
careful management and prudent forethought, acquired a
position which would bear favourable comparison with any
Club in London of a similar age.
rue wane oi such an institution
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84 tteUsdical fYess and Circular. OVER-POPULATiON AND PUBLIC HEALTH. idniufi.
especially when medical reform occupied so large a share
of professional attention. A club of this kind must,
necessarily, in time exercise considerable influence upon
the politics of the profession, for there could be no social
life without political life. The opinions of the profession
could not fail, through the medium of the Club, ulti¬
mately, to obtain increased weight and importance.
It is not proposed to limit the membership of the Club
to doctors, but to admit gentlemen connected with science
and literature generally. It may fairly be anticipated that
the Medical Club will ultimately become the favourite
resort of the scientific men in the metropolis.
Since the first establishment of the Club the number
of members have continued steadily to increase, and we
now muster about 700 names on the roll of the Club. To
carry out all the improvements still in contemplation, it
has been decided next year to increase the amount of the
annual subscription. This step has always been in con¬
templation, and its adoption has often been urged upon
the Committee by members of the Club, but it has been
thought desirable to delay asking for such an increase
until we were in a position to offer increased accommoda¬
tion.
Sir William was repeatedly cheered during the delivery
of his speech, and the toast was received with the greatest
enthusiasm. With it was associated the name of Dr.
Lory Marsh, to whose untiring energy the profession
owes the establishment and much of the success of its
Club.
-4-
OVER-POPULATION AND PUBLIC HEALTH.
At a crowded meeting of the Dialectical Society, held in the
Medical Society’s Rooms on July 1st—Vice-President, Lord
Amberley, in the chair—a paper was read by James Laurie,
Esq. (formerly Inspector of Schools), “On the Happiness of the
Community as Affected by Laige Families.”
Among those present were Dr. Steele, of Guy’s Hospital;
Mr. Cowper, of London Hospital; Mr. and Mrs. F. Malleson,
Mr. Stirling, of New York; Dr. and Mrs. Edmunds, &c.
The author of the paper showed by reference to history, both
from that contained in the Bible and in other works, that
the constant state of human society had been one of continued
struggle for existence, which had been caused by the well-
known tendency of all organized beings, including man, to re¬
produce their numbers more rapidly than food can be obtained.
The law of population, he explained, had frequently been
alluded to by ancient writers among the Greeks and Romans
—for exiRnple, both Aristotle and Plato had been fully con-
saious of this important truth. But it was not until the im¬
mortal work of Malthus, written about the commencement of
the present centuiy, appeared, that the question had been
clearly understood; and it was now one of the most certain
acquisitions of science that the human race has the power of
doubling its numbers, by the mere power of fecundity it pos¬
sessed, In twenty-five years, or less, when supplied with the
necessary food. As a consequence of this law, Mr. Laurie
added, it was impossible to get rid of poverty in old and long-
peopled countries such as this without a most careful limitation
of the oize of families; and he quoted from the great work on
the “Principles of Political Economy,” by Mr. J. S. Mill, to
show many fallacies were entertained on this question, persons
actually contending that paupers in the workhouse should be
allowed to engender hereditary paupers. After explaining that
emigration did not go nearly fast enough to take off the surplus
population of Europe, and adverting to the cultivation of waste
lands and other so-called remedies for over-population, Mr.
Laurie ended by saying that the least disagreeable of all the
ways of preventing over-population and poverty seemed to him
to be the small family system prevailing, to a certain extent,
in France and elsewhere.
Mr. McSweeney related a conversation he had had with
a country labourer in Salisbury Plain, who said that he had
only 8s. a-week, and on this kept a wife and three children.
This deplorable state of matters was owing, in great measure,
to the fact that the people of this country were a landless
people, and to the existence of large tracts of. country taken
up by the hunting-grounds of the aristocracy. He m ai n t ained
that new laws were required to make this evil cease.
Mr. Levy said the causes of the poverty and misery of the
poorer classes were not fully realised by the majority of the
members of society. He avowed himself a complete convert to
the opinions put forward by the author of the paper, which,
he believed, were undoubted truths. Mr. Malthus’s law of
population was the explanation of the poverty which existed
in industrious countries. The different tenures of land much
tended to obstruct a clear view of the subject. Thus, the
cottier tenant of Ireland having always to pay a mere nominal
rent, had no inducement to be prudent in the matter of multi¬
plication of children, since his real rent was never more than
he could afford to pay after furnishing a scanty meal of
potatoes to his family out of the produce of the soil. As to the
way in which the limitation of families should take place, he
(Mr. Levy) did not think, with many, that each family should
only have two or three children. Delicate persons would be.
better without any children, and the robust and capable ought
to have the privilege of engendering a larger number than the
average.
Dr. Chapman accepted the _law of Malthus as a scientific
truth, and thought there was no doubt that the human race
was capable of doubling its numbers in circumstances in
periods of twenty-five years by the mere powers of fecundity
inherent in it. He thought, however, that the subject
required also to be considered from a national point of view,
and contended that if the superior races, such as the
English, were to restrain their increase, the inferior races
would fill up the vacant spaces on the earth to the de¬
triment of tne prospects of the race. The tendency to pro¬
creation helped us to keep down the inferior races, and thus,
with the palliative of emigration, he thought that the “struggle
for existence” was, on the whole, beneficial to mankind. Why
not carryall our surplus population to the Colonies? The
land tenure was capable of great improvement, and he held
that the State should be the tynd-owner, which would be a
great remedy for poverty at present. The .principle of co¬
operation, too, would tend to palliate the evils of poverty.
Lastly, he had, some years ago, emitted a theory, afterwards
taken up by Mr. H- Spencer, that, just in proportion as the
members of the human race became more cultivated, so did
their tendency to reproduce themselves become lessened.
Hence, probably, as civilization advanced, the mere animal
propensities would become more easily kept in abeyance, and
poverty, arising from our over-population, would cease.
Mr. Bradlaugh thought that no subject could possibly be
more interesting than that before the society. He thought
there was no doubt that population had a tendency to increase
more rapidly than food could be obtained, and hence the
frightful destitution which was so commonly witnessed. With
regard to the inferior races, as Dr. Chapman urged, being
alone kept from having large families, they were the veiy
persons who at present had the largest families: and, again,
no person would submit to be told that, because they belonged
to an inferior breed, they should not have any children. The
speaker said that many of the flower of the working classes in
all parts of England were agitating this question ; and he
would add that, although the question of large families was a
delicate, one, the sufferings and misery of the poorer classes
was so great that it was quite essential that the subject should
be thoroughly gone into.
Lord Amberley said the subject brought forward by Mr.
Lawrie was of first-rate importance. There was no doubt that.
prevention of over-population was by far the most satisfactory
method of attacking the evil. How was this idea to be best
spread among the poorer classes ? He was glad to hear from
Mr. Bradlaugh that the working classes were beginning to
debate this vital point. Unfortunately the influence of the
clergy in common with that of society, and the natural pas¬
sions of mankind, were opposed to tne prevention of over¬
population. He believed, indeed, that women would naturally
have a stronger feeling against huge families, had they any
say in the matter, -and u their opinions were more heard. He
was truly glad to hear the credit of the discovery given to the
illustrious Malthus. Like all other discoveries, there was
something wanting in the working ont of the details of
Malthus’ views, and in the ways in which overpopulation •
could be prevented with the least pain and discomfort. He
ventured to think that the propositions of Mr. McSweeny, thst
the evils of over-population could be remedied by taking tht
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The Medical Pros and Circular.
SUMMARY OF SCIENCE.
July 22, 1868 . 85
btmting-grounds of the nobility, were erroneous. If it would
do so, he, for one, did he possess such a park, would gladly
part with it to do away with poverty; but, in fact, population
would swallow up such small gifts in a few years, and leave
only fewer open spaces for all to enjoy. Emigration was
good, but not rapid enough to relieve the pressure caused by
rapid multiplication. The practical conclusion from all of
which seemed to him to be, that Mr. Mai thus was correct, and
that, if ever we are to escape, as a nation, from poverty, it
must be by the limitation of the size of our families. He
(Lord Amberley) objected to celibacy; we all naturally objected
to war and famine. Well, then, the only remaining alternative
seemed to him to be small families; and after all it turned out
to be a medical question how this could best be accomplished
without injury to the health. He wished much he could hear
the proposals of the medical men in the room as to the best
means of limiting numbers. In America ladies were in the
habit of keeping back their families, but the methods they
employed seemed to him to be dangerous to health. Hence he
should much like to hear a discussion as to whether some
innocuous measure might not be discovered. It was remark¬
able that the subject should have first been taken up in
America, where it was not so much required as it was here.
Mr. Rigby Smith observed that he was completely con¬
vinced of the truth' of the Malthusian law of population, and
also quite convinced of the inadequacy of any alteration in the
rapidity of emigration to cope with the rapidity of increase of
the race. He, therefore, believed that the existence of large
families was an immense evil. He would add that, at present,
it was by no means the best portion of the race which increased
and multiplied too fast; it was precisely the opposite of this.
Witness the celibacy of the barristers and of the upper and
educated classes, and the rapid multiplication of the unedu¬
cated classes.
Dr. Charles Prysdale said he would not assume that all
in the room agreed with the law of population, according to
Mai thus. He believed it was but proved by the following
facts :—During the years from 1790 up to 1810, there was
scarcely any emigration into the United States of America,
and yet the population there nearly doubled itself in these
twenty years. Now, in Great Britain the greatest rapidity of
multiplication ever known — i.c., from 1800 to 1853, had caused
the population to double only in 53 years. In France the rate
of increase of late was almost null. In Turkey it was calcu¬
lated that it would require 555 years for the population, at its
present rate of increase, to double itself. Now, it was evident
that if in France, for example, the population did not double
itself so fast as in the United States from 1790 to 1810, it
must be because it was checked in various ways. And, on en¬
quiry, it would be found that in France, as in England—(1)
Marriages were contracted later than in America. (2) Wages
were far lower in France than in the United States. (3)
There were far more prostitutes in France than in the United
States. (4) There were fewer children to a family in France
than in England, or, a fortiori , in the United States. Lastly, a
vast number of children died from privations and poverty. If
any person would calmly survey these facts, he could not, Dr.
Drysdale thought, avoid the conclusion come to by Mr. J. S.
Mill, Lord Amberley, and others—namely, that since it was
perfectly impossible for the inhabitants of old countries, such
as this, to double so fast as in new states, they should ear¬
nestly endeavour to find out what was the least disagreeable
way of checking their overpopulation. The sorrows attending
poverty, the diseases caused by bad living, the fevers and con¬
sumption caused by overcrowding and town life, were deplor¬
able and distressing to contemplate, and so were the fearful
pestilences, such as the plagues and cholera which so decimated
the ill-fed districts of our European cities. Then, again, wars
were hideous evils, and would not cease as long as misery was J
so common. The wretched and the poor were ever the tools
of tyrants, and that fraternity which all the good desired
would never arrive so Ion** as men were so poor. sHe, there¬
fore, admitted with Lord Amberley, that the question was
mainly a medical one—viz., how could married persons limit
the number of their offspring without injuring their health ?
He thought this question required much calm thought and
dtatassion, and meanwhile would only Btate that in France, a
few years ago, he had in one hotel met with two young couples
both married about 5 years, and both without children. On
interrogation the same answer was returned by both husbands,
thh^thej^ wore not rich enough yet to afford children. This
w^t-hbe potation of the difficulty of over-population, if not the
beat.
Mr. Nasmyth contended that the over production of chil¬
dren was, in a great measure, dependent on fashion. ' It was
the present fashion in England to have large families, whilst
in France, as everybody knew, a great number of persons
thought it absolutely wrong to have more than two or three.
This reduced the question to one of education, and he con¬
tended that it was disgraceful to educate children, as was dons
without any knowledge of physiology and anatomy. It seemed
to him as if this were done simply for the purpose of keeping
up a priesthood of medicine, and the sooner it was altered the
better.
Mr. Davis contended that the cause of the poverty of the
poorer classes in this country was not that they had too many
children, but that the land laws were bad and required altera¬
tion.
The debate was adjourned until the 15th July, at the motion
of Dr. Roberts. ‘
$nmmarjr of $tkm.
[Specialty edited and Compiled for the Medical Press and Circular.)
By 0. B. 0. TI0HB0RNE, F.O.S., F.B.G.ai., Etc.
[The Editor of this Summary wishes it to be understood that he is
not responsible for the idea*, theories, or the correctness of statements
made in any of the papers quoted in the compilation.]
DR. CRUM BROWN'S PAPERS ON CHEMICAL CONSTITUTION AND ITS
RELATION TO PHYSIOLOGICAL ACTION.
The investigations of the above gentleman and Dr. Frazer are
intended to open a most important field of inquiry, but one of
which there is none so difficult or so hidden in its manifesto*
tions. The mode in which these gentlemen proceed is the fob
lowing:—They take a certain class of compounds the physio*
logical action of which is well-marked (strychnia, brucia,'thebaia,
morphia, codeia). These alkaloids contain a similarly situ¬
ated atom of nitrogen, which is capable of being changed as
regards its atomicity or relation. The salts of these alkaloids
do not differ from the alkaloids themselves, because the com¬
bination is not of a very stable kind, and because the acid
produces no particular molecular change in the alkaloid itself.
They therefore combined the strychnia with methyl, and pro¬
duced a stable compound—methyl-strychnium, first studied by
How and Stahlsmidt. Large doses of thirty grains of the
methyl-strychnium salt produce no action upon rabbits when
administered by the stomach; fifteen grains killed, however,
when injected by the skin. But instead of violent tetanic
convulsions, a condition of general paralysis is observed.
On examination, paralysis was proved to have been produced
by the destruction of the power of the terminations of the
motor nerves to receive the stimulus and transmit it to the
muscles.
Strychnia produces tetanic convulsions by exciting the nerve*'
centres in the spinal chord; but the methyl compound produces
paralysis, and does so in a very remarkable way.
The same change is produced in every alkaloid examined
which has an action like that of strychnia.
ANALYSIS OP POTABLE WATER.
Some considerable discussion has arisen in scientific circles
upon the above subject. The analysis of water has been
thoroughly (investigated by Dr. Frankland, who read before the
Royal Institution a resume of his experiments, from which we
have culled the following important observations:—
The author, in his lecture, exhibited the test usually employed
for determining the nitrogen existing as nitrates and nitrites,
which, as he said, is called combined nitrogen. But it is not
organic nitrogen, although it has in most cases been derived
from organic matter. It is also necessary to determine how
much nitrogen is present as free ammonia. This is done by
what is called Nessler’s test.
Dr. Frankland divides the mineral portions of the water into
three subdivisions, viz.:—
1. Soap-destroying substances.
2. Mineral compounds, constituting chiefly the skeleton of
the decomposed sewage, or manure.
3. Poisonous substances, such as arsenic, copper, and lead.
The first communicate to water its hardness. Medical
arguments have from time to time been advanced, now in
favour and now against both hard and soft water— i.e., it has
been stated that hard water is necessary for the formation of
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86 The Medical Prc*n and Circular.
SUMMARY OF SCIENCE.
July 22, IMS.
bone, Ac. Again, M. Belgrand states that the inhabitants of
the hard-water districts of France notoriously suffer from
carious teeth. But as regards the enormous advantages of soft
water for washing and manufacturing purposes, there is
no difference of opinion.
The saving of soap, by the introduction of the Loch
Katrine water, is estimated by Dr. Frankland as £36,000
annually. 44 My own experience,” says the author, on refer¬
ring to the hardness of the London water (which is tempo¬
rary), 41 leads me to the conclusion that the advantages of tem¬
porary over permanent hardness has been considerably over¬
rated. In reality water used for domestic purposes is even
when used hot, either not heated to the boiling point, or is
boiled far too short a time to remove more than a small pro¬
portion of its temporary hardness. Thus, water drawn from
the kitchen boilers of the Athenaeum Club, was usually almost
as hard as the cold water with which they -were supplied.”
We give three examples from a list of some of the waters, os
representing the importance of the hardness of waters :—
Soap destroyed by 100,000&r. of water.
Thames water . 212
Glasgow (Loch Katrine) . . .4
Lancaster .... 1
The putrescible nitrogenous organic matters present in
water, consists of the mineral compounds constituting chiefly
the skeleton of decomposed sewage, or manure. The putres¬
cible nitrogenous organic matters present in water or in the
soil through which water percolates, undergo gradual oxida¬
tion and decomposition, by which their carbon and hydrogen
are converted into carbonic acid and water, and their nitrogen
into ammonia, nitrous, and nitric acid. The last three consti¬
tute a record of previous contamination with putrescible nitro¬
genous organic matter. Dr. Bence Jones has, however,
demonstrated that rain water always contains about *032 parts
of ammonia in 100,000 of water, therefore, this amount must
be deducted from that found on analysis, as nitrogen derived
from serial sources. The remainder, if any, represents the
nitrogen derived from putrefied nitrogenous matter in the
water.
The following paragraph is of considerable importance, and
we therefore give the author verbatim: —
44 To express this (sewage contamination) in terms of some
known standard, I employ average filtered London sewage,
which contains 10 parts of nitrogen in the form of putrescible
oiganic matter in 100,000 parts. Thus, a water which con¬
tains one part of nitrogen in 100,000, as nitrous acid, nitric
acid, and ammonia would contain in 100,000 parts the re¬
mains, or skeleton of, an amount of putrescible organic matter
equal to that contained in 10,000 parts of averaged filtered
London sewage. Such a water, therefore, is said to have a
previous sewage contamination of 10,000 parts in every
100,000 parts. But it may be asked is this a true record of the
previous history of the water in this respect. I believe that
this nitrogen as truly represents a quantity of previously exist¬
ing putrescible organic nitrogenous matter, as that the bones,
of a megatherium demonstrate the previous existence of an
individual of that species—just as chemical and mechanical
agencies have broken up and dissipated the remains of millions
of animals during long geological periods—so does the action
of growing plants, and,.perhaps, also of living animals, remove
from water in a few hours or days some portion of this skele¬
ton of previous putrescible organic matter.. Thus, by storage
the East London Company reduced the sewage contamination
of the l^ver Lea from 2000 down to 230 parts in 100,000.
These skeleton compounds are in themselves innoxious,
but inasmuch as they show 4 that the water has been in con¬
tact with animal refuse, they bring a heavy charge against it.
Jiefu9e animal matters are known to contain what is
hurtful to human life. This hurtful matter is believed, on
good evidence, to consist of spores, or germs of organisms;
which are capable of producing in man Buch diseases as cholera,
typhoid fever, and dysentery.
No practical process is known by which these spores, once
introduced into water, can be again removed, or can have
their vitality destroyed. Filtering will not do it; boiling,
even for several hours, cannot be relied upon for the destruc¬
tion of such germs, some of which have recently been shown
to retain their vitality after four hours’ boiling.
As regards the third class, or poisonous substances, such as
arsenic, copper, and lead—these substances are only likely to
occur in waters connected with mineral works.
. Dr. Frankland states that the presence of a minute quantity
of phosphate of lime prevents the water from acting upon leafl.
Mr. Simmons, the medical officer of the Privy Council, says
—that the person who contracts cholera in this country it,
ipso facto , demonstrated with almost absolute certainty to have
been exposed to excremented pollution, that what gave him
cholera was mediately, or immediately, cholera contagium dis¬
charged from another’s bowels. Excrement, sodden earth, ex¬
crement reeking air, excrement-tainted water, these are for us
the causes of cholera. That they respectively act only in so
far as the excrement is cholera-excrement, and that cholera-
excrement, again, only acts in so far as it contains certain
microscopical fungi, may be the truest of all true propositions;
but whatever be tueir abstract truth, their separate application
is impossible. Nowhere out of Laputa could there be serious
thought of differentiating excremental performances into
groups, diarrhceal and healthy, or of using the highest powers
of the microscope to identify the cylindro-taenium for exter¬
mination. It is excrement, indiscriminately, which mustbs
kept from fouling us with its decay. The way in which the
southern districts of London have gradually gained compara¬
tive immunity from cholera, in proportion as their two water
companies have ceased to distribute sewage-tainted water
among them, is a matter of history.
black varnish.
The Paris correspondent of the Chemical News mentions the
following curious optical experiment. In a litre of alcohol, 12
grammes of aniline blue, 8 grammes of fuchsine (rod), and 8
grammes of naphthaline yellow are dissolved. The whole is
soluble, or nearly so, in less than 12 hours. One application
renders a white object ebony black; the varnish can be filtered,
and will never deposit afterwards. The three colours are not
destroyed, for each can be separated by analysis with their cha¬
racteristic properties.
CARBOLIC ACID.
Dr. Glover, of Millbank Prison, was sent down to Terling
by the Home Secretary, to superintend the application of dis¬
infection by carbolic acid to this town. His visit was in conse¬
quence of an epidemic of intestinal and typhoid fever prevailing
in the village. In his report, he says that incredible quantities of
foecal matter had accumulated in uncovered cesspools, open
ditches, Ac., and had soaked into the soil. A strong solution
of carbolic acid was distributed over the entire village. Large
quantities of the solution were poured into the cesspools, and
it was freely applied to the filthy yards, courts, and stagnant
ditches, by which many of the houses were surrounded. Many
of the inhabitants at first fancied the smell of the acid pro¬
duced headache, and for some few days the medical officer and
inspector of nuisances were most unpopular people in Terling.
We can well understand this, as in the report it is described
that the village was soaked with acid, and the atmosphere
became highly charged with its vapour.
Out of a population of 900 persons 300 had been attacked
by typhoid fever since 4th December, and of this number 41
died. Fresh cases continued to occur daily up to the end of
February, while only two persons have been attacked since the
1st of March. The carbolic acid was first used on the 17th of
February. The author of this Summary is only too glad to
adduce another practical instance of the value of this powerful
antiseptic, which he considers he was instrumental, in a great
measure, in bringing before the Dublin public.
' SOLUBILITY OF OXIDE OF IRON.
M. Jeannel states that the principal cause, if not the only
cause, of hydrated sesquioxide of iron being more or lest
insoluble in water is due to the presence of a small quantity of
sulphates. A new compound indefinitely soluble, wnich might
be named ferric chloroxide, is easily obtained in solution or in
the solid state. This compound is represented by perchlorids
of iron, Fe, Cl„ and an indeterminate quantity of sesquioxide
of 4 iron, Fe, O s . M. Jeannel says that he has prepared in the
cold a stable aqueous solution, containing nine times the iron
contained nn the officinal solution. This solution would be
found specially advantageous in checking haemorrhage. The
solution possesses in the highest degree the property of coagu¬
lating albumen. It is decomposed by sulphuric, citric, or
tartaric acid, and is even decomposed by a few drops of con¬
centrated nitric or hydrochloric acid.
gamqbb’s experiments upon blood.
On using nitrites as a reducing agent, arterial blood aonxmee
a chocolate colouration, and the spectrum, when viewed^ Is
found to have been converted from that of scarlet orwmqt to.
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Hu Medictfl Preas and Circular.
FOREIGN MEDICAL LITERATURE.
July 29,1808. 87
that of acid hamatin. When sulphate of ammonium, or a reduc¬
ing solution of iron is added to a blood solution, which has
been acted upon by nitrites, all effects of their action disappear,
and the solution again possesses the spectrum of oxidized
Uood-colouring matter, although precautions hare been taken
to exclude atmospheric air. The continued action of the
reducing solution then leads to the reduction of the blood-
colouring matter, which, when shaken with air, again yields
the perfectly normal spectrum of blood. It would therefore
appear that when nitrates act upon the blood-colouring matter,
they do not decompose it, nor thrust out or remove the loose
oxygen with which it is combined.
The gases of both normal blood and blood treated with
nitrites were boiled in vacuo, their amount estimated, and
their composition determined. It is shown that when blood
has been acted upon by a nitrite, the amount of oxygen which
can be removed by ebullition in a very perfect vacuum is
immensely diminished, the. greatest difference being perceived
when the nitrite has been in contact with the blood during
the longest period of time.
Although blood which has been acted upon by nitrites has,
to a great extent, lost its power of absorbing oxygen, it still
retains the property, which normal blood possesses, of ozonising
the atmosphere. Oxygen-nitrite blood reacts with guaiacum
paper exactly like normal blood, and when added to a solution
of peroxyde of hydrogen it causes an evolution of oxygen.
The changes in the optical properties of blood are shown to
be due to the formation of compounds of the nitrite used
with oxidized haemoglobin. These compounds, with the excep¬
tion of that with nitrite of silver, presented the same crystalline
form, colour, and spectrum wherever the nitrite was employed.
The author obtained compounds with nitrite of sodium,
potassium and silver, and nitrite of amyl. From the researches
of Hoppe, Leyler, and Preyer, hydrocyanic acid possesses the
property of forming compounds with oxidized haemoglobin.
AN ABSTRACT OF DR WESTPHAL’S PAPER ON
THE GENERAL (PROGRESSIVE) PARALYSIS
OF THE INSANE.
UB1B DEN OBOKNWARTIGEN STANDPUNCT DEE KENNTN188E VON
DBB ALLGEXEJNEN PROGRESS I YEN PARALYSE DEB I BEEN.
By Db. WESTPHAL,
LECTURER AT BERLIN.
{Journal /Ur Ptychatrie . 1868.)
The disease is known under various terms as paralysie glnlrale
incomplete (Delaye), paralysie g^ndrale des alidnes (Calmeil),
psralysie gdndrale progressive (ftequin, Sandras), folio paralyti-
que (Parchappe), etc. Westphal first reviews the clinical
symptoms of the disease, and afterwards the anatomical
lesions. Respecting the former, we find certain disturbances
of motility which formerly were considered as complications
of the mental disease. They were afterwards brought into
closer connection with the psychic symptoms to form one group
of symptoms of the disease (entitd morbids).
As regards the psychic symptoms, the mania of ambition
(Grossendelirium) was formerly, and even recently by some Eng¬
lish writers, considered an indispensable stage (Bayle), which
wes followed by mania and dementia. But Westphal considers
this opinion as erroneous, as all forms of mania are found
in paralytic patients, viz. : melancholia, hypochondria, idiotsm,
eta, even one individual may suffer from them in turns. We
might, possibly assume a stage of depression preceding that of
maniacal disturbance, as common in mental disease, by rang¬
ing gassing states of anxiety and uneasiness under the head
of depression, but even in the beginning the psychic symptoms
differ from common cases. In common hypochondria or
mBanrhotla the intellectual faculties are not impaired in the
CQEypiffTicement, but if a cure does not obtain, they after a
certain, and perhaps considerable time get lost in a rapid man¬
age Bat all the paralytic patients suffer from mental weak¬
en foifte beginning.
Further, melancholia, mania or hypochondria, are not always
present, but only a certain weakness which increases gradually
ufi 2ft reaches ldiotlsm. Next to these symptoms we find
hftfctafeftoeu of a violent character, ana neuralgic pains,
Of cerebral origin. Though the mental faculties
uflM|Mmh^wm>nsta3it progressive impairment, there are
exceptional cases where improvement seems to take place for
a time.
The disturbances of motility regard principally the tongue,
especially so far as the language is Concerned, the muscles of
the face, the extremities, and often also the sphincters of the
bladder and rectum. The most characteristic and easiest to
recognise is the impairment of the language. In the beginning
a slight occasional difficulty is observed, though the language
is fluent, as if tbe patient stumbled over a word, but this is
so slight that it is overlooked ; in other cases, the language be¬
comes altogether more slow, emphatic-like, as if the patienft
spoke with a certain caution, and as if in a state of slight
drunkenness. Later the language becomes stuttering and at
last only inarticulate sounds are heard. The tongue may be
seen tremulous, later the power of volition over it gets lost, for
instance the patient when ordered to show it jerks it ont
and in. Similarly the muscles of the face are affected,
the masticatory ones act involuntarily, and the teeth are
fletched. Paralysis of the tongue and face on one side are
rare, and follow a fit, they are of a passing character. The
voice looses its timbre, becomes sometimes nasal without para¬
lytic lesions of the apparatus becoming evident.
Complete paralysis of the muscles of the eye is not observed,
but duplex vision is frequent. Inequality of the pupils is
of no value for the' diagnosis, an exquisite myosis is often
found, so that the pupils are not larger than pins heads.
The limbs. —Some spoke of paralysis or imperfect paralysis,
especially of the lower extremities, others (Bouilloud) objected
to the term paralysis as motility and sensibility are retained,
but the movements lack inordination. They are irregular and
comparable to those of animals whose cerebellum has been
removed. Westphal believes both opinions founded on fact,
and consequently adopts two Classes of paralysis, which may
be followed np clinically. The first comprises those patients
who have the gait of tabetic patients, they sway to and fro
when the eyes are closed. The second ones do not lift the feet
properly when walking, they have a shuffling gait, making
small steps and with widely separated legs. It is to be noticed
that all the patients when in bed are able to execute move¬
ments, only at a late stage also this faculty is lost.
. But though the disturbances of motion are usually more
general, it happens sometimes that more or less complete
paralysis of one limb or one side of the body occurs. These
patients suffer at a later stage from involuntary evacuations of
bladder and rectum ; but it is not clear whether this is owing
to paralysis or idiotism. In some cases, the disturbances of
motility are so little manifest that we might speak of latent
paralysis.
The impairment of sensibility is more difficult to describe
and elucidate, as the answers of the patients are not reliable, jj
Elepsifofm or apoplectic fits play a considerable part in the
development of the disease. Loss of consciousness maybe
complete or incomplete—and giddiness, tumbling to oile side,
convulsions or passing paresis of one side of the body, or
both. The language especially is defective after the fits, by
the facialis and hypoglosus suffering. The psychic Btate is
much worse after a fit.
Nature of the disease .—Bayle considered it a chronic menin¬
gitis, the symptoms depending upon different stages—viz., stage
of monomania, mania, and dementia. But Westphal showed
that, in reality, they do not exist. L. Meyer based the symp¬
toms on the condition of the temperature, acute attacks being
accompanied by high degrees of temperature. But Westphal
thinks that the maniacal fits are in no distinct relation to
the temperature, which is often increased by inflammatory
diseases, and the temperature also varies without any
known cause. Westphal also denies that purulent meningitis
can be deduced from the presence of the whitish spots in the
membranes. He also objects to Parchappe’s affection of the
cortical substance, especially the median one, as not proved.
Rokitansky believed in hyperplasia of the cortical substance
with amyloid degeneration. Westphal spoke of transforma¬
tions of the walls of the blood-vessels which thicken. Robin
and Lockhart Clarke examined the adventitia of the vessels,
and came to the conclusion that in most cases that which had
been considered pathological wa9 a normal state, the latter
believed to have found ectaSiae of the vessels. Virchow had
seen them previously, and not considered abnormal. Westphal
admits that the brain of the insane has sometimes a dark
violet colour owing to congested blood-vessels, but he doeft not
consider it necessary to admit newly-formed blood-vessel! for
explaining this condition, with some others (Mettenheimer, L.
Meyer). Moreover, the cortical substance it often very pale.
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88 The Medical Press and Circular.
CORRESPONDENCE.
Westphal once saw genuine inflammation of it in its first stage.
A phthisical patient had symptoms of congestion with tran¬
sient loss of consciousness, he got a little better, but worse
$hgain on the second day of the evening of which he died. A
portion of the right hemisphere was found enormously swelled
at the post-mortem, and there were numerous small blood ex¬
travasations. Such condition is never found in the brain of
paralytic patients.
Others considered changes of the ganglion cells as originat¬
ing the disease, but Westphal cannot confirm either Meschede’s
congestive imbibition, or Tigge’s cellulous hyperplasia, or Vir¬
chow’s and Mannkoffs fatty degeneration. Westphal admits
that ,he is unable to give any explanation respecting the sub¬
stance. As for the membranes, they often offer changes, but
these are also found in other nervous diseases. Atrophia
cerebri is likewise associated with progressive paralysis, but
not less with other affections.
. Westphal, without denying that Toffe drew first attention
to the affection of the spinal cord in a more general manner,
and without special cases, believes to have first clearly demon¬
strated that the cord is generally diseased in paralysis. He
subdivides the affections of the cord thus : (1) Affection of the
posterior tract from the neck down to the lumbar region. (2)
Affection of the posterior portion of the side tract to the same
extent. (3) Mixed affection of the posterior tract, and the
posterior portions of the side tract. Pachy meningitis may or
may not be associated with these lesions. The posterior tract
wastes, owing to a considerable loss of nerve elements, they
are replaced by a substance of connective tissue, which is in¬
terposed between the nerve tubes. The latter are either
narrow, or of normal size, or very broad. This condition is
most pronounced at the periphery of the posterior tract, espe¬
cially in GolTs tracts (KeilstrangeJ. There is no constant dif¬
ference between the superior and inferior portion of the tract.
This Btate is found in the medulla when hardened. In fresh
specimens fatty granules and corpora amylacea may be found.
Things are otherwise in the second and third affection. Free
corpuscule cells are in fresh specimens, and the condition of
chronic myelitis obtains. In the first-named class, generally
the upper portion only of the posterior tract suffers.
The degeneration may be followed into the medulla ob¬
longata, but does not reach beyond the fourth ventricle.
The connection between the affection of the medulla and the
brain is not yet demonstrated. No constant extension of a
morbid process from the brain to the cord, and vice versa , could
be deduced from the anatomical changes, nor from the clinical
symptoms during life. We may only assert that the psychic
disturbance is generally observed at a later stage than the
affection of the spine. Where psychic symptoms are the first,
it is even more difficult to prove that the spine gets degene¬
rated at a later stage, because the latter affection may exist
latent for a long time. We are, therefore, at present entitled
to consider both affections as independent from each other.
Tabes dorsalis (locomotor ataxy) or grey degeneration of the
posterior tract (Westphal’s affections, No. 1) was formerly
considered an independent affection of the spine, without the
brain Buffering, but Westphal believes it only relatively inde¬
pendent, as it occurs in the said peculiar connection with brain
disease, with typical symptoms. The atrophy of the optic
nerve, as observed in locomotor ataxy, and in progressive para¬
lysis, points in the same direction. Epileptiform and apo-
pletic seizures were likewise observed in grey degeneration,
without mental disturbance, and with it. Therefore Westphal
concludes that a certain disposition obtains of the nervous
system, in consequence of which sometimes the spinal, at others
tne cerebral portions, at others, again, peripheric nerves suffer
in succession, or simultaneously.
-♦-
REFORM IN THE MEDICAL COUNCIL.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir,—R eform has been the cry for years in the political worlds
and I think the medical world may echo the same, with not only
fairness to themselves, but with justice to the public—inas¬
much, as what tends to advance medical interest, must react
beneficially on them likewise. In general medical politics there
is ample scope for reform ; but when we consider the manner
of election of the representatives in the Medical Council of
(he various universities and licensing corporations, reform is
especially needed, if it were only for one thing, “ to get the
general practitioner represented.”
The major part of the profession consists of general practi¬
tioners, and this class—for whom the Medical Council was
thought to do, or rather it was anticipated it would do, a very
great deal—is entirely ignored, having no representative in
such Council: because the councillors representing each un-
versity and college are elected by the various officers who
compose the committee or council of such corporations^ to
the entire exclusion of the holders of their various decrees
or licenses. Now, such representatives being generally either
pure physicians or pure surgeons, they are well calculated to
look after their own interest or the interests of the corporations
they represent; but what do they know ? What can they
know ! of the everyday wants of the general practitioner of
medicine and surgery ? The general practitioner ought to be
represented in the Medical Council. How is it to be done!
I see by your admirable leader of this week, Dr. Andrew
Wood proposed direct representation by increasing the number
of councillors from men chosen by the profession, which must
add to existing expenses ; and surely they are large enough
already—nay, too large, if compared with the real good (he
medical man has received for his £5 registration fee. Quackery
is as rife as ever, and the public are very little wiser in matters
medical now than they were prior to 1858.
Dr. Andrew Wood’s proposal is fair and just, and he deserves
the thanks of the great body of medical practitioners for it;
but, for my own part, I hope to live to see the day when (he
proposal of Dr. Prosser James, to allow those who hold the
diplomas of the various corporations to elect the representa¬
tives of such corporations, will become the law of the land. It
is only fair and right that the Doctors and Bachelors of Medi¬
cine should each have a vote for electing the representative of
their university in the Medical Council, and (he Fellows,
Members, and Licentiates of the three Colleges of Physicians
and JSurgeons, not forgetting the Faculty of Physicians and
Surgeons of Glasgow, and the two Apothecaries’ Halls, should
enjoy the same privileges. If such were the case, I think the
profession would reap great and decided benefit. Men would
stand a chance of being elected, who might fairly be depended
upon for doing justice to, and advancing the interests of, not
only the select few, the chosen of the various corporations, hut
of the hard-working—in many cases overworked—and under¬
paid general practitioners. It might be that such representa¬
tives would not be afraid of speaking boldly on many point* of
medical reform. In this one particular, as in all others affect¬
ing the well-doing of the medical profession, Dr. Prosser Janie*
has always shown that he has the interests of the medical man
at heart; and now since he has been requested to become »
candidate to represent the Universities of Edinburgh and'St.
Andrew^ in Parliament, I can only wish him every snocett,
because I feel sure he will be the right man in the right plwe,
and I sincerely hope and trust that all who have a v°tef° r
either universities, and who would like to see the profession
well represented in the House of Commons, may come forward
and vote for him—well bearing in mind that the more
medical we have in Parliament the better, and now when we
get a candidate so well up in the requirements of the profe*
sion, it would be a great pity not to secure his election, *ay
nothing about the loss to the medical world.—I am, air, yjJF®*
&c. f Henry W. Williams, C.M., M.D.
THE CARMICHAEL PRIZE ESSAYS.
TO THE EDITOR OF THK MEDICAL FRES8 AND CIRCULAR.
Sir,—I n the report of the proceedings of the Medical Council
(in your number of July 8th), your reporter states
Dr. Alexander Wood suggested that my letter on the reotnl
* illegal ’ award of the Carmichael Prize shotdd be refenw to
the Lunacy Committee, and that this recommendation afforded
considerable merriment.” Your readers will scarcely befievo
me to have been so “ daft,” as to have expected that this
matter would have been investigated by this corporate courted I
their game is not among the Tritons , but I think it wuWd
have been more becoming on the part of Mr. Hargrave, we
representative of the Dublin College, if be had' courted inquiry
instead of suppressing it.
I ask you in common fairness to publish my letter sent to
you last week, and let your readers judge for themselves.—
Yours obediently, - ’ - - '
. EDWABD3 Jfi ) -
2d, Beauforfretreet, Chelsea, July ’9,186$.
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MEDICAL NEW&.
July 22, 1868. $$
The following it a copy of (he Utter above referred to :—
THE LATE ILLEGAL ADJUDICATION OF THE
CAB MICHAEL PRIZE ON MEDICAL REFORM
AND MEDICAL EDUCATION TO ONE OF THE
COUNCIL OF THE ROYAL COLLEGE OF SUR¬
GEONS OF IRELAND, MAY 1, 1868.
TO THl PRESIDENT AND COUNCIL OF MEDICAL EDUCATION.
Gentlemen, —In September, 1862, when vour proceedings
were closed to the medical press, I placed before jou the
leading points connected with the illegal adjudication of the
triennial prise of fifty guineas at the Royal College of Surgeons
of England, and the illegal non-ad judication of the Carmichael
prises by the Royal College of Surgeons of Ireland, believing
that it was your special province to investigate such matters
as related to medial education , and to scientific progress. As
you have probably forgotten the circumstances, you will, I
trust, pardon me for directing your attention to the subjoined
brief recapitulation. In the first example, a prize was given
to a gentleman (one of the adjudicators being his colleague)
for an essay full of vital and unmistakable errors, nearly all
of which essay (nineteen twenty-fifths) had been published
before. This gentleman did not comply with one of the
printed directions of the Council, and on thirteen different
occasions, as shown by the pamphlet I placed before you,
told his colleague, that he was the author of the essay.
The other example, which has an important bearing upon
the complaint I now place before you, was that of the Car¬
michael Prizes which, according to the will of Mr. Carmichael,
if notlthought worthy by the Council in 1864, the grant might
be postponed until 1859. I place the word postponed, in ita¬
lics. "The adjudication to be made by the Council. The com¬
petitors to send in their essays three months before the first
Monday in May, upon which day the Council shall pro¬
nounce judgment** (see Mr. Carmichael's will, Dublin Medical
Journal, I860, p. 409).
Notwithstanding these injunctions, the Council deputed
three of their number to adjudicate, and although there
were several candidates, Dr. E. Lee,l an old medical reformer,
and one faculty advocate, Mr. Dale, of Plymouth (both which
gentlemen have published.their essays), Dr. Anaell, myself, and
others, all I believe Englishmen, the prizes were illegally with¬
held, and no public report made by the three adjudicators.
In your reply to my letter, you said “ that the matter did not
come within your province. I now make bold to bring the
Subject in a new dress ; one in which the corporate habiliments
are of the same colour, but the hue is more glaring and
offensive*
In 1862 I protested against the legality of the proceeding:
t^eleaving a political matter, to the judgment of three persons,
especially in a country like Ireland where politics and
religion exercise such a potent influence. Mr. Carmichael (as
■hewn by his will) never intended that the adjudication should
Hhit to a small section , but to the council at large.
Jout, gentlemen, as regulators of medical education, and as
censors of medical honour, what think you of the recent adju-
donation of this prize to an adjudicator , one of the Council of
f&i College, who in his corporate capacity (Medical Press and
(SECULAR, May 6th, p. 410) moved that the amount of the
prizes should be doubled; but who, to use the words of the
same Journal, tried for this prize in his private capacity (June
17th, p. 625.) According to the will of Mr. Carmichael, not
a word is said about the power of doubling the prizes after
1859.
Gentlemen, these are the firsts Carmichael prizes that have
been awarded, although they bear so materially upon medical
education and the good of humanity; they are to be competed
for, according to the will of Mr. Carmichael, eveiy four years,
.•Mmis for this reason that 1 bring this subject before you
amp, As I have said before, it is one that especially comes
whin your province— Firstly , Because it particularly relates
tci m edical education; and, secondly, because those who have
. the power to sit in judgment upon others, should be careful
<th*Mhsir own acts should be free from corporate taint and
n £. ft wdspoor Syme, one of your Council, in speaking of the
ffMpey Gup adjudication by the elect of the London College
eCFhysirians, said in his essay on "Medical Reform," 1850,
x UbM Mkge that supported their own President on, and identic
Mm »ith t thepmpdratimgn wch a* outrwco* decency
A Set M s let ter , Mspioal Press avx> Cjectlai, June 24th, p. 549.
TsWymiuTo elapsed since 1650.
and propriety , could not be safely trusted with any power of con-
trolling the members of a liberal profession'* I am sure that on
the present occasion I shall have the Professor's support.
But let me in common fairness ask how many of the Council
of Dublin College may, in “ their private capacities " compete
for the prizes in 1871 ? especially it the amount be doubled by
themselves or their friends (£400, £200) ? How erfn the
Council, me directed by Mr. Carmichael, decide the question, if
even one of their body become a candidate for the prize ?
In justice to myself, I may add, that I have no pecuniary in¬
terest whatever in this matter, my essay now at the Dublin
College of Surgeons (to be published by Dr. Mapother, the
gainer of the first prize), and also the one sent in 1859, went
far too deeply into oorporate abuses, and into grades and dis¬
tinctions in the very chambers of death, to lead me to
expect even a commendation or an honourable mention. In¬
deed, according to the three adjudicators, who reported to the
Council (Medical Press and Circular, May 6, p. 410), and
whose judgment it would be treasonable to question, it, with
the two other unsuccessful essays, “ did not come up even to the
present advanced position and requirements of the profession.”
I again ask you as a Council of Medical Education, and, to
nse the appellation of your President, as a “ Commonwealth of
Medicine/’ to investigate this important matter, so that
future candidates for these prizes may know the amount of
money they have to contend for, and the amount of corporate
interest they have to contend against! Waiting your reply—
I am, gentlemen, your obedient servant,
Edwards Crisp, MJ>.
-♦-
GUY’S HOSPITAL, LONDON.
At a cost of about .£30,000 the Directory of Guy’s Hos¬
pital have determined on still farther enlarging its
capacity by accommodation for 160 new beds. This num¬
ber is to be evenly distributed over four storeys, and the
Ophthalmic department of the Hospital is to be transferred
to the lowest of the four.
REJECTIONS AT THE LONDON COLLEGE OF
SURGEONS.
Those who complain that the standard of medical educa¬
tion is lowered from the standard at which it should rest,
can hardly charge the Royal College of Surgeons of England
with accepting from its candidates an insufficient amount of
professional information. Students appear, however, to
have become imbued with a different idea, or else they are
callous to the disgrace of being rejected for their ignorance,
for the proportion of the “ referred” to the 4t passed” can¬
didates increases every year.
We are informed that out of 71 students who offered
themselves at the last Anatomical or first half examination
at the College, no less than 23 were sent back.
Whether teachers or students be responsible for this
state of things, it shows a very dangerous indifference in
the matter of education, and requires the most earnest
attention of the profession.
jebijcal gfefirc.
The Public Health. —We extract the following
weekly returns from the RegistrarGeneral:—In the week
•hat ended on Saturday, July 11, 4854 births and 3168 deaths
were registered in London and in 18 other large towns of the
United Kingdom. The annual rate of mortality was 26 per
1000 persons living. The rate of mortality last week
was 25 per 1000 in London, 19 in Edinburgh, and 16 in
Dublin ; 23 in Bristol, 26 in Birmingham, 27 in Liverpool, 36
in Manchester, 27 m Salford, 29 in Sheffield, 21 in Bradford,
80 in Leeds, 24 in Hull, 27 in Newcastle-upon-Tyne, and 27 in
Glasgow. The deaths registered in London during the week
were 1505. It was the twenty-eighth week of the year, and
the average number of deaths for that week is, with a correc¬
tion for increase of population, 1879. The deaths in th* pro¬
mt return exceed by *26 ike sethnated amount. The annqal
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rate of mortality was 23 per 1000 in West London, 23 in
North London, 25 in Central London, 28 in East London, and
26 in South London. The deaths from zymotic diseases were
582, the corrected average number being 430. Nine deaths
from' smallpox, 31 from measles, 39. from scarlatina, 14 from
diphtheria, 42 from whooping-cough, 59 from fever, 800 from
diarrhoea, and 19 from cholera were registered. The deaths
from diarrhoea differ little in number from those in the preced¬
ing week. In the week which ended June 6, the deaths from
diarrhoea were 27, in the four following weeks 31, 66, 171, and
286 persons died, and last week the deaths recorded were 300.
Statistics of Insanity— The report of the Com¬
missioners in Lunacy lately issued records 33,213 patients
in the various institutions of England and Wales on the 1st of
January, 1867, against 31,917 in the previous year. The
inmates were distributed as follows:—25,680 in county and
borough asylums, 2282 in registered hospitals, 2546 in
metropolitan licensed houses, 2097 in provincial licensed
houses, and 608 in naval, military, and State criminal
asylums ; of these numbers 27,361 were pauper lunatics,
’and 5852 private lunatics. Since January, 1867, 3572
Were discharged as recovered, and 3365 died, including
25 by suicide. Of the 33,213 remaining in January, 1868,
3884 were deemed curable, 435 were found lunatic by inqui-
Iritfon, and 675 were criminals. In Colney Hatch Asylum the
patients numbered 2036 on the 1st of Jan., 1867 ; the deaths
during the year 1867 were 174, and the number discharged as
recovered was 105 ; the admissions during the year were 806.
On the 1st of January, 1868, there were 2035 patients,"only
62 of whom were deemed curable. The principal causes of
death were paralysis, epilepsy, phthisis, pneumonia, bron¬
chitis, and exhaustion after mania. The mortality was lower
than usual among females, but higher among males. No less
than 380 applications for admission were refused from Novem¬
ber, 1866, to November, 1867. The average numbers attending
chapel were 270 men and 367 women ; and not more than 300
* altogether attended the general entertainments. In Hanwell
Asylum the patients numbered 1723 on the 1st of January,
1867 ; the deaths during the year were 177, and the number
discharged as recovered was 102 ; the admissions during the
year were 344. On the 1st of January, 1868, there were 1723
patients, of whom 87 were deemed curable. At the visit paid
by the Commissioners to this asylum in Dec., 1867, the records
of employment showed that 789 of the patients were employed
—viz., 239 men and 550 women ; of the former, 60 worked on
the farm and land, and 55 at trades ; of the latter, 235 were
engaged in needlework, 91 in the laundry department, and 23
in the kitchen, dairy, and bakehouse. The chapel attendance
on Sunday was about 550. The asylum was much over-
. crowded, and the necessity of making further provision for
the pauper lunatics of the county is a matter of pressing
urgency.
Malvern Hospital.— The stranger, on approach-
mg the Rural Hospital, will at once see that it belongs to the
public—or that it is a public institution set apart for their use,
out what he cannot conjecture unless some outside show be
made. The building stands, as we before said, on elevated
ground, and is surrounded with a rough stone wall, except in
the front,, and that is built and ornamented with red and blue
bricks. There are two entrance gates, one for foot passengers
and the other for carriages. The building and grounds occupy
nearly two acres. That in front will be laid out with grass,
shrubs, flowers, Ac., and will contain a drive for carriages.
The ground at the back will be used as a kitchen garden where
the vegetables required by the servants and inmates will be
grown. Round the building which is constructed with brick
and Bath stone dressing, the latter used very sparingly, there
is a protection wall to the foundation to keep it dry. The
basement storey up to the ground line is of Malvem-hill stoup,
with brick quoins, and above are lines of red, white, and blue
'bsieks. The arches and tympanum are set out with white and
blue bricks, each arch being varied in style. The entrance to
the building is bv a flight of stone steps, over which is a
hooded porch made of wood and covered with tiles, similar to
those on the main building, which are capped with ornamental
ones on the ridge. Over the entrance door is a fanlight
leaded, the quarrys being of Cathedral glass. The door being
opened, a vestibule or passage is entered six feet wide. It is
stuccoed'in imitation of Ashlar work. The floors of the vesti¬
bule and corridor are laid with Godwin's tiles, which he put
do#n it half prioe. Passing down the vestibule) and on turn-1
ing to the right, the corridor leads to. the, large ward for men.
This is 17 by 26 feet, and 15 feet high, well lighted, and venti¬
lated on north and south with cold air, and on the east with
hot air. There are all necessary conveniences, water-closet,
hot and cold water, and pipes for gas, when that is brought so
far on the road. This room will accommodate four beds
Near to this is a smaller ward, similarly filled up, 13 by 16
feet, for two beds, and opposite this is the bath room, 9 by 11
feet, with all necessary appliances. The east side of the build¬
ing will be occupied by men, while the west side will be appor¬
tioned to the females, and is in most respects nimilar to the
men's side. Over the corridor and vestibule are groined arches,
which give a light and elegant appearance. Opposite the «•
trance is the operating room, 20 by 14 feet, which is convent*
ently fitted up. It has two closets and a cupboard, one with
hot and cold water, and one where the instruments will be
kept.' The ventilation and light are very efficient, as a lain
quantity of the latter comes in from a skylight. In the naira
west end of the corridor is a flight of steps leading to the base*
ment part of the building, which is fitted up for attendants
and nurses. The housekeeper's room is 17 by 26 and 9 feet
high- It has convenient cupboards, piping for gas, and grate.
It is flanked by a beer and wine cellar, fitted with zinc and
glass, and necessary shelves and trams. The kitchen is 18 by
16 feet, and has a capital range with appliances for Bending
hot water all over the building. Out of it is a door leading to
the scullery, where the force-pump, boiler, Ac., are found.
Adjoining this is the mortuary, coal celler, and small closet,
the latter being flanked by a larder and visitors' waiting-room,
The woodwork of ail parts of the building is of the best red
pine. The frames of the doors are stopped, champhered, and
stained, while the panels are uncoloured, the whole being var*
nished .—Malvern News.
Cinchona in Jamaica.— We learn upon reliable
authority that there is every prospect that the attempt which
is being made to add an important staple to the resources of
the island of Jamaica in the cultivation of cinohonas will
be attended with success. Under the direction of Mr. Robert
Thomson operations were at first confined to propagation,
which was undertaken in a systematic way in the early part of
1866. In March of the following year progress had so far
been made that there were some 800 plants fairly growing. R
was then decided to cultivate the trees on a more extended
scale. With this view, plantations of from 100 to 200 acres
were marked out in the Blue Mountain range and propagation
was again carried on in contiguous sites ranging as regards
elevation above sea level from 8500 to 6500 feet. The M
that certain plants, few in number it is true, had been growiflfr
here and there since 1861, and that one or two of these had
actuaUy attained the height of 20 feet, proved that the islarifl
in some parts was well suited to the growth of certain cin¬
chonas. At the present time, as the result of the growth df
cuttings and of seed furnished by Dr. Hooker from Ceylod,
there are about 25,000 plants in vigorous growth. In M*y?
1867, a score of cinchona simarubra were transferred' to a rib
of an altitude of 3700 feet, when they were about six irMtik
in height ; at the beginning of the present year they h*f
actually grown to that of three feet. The larger number,
however, of the 25,000 were in pots, 500 only haa Vrm yfagjtrf
out at a height of 5200 feet. Mr. Thomson, we understariGLli
fully impressed with the ■ opinion that the cultivation of tbs
cinchona will be “ highly remunerative." He is not prepared
to say which species is likely to be most luxuriant, but he hie
every reason to believe that the ultimate success in Jamal#
11 will not yield to that of India." These facts are of great in¬
terest, not only in regard to the increasing demand for quinint,
but the commercial and consequent social improvement of this
island. Should the government experiment be successful do
doubt the landowners of the island will follow the example
them, and undertake the culture for themselves.-— Standard*,
Testimonial to De. John Haslet.— On Frwkg
last a few of his old students presented this distingttiiiA
physician with a copy in silver of the Cellini Vase, bearing^#
appropriate inscription, on the occasion of his retirement
King's College, London, as Lecturer on Physiology iirfls
evening class department. The .testimonial wasaooompanHd
by a very flattering address. Regret is expressed on all ri#
at the inconsiderate manner in which Dr. Harley has be#
treated by the Medical Board >f King's Oolllffle r an& It-ll
pleasing to find the Doctor’s students reeentuurtjw flighfr ft*
upbnhim. XT f/
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44 SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, JULY 29, 1868.
CO NTENT S.
ORIGINAL COMMUNICATIONS.
Benarkabto and Carious Owe of Foreign
Body in the Lams. B j Henry Gray
Crwy.FR.C.8.1.. paoh 91
The rood Question. By Henry
Mao Comae, M.D.-. 92
Urea and Uric Add; Their Relation to
Health and Disease. By B. Kell/, M.D. 93
A Two Months* Summary of Cases
Treated at the Westmoreland Lock
HospitaL By Mr. Morgan... 95
Gases Occurring in the Practice of J.
. Martin. F.B.C.8.I., L.K.Q.C.P.1. 97
Morbid Conditions of tha Throat in
their Relation to Pulmonary Consump¬
tion : their Diagnosis and Treatment.
No. HI. By 8. Scott Alison, M.D., Bdin. 97
HOSPITAL REPORTS.
JLoro's College Hospital—
Cases under the care of Dr. Beale, F.R.S. 99
Da- 8tebvkxs* Hospital—
Case under the care of Mr. Hamilton. 100
City of Dtrau* Hospital—
Ctaes under the oars of Mr. Croly. 101
PAOK
LITERATURE.
On Spinal Weakness and Spinal Curva¬
tures; their Early Recognition and
Treatment. By w. J. Little, M.D. 101
Plastics: a New Classification and Brief
Exposition of Plastic Surgery. By
David Prince, M.D. 102
Pathological Anatomy of the Female
Sexual Organs. By J. M. Klob, M.D.
Translated by J. Krammerer, M.D.,
and Benj. F. Dawson, M.D. 102
Principles of Forensic Medicine. By W.
A. Cray, M.B., F.R.8. Third Edition... 102
LEADING ARTICLE8.
MovemeXt op Troops is India. 102
ElKCTIOW OP THE KlXO's PROFESSOR OP
Physic ix Dcblix. 103
Specialists axd Specialism . 103
14 NOCTBS, CdXjEQUE Doctobum.”. 104
NOTES ON CURRENT TOPICS.
The Duke of Edinburgh.—St. Andrews
Medical Graduates* Association.—The
Registrar-General's Quarterly Return
for Ireland.—Prevention of Cruelty to
Animals.—Accidentally Poisoned. 104-5
PA OS
FOREIGN MEDICAL LITERA¬
TURE.
Professor Bamberger on acute Poisoning
with Phosphorus. Translated by W.
D. Moore, M.D. Dub. et Cantab.,
L.K.Q.C.P.1., M.R.I.A. 106
PROCEEDINGS OF SOCIETIES.
St. Andrews Medical Graduates* Associa¬
tion. ior
Forfarshire Medical Association. 108
CORRESPONDENCE.
Hargrave on the General Council of Medi¬
cal Education and Registration. 106
Cantab on Medical Reform. 100
8aiut Pancras on Dining. 109
E. L. on the Contagions Diseases Act. 109
Graham on Poisonous Effects of 44 Cytisus
Laburnum'’. 110
MISCELLANEA.
Rules for Registration in the Scottish ’
Universities. 106
Medical News. Ill
(Drigimil
REMARKABLE AND CURIOUS CASE OF
FOREIGN BODY IN THE LARYNX;
6EVB1 1 ARTIFICIAL TEETH (BET IN GUTTA-PERCHA) HAV¬
ING ENTERED THE WINDPIPE DURING A FIT OF EPI¬
LEPSY : IMPENDING SUFFOCATION : TRACHEOTOMY PER¬
FORMED : FOREIGN BODY EXTRACTED : DEATH THE
RESULT OF A VIOLENT EPILEPTIC SEIZURE.
By HENRY GRAY CROLY, F.R.C.S.I.,
ncnrmti op the kwo aid queen’s college or physxciaxs;
8UBOEOX TO THE CITY OF DUBLIN HOSPITAL;
LECTUBBB OX CLIXICAL 8UBOEBY, ETC.
At 11 o’clock on the night of the 9th of July of the
present year, I received an urgent message from Mr. Lyon,
of Patrick-street (general medical practitioner), request¬
ing me to visit Mr.-, a dentist, aged 30 years, resi¬
ding in Parliament-street, who had missed a set of arti¬
ficial teeth from his own mouth, on recovering from an
epileptic fit in the afternoon of that day, and who was
then suffering from urgent dyspnoea,
r Having placed in my pocket the instruments and appli¬
ances required for tracheotomy, I drove. at once to the re¬
sidence of the patient, and found him sitting up in bed
tyfienng from croupy breathing.
^'/In ieply to my questions, he spoke in a whisper ; I as¬
certained, on inquiry, from his wife, the following facts :
Her husband had been the subject of severe epilepsy for
.sixteen years; he lost bis teeth earlv in life, and before
ins marriage bad an artificial set, which she was in the
habit of removing when he was seized with a fit. The
deep Of the upper set was broken, and through negligence
hid hot been repaired ; he was frequently attacked with
—- whan in the act of operating as a dentist; he
lily at four o’clock on that day, and at five
l a Violent fit, and on recovering could not find
.iper set of teeth belonging to the front of his
i; jie fslt uneasiness in his throat; lost his voice, and
y difficulty -breathing ; he searched his bed and
r tbe t$e>th but conld not find them, and yet he
Here that he had swallowed them. His wife sent
l Shortly alter the occurrence, who, finding the
patterns becoming serious, requested that I
LHMfc: I proceeded to examine the patient in
lowing manner: 1 first passed the forefinger down
of the windpipe to ascertain if the foreign
body lay across the opening. I then examined his chest
carefully with the sthethoscope, but could not discover
any alteration from the natural respiratory murmur. I
next drew forward the tongue, and introduced a long curved
forceps into the larynx; this produced alarming dyspnoea.
The patient vomited large lumps of meat and potatoes. I
informed the patient and his wife that I believed the teeth
were lodged in the windpipe, and that an opening should
be made without delay into the air-tube to prevent suffo¬
cation. I also stated that if he got an epileptic fit while the
foreign body lay in the windpipe he might be suffocated.
I had the advantage of a consultation with my able friend
Mr. Porter, now President of the Royal College of Sur¬
geons. He agreed with me as to the imperative need for
immediate operative interference. In his presence I again
attempted to feel the foreign body, with the aid of a long
curved forceps, but was obliged to desist, in consequence of
the urgent dyspnoea and struggling of the patient.
The necessity for the operation was fully explained to
the patient and his wife. They agreed to our proposal,
and I then proceeded to operate.
The patient was placed on his back on a table, as near
as possible to a jet of gas which was over the mantel-piece.
His shoulders were raised, but he suffered considerable
dyspnoea when his head was brought backwards. His
beard having been shortened, and the integument over the
trachea steadily fixed, I made an incision in the median
line with a scalpel, commencing about half an inch above
the sternum, and extending nearly as high as the cricoid-
cartilage. The fascia connecting the sterno-hyoid and
sterno-thyroid muscles was divided on a director, and then,
with the handle of the knife and the end of my forefinger,
I quickly reached the tracheal fascia, which I scraped
through with a director. Scarcely a drop of blood was lost.
Enormous veins (the inferior thyroids), almost as large as
goose-quills, were seen lying parallel to the trachea—these,
with the sterno-hyoid and thyroid muscles, were carefully
retracted by Mr. Porter. Having laid bare the rings of
the trachea, which was very deep and small, I seized and
raised the tube by means of a small hook, and with a nat-
row-bladed knife I cut a circular piece out of the trachea,
as large as a sixpence.
The dyspnoea was relieved, and the air passed through
the wound with a loud hissing sound. The windows were
thrown widely open, and the patient sat up. I proceeded
to search through the wound alternately with my finger,
a bent probe, and a wired forceps, in every direction, but
1 Digitized by VJfUVJv liL
July
92 The Medical Prtss and Circular. MAC CORMAC ON THE FOOD QUESTION.
could not touch the foreign body. This proceeding caused
urgent dyspnoea.
Soon after, the patient was seized with one of the worst
epileptic fits which I ever witnessed. His face became
almost black, and his features were hideously distorted.
The air passed freely through the artificial opening during
the fit, as evidenced by holding a lighted candle to the
wound. The flame was blown out three times in succes¬
sion. We dashed his face with cold w r ater, and I raised
with a hook the opening in the trachea, and kept it raised
on a level with the wound. The mucus was carefully re¬
moved with a small sponge and feathers. The fit lasted
about a quarter of an hour, and we feared that he would have
expired in it. He recovered, and I again attempted to find'
the foreign body. On introducing the end of the little
finger, I touched a hard substance lying at the left side of
the larynx, close above the wound. I tried to seize it in a
polypus forceps, but it slipped upwards towards the mouth.
I then caught, and was enabled to remove, the set of arti¬
ficial teeth, as represented in the accompanying woodcut.
The patient was shortly afterwards seized with another
epileptic fit, in which he soon expired.
The annals of Surgery afford numerous instances in
which foreign bodies, of various forms and size, have acci¬
dentally entered the air-passages, amongst the most re¬
markable of which are the case of Brunei, the celebrated
engineer, into whose larynx a half-sovereign slipped, and
which, by a combination of artistic and scientific skill, was
happily expelled thirty days after the accident—trache¬
otomy having been performed by Sir Benjamin Brodie;
Houstoms case, in which a large molar tooth entered and
passed through the larynx during the operation of extrac¬
tion ; also cases of buttons, pease, fruit-stones, portions
of bone, &c. ; but, perhaps, the case now related has no
parallel, in which so large a foreign body as seven artificial
teeth, set in guttapercha, entered the larnyx and passed
through the rima glottidis, and lodged at the junction of
the larynx and trachea.
That a foreign body had entered the air-passage during
a fit of epilepsy was evident in this case from the croupy
breathing, urgent dyspnoea, and aphonia, corroborated by
the fact that the artificial teeth belonging to the upper jaw
were missed by the patient after the epileptic seizure, and
could not be found. The stethoscopic signs were negative,
in consequence of the foreign body having been fixed in the
long axis of the trachea (as was afterwards ascertained in
the removal of the teeth), and thereby not fully obstruct¬
ing the entry of air into the lungs.
The necessity for bronchotomy was obvious, and was
sanctioned on consultation with Mr. Porter. The danger
of spasm of the glottis in this case was imminent and two¬
fold, either from the foreign body being forcibly driven
against the rima glottidis during expiratory efforts, or dur¬
ing a return of the epileptic seizure. I accordingly per¬
formed the operation of tracheotomy, ably assisted by Mr.
Porter.
Such a procedure, at midnight, on an epileptic patient,
having a fat neck, with enormous large veins, and a small
and deeply-seated trachea, was a serious undertaking, and,
so far as the operation itself was concerned, was perfectly suc¬
cessful. Death was obviously caused by prolonged and vio¬
lent recurring epilepsy.
THE FOOD QUESTION.
By HENRY MAC CORMAC, M.D.
This question, its discussion and solutiou, comes, or ought
to come, especially within the competence of medical men.
1 think it needs no insisting upon that the working-
classes of these countries are not adequately nourished,
thereby impairing or losing, so far as it depends on nourish¬
ment, the safeguard against disease of body and mind,
which a sound habit of body ensures. The working-classes
are adequately nourished nowhere. But many of the
wealthy themselves, particularly women and children, and
men who have much “ head-work,” as it is termed, are not
at all sufficiently nourished, -whether as regards quality or
quantity. It is a great question, is the food question, and
one that well-deserves patient care and attentive considera¬
tion. Tn limine , the appetite for and assimilation of food,
largely depend on air, exercise, cleanliness, and variety.
The art of cookery, irrespective of procuring proper sus¬
tenance of any kind, may, as regards the immense majority
of the people of these lands, be well regarded as in next to
a savage state. We do not devour our food raw, indeed,
but the aid of art is very imperfectly called in. The
cookery books are, one worse than the other, crude, ridicu¬
lous, and impracticable. There is a general rationale or
principle of cookery which the authors of these treatises
know nothing at all about, and which, nevertheless, should
be prefatory to every treatise on cookery. The French have
not arrived at the consummation or climax of the cook¬
ing art, nevertheless, they have arrived at a degree of empi¬
rical skill which, though somewhat exaggerated, is not the
less perfectly surprising. If a French teacher of practical
cookery were attached to every school, as well as a teacher
of French, it would do a mint of good. I think Thomas &
Kempis a wonderful book. I have read it several times,
and hope to read it again. Nevertheless, Brillat Savarin
would be productive of more material happiness at least.
Dear Thomas was an ascetic of the first water, but Savarin
was a cook in a very high sense, and certainly shows the
importance of being well “done for” in the dining line.
And, really, I do not see, I should like to know, what a
man is good for that gets no dinner, or, at least, no ade¬
quate one. I have perused Soyer, Francatelli, and several
other French treatises, but they are all, Jules GoufFe (which
I have not as yet read), I fear inclusive, highly empirical,
and no more calculated to teach cookery than treatises on
the piano, or on swimming, alone, are calculated to teach
swimming or playing on the piano. There must be prac¬
tice. But practice, after all, is a poor thing without prin¬
ciples, and the cooks who write are hazy in the extreme on
the subject of principles. They do not, in fact, Brillat
Savarin, in a certain limited sense, excepted, know any¬
thing at all about principles.
Now, principles in cookery are like principles in every¬
thing else, the very lights and guides of the world. What
we need are principles coupled with efficient practice ; in
fine, principles and practice, sound principles and sound
practice. For the infant, the best food is, first, mothers
milk, the healthy milk of a healthy mother. The next
thing it needs, is the healthy milk of a healthy animal-
say a healthy cow, or ass, or goat. Farinaceous matters
and animal solids will come in due time. The various
“ foods” and “ substitutes” are perfectly inadequate. Good
cow, or goat, or asses milk, a little of the bruised yolk of a
good egg, or a little good recent beef-tea, one or all, is the
only approximately good substitute or substitutes that I
know of, and one and all they are inferior, in its own time
and place, to good mothers milk. For the mothers milk
is prepared by the cunning hand of Nature, and for the
creature it is designed for, is the best of all possible
nourishments. And why is it so, simply because it is
thus designed by the Maker of the infant. It contains, as
to artificial “ food,” the azote, the carbon, the water, the
sugar, the flit, the casein or fibrin, the phosphates, the car- !
bonates and the sulphates, the iron, the lime, and, in fine, j
the various matters needful to build up the infant, whole- [
somely, blood and bone. Now, the mans food, mutatti
mutandis , is the childs food. He must have the same in¬
gredients, so wondrously combined in the mothers milk,
that the babe has, agreeably, sufficingly, and variously
served up to him. It any ingredient be absent or bad,
Digitized* by VJ U
SteJMkal Pna and Circular.
KELLY ON UREA AND URIC ACID.
July 29,1868. $$
or insufficient, he is sure to suffer, and in effect does
suffer, grievously. The whole art of cookery, then,
is to procure these diverse food ingredients, and to
present them in an agreeable and sufficing form to the
palate of the human being that is to make use of them,
in the first place, the water must be pure. It must not
be loaded with foreign matters or with living organisms.
The food should be varied. Though milk no longer prove
the exclusive sustenance, good milk, variously prepared, is
an excellent ingredient of adult regimen. Wines, spirits,
ales, tea, coffee, chocolate, each ana all of them good of
their kind, and in the guarded measure which sound sense
dictates, have their uses. Bread comes next, good bread,
to good water. Bread, too, should be varied, well prepared,
ana well cooked. Bice, barley, rye, wheat, Indian corn,
with some foreign grains, separately or mixed, constitute
the desirable ingredients. The grains, also, may be pre¬
pared whole. In the form of bread, the grains should be
good of their kind, well mixed, well baked, careftilly and
deanly manipulated. Wheat has the singular peculiarity
that the inner or internal husk may be ground up, and
incorporated with the bread. The advantages are great.
There is a surplus of nitrogen gained, then there are
the extra phosphates. Lastly, the bran particles obviate
the constipation or costiveness which white bread promotes,
and which proves in various ways so frequent a source of
injury and distress. Whole meal bread, well baked and
prepared, will sustain life alone, white wheaten bread will
do nothing of the kind. Working men and women suffer
very much from the bad white bread which they now so
exclusively use, and which is really inadequate to the
wants of the living organism. Some, however, very super¬
fluously, I think, object to the bran particles. They say
they irritate the bowels. Admitting that, as thus, the bran
particles are objectionable, at least, in some persons, wheat
has receutly been ground down by the Messrs. Chapman
into a perfectly smooth and homogeneous flour, by which
all the nutritive properties of the bran are retained, while
the roughness and grittiness appertaining to the bran in
ordinary are entirely obviated. Probat urn est.
As we are constituted, animal food, fish, flesh, fowl,
variously and agreeably prepared, seems, if not absolutely,
at least approximately, requisite. It is to the preparation
of these, variously combined with pulse, vegetables, and
fruit, that the art of cookery is considered more especially
to apply. In fact, the animal foods, as prepared, and
coupled with those derived from the vegetable worlds,
mineral and vegetable condiments inclusive, must contain
the ingredients of which mothers milk or the egg yolk is
the so perfect standard. If they do not contain these in¬
gredients, the animal frame perishes or becomes inadequate
to the performance of the various requirements of this life.
The cook would need to be something of a physician, the
physician somewhat of a cook. Into the preparation of
foods, it is here out of the question to go. I have, at least,
signalised some of, nay, the leading principles which
the consideration of the preparation of food should com-
S Milk, water, bread, animal fibre, along with wines,
and vegetables, constitute the food of man, a varied
fare truly. There is, however, one dish to which I
must advert ere I have done, as it much concerns the welfare
of working-men, and all men, in fact, are, or at least ought to
fot working-men. That is the Stew. With good bread, 1 *
gQod water, good milk, good wine, good fruit, grains,
palpe, and vegetables, and a good stew , any man might live,
MJtd live wejl. And, really, I do not think that any human
fy yng should have a more restricted fare. Every working
B 64 A and working woman should, at least, have this. If I
have my will, I would have the Legislature or, at
beat, some public body, to offer a thousand pound prize,
“***- approximately smaller prizes, to him or to them who
A devise the best stew or stews. And having devised
er stews, I would have the process taught in every
^ jipd in evejy school. It would prove a more im-
gill&jMUfsmt solved, than the philosophers stone, even
&3jPpOgl # 0f tip north-west passage, or the finding of the
longitude. With a good stew, daily, and the other in¬
gredients I have mentioned, disease of body and mind and
material unfitness, generally, would have received a sore
blow and great discouragement. The “ Irish stew,” the
Spanish the French “ pot-au-feu” and “ bouilli -
baisse,” or fish stew, and the u Indian curry,” are all ap¬
proximately good dishes. And there might, perhaps, be
something better. Some years since I published a receipt
for a stew. Hopefully, some one else will do yet better,
and a very great good might thus be effectively and finally
consummated.
UREA AND URIC ACID :
THEIR RELATION TO HEALTH AND DISEASE.
By B. KELLY, M.D., L.K.Q.C.P.I.
(Continued from page 74.)
Considerable controversy has long existed, and still ex*
ists, respecting the topical formation of carbonate of am¬
monia in albuminuria. Frerichs is of opinion that this
substance is always generated in the circulation, from the
decomposition of urea, and not in the stomach and intes¬
tines, as Barreswil, Bernard, and other physiologists main¬
tain. But, apart from the high authorities opposed to the
theory of Frerichs, there are many considerations which
militate against the correctness of his views. In the first
place, I cannot well understand why ammonia should be
so readily formed in the blood of urcemic patients from the
decomposition of urea, when we know the latter substance
constantly exists in greater or less quantity in the blood
during health, without giving rise to a similar metamor¬
phosis. Were Frerichs* theory, -moreover, perfectly sound,
albuminuria would cease to be the formidable and fatal
disease it really is, for all the urea generated in the system
would be gradually changed into carbonate of ammonia,
and be steadily eliminated by exhalation from the lungs.
This is the usual manner in which this agent is removed
from the economy, when injected into the veins; and the
same, doubtless, would ensue in albuminous nephritis.
When, however, the urea accumulates to such a degree as
to require to be excreted by the gastro-intestinal mucous
membrane, it becomes readily transformed into ammonia
by contact with altered mucus and other vitiated secretions
which abound, under such circumstances, in the stomach
and bowels. The new-formed carbonate is then capable of
being absorbed, precisely in the same way, and with similar
effects, as when given as a medicine by the mouth; so that
its presence in the blood in cases of uraemia is by no means
conclusive evidence that it had originally been formed in
the vascular system.
As to the nervous accidents—amaurosis, deafness, con¬
vulsions, &c.—which are said to depend upon the existence
of ammonia in uraemic blood; there is good reason, on the
contrary, to suppose that these symptoms arise rather from
the loss of albumen, coupled with an excess of retained^
urea in the system, and the consequent escape of the serum
into the connective tissue of the body. Ammonia has been
injected in large doses, by way of experiment, into the
jugular veins of healthy animals, without producing any
graver accidents than acute pain and jactitation, which,
however, soon subsided. Even in the cases cited by
Frerichs in corroboration of the former theory, in which
convulsions, stupor, &c., followed the introduction of car¬
bonate of ammonia into the vascular system, the animals
speedily recovered the shock, and soon regained their usual
health and vigour. The escape of the serum, consequent
upon the abundant excretion of albumen by the kidneys, is
virtually tantamount to one or more copious general bleed¬
ings, for the blood becomes thereby depleted of two most
essential constituents, not to speak of numerous saline sub¬
stances scarcely less important. The mere presence of the
serum in the meshes of the areolar tissue, or in the cavities
of the chest and abdomen, is of no more avail to the healthy
nutritive functions than if it were totally eliminated front
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the body. And as the blood in such cases has lost its
plasticity and endosmotic power in a great measure, it re¬
mains permanently altered in quality, and deficient in nor¬
mal proportion. Bleeding, we know, when carried to ex¬
cess, will produce all the symptoms following in the train
of albuminuria—amaurosis, deafness, convulsions, coma,
and death.
In gout and rheumatism there is a remarkable disparity
in the final disposition of the uric acid and urates, so abun¬
dantly generated in both these diseases. In the former
the acid, with its compounds,, exhibits a peculiar tendency
to collect, in the form of tophaceous concretions, in and
around the diseased joints, as though these parts were the
laboratories in which they had been fabricated, while only
a comparatively small portion of them is eliminated by the
kidneys. In rheumatism, on the contrary, the articula¬
tions never become the seat of similar deposits, it matters
not however long the disease may have continued, or how
swollen and painful have become the joints; whereas the
sweat and urine point to the proper emunctories, and bear
ample testimony to the free removal of the morbid pro¬
ducts from the system.
The acidity of the urine, as it appears, does not depend
upon the amount of uric acid and urates, but rather upon
the quantity of acid phosphate of soda held in solution in
this liquid. Liebig, after emphatically enunciating this
fact, advances a step farther, and states that as lactic and
acetic acids are rapidly formed in the urine after its excre¬
tion, its acidity, therefore, does not always depend upon
the acid phosphate of soda alone, but also upon free kip-
puric ana lactic acids. It is not necessary, however, that
urine should contain grape sugar in order that lactic and
acetic acids be produced by fermentation—their presence
in this liquid being sometimes traceable to the decomposi¬
tion of an azotized extractive matter in union with a sub¬
stance resembling dextrine, if* not in physical, at least in
chemical characters. Furthermore, when the perspiration,
which also contains free lactic and acetic acids, is suddenly
checked by cold, or by inflammatory action, these sub¬
stances are thrown back upon the blood, and are elimi¬
nated by the kidneys. Then, again, the amount of carbonic
acid, dissolved or suspended in the urine, is sometimes so
considerable as to give it a decided acid reaction, and it
generally exists in sufficient quantity to keep the phos¬
phates, even when abundantly excreted, soluble in this
fluid. After micturition, however, the greater portion of
the acid escapes, owing to its volatility, when the phos¬
phates become precipitated in the form of a whitish, floc-
culent deposit. Upon the application of heat, the carbonic
acid is more thoroughly expelled, and hence we often see a
copious sediment of earthy phosphates produced, which, in
the absence of the nitric acid test, is so liable to be con¬
founded with albumen. These facts sufficiently account
for the urine containing these salts being acid on emission,
but soon after becoming neutral or alkaline, without hav¬
ing recourse to the more complex mode of explanation de¬
duced from the development of ammonia by the action of
putrid mucus upon urea, and the consequent precipitation
of the neutral or acid phosphates.
Dr. Bence Jones, lecturing on the urine, says—“ If the
degree of acidity is slight, a large quantity of urate of .am¬
monia may remain in solution; if the acidity is conside¬
rable, then even a small quantity of urates may give a pre¬
cipitate.” The thicker and more turbid the urine in such
cases, the more acid, generally, will be its reaction, and
<vice versa . From this we may reasonably infer that urate
of ammonia and other urates, whether they exist in small
or large quantity, are precipitated by a highly-acid urine;
whereas a sparingly acid, neutral, or alkaline liquid is
favourable to their solution. The knowledge of these facts
is most important, for by it we not only get a clue to the
formation of urate of ammonia and uric-acid calculi, but
also to their most rational and efficacious treatment. It
may be mentioned in connection with this subject, that
Heller attributes the acidity of the urine, so common in
JlrightV disease, not to the presence of uric and hippuric
acids (for these substances are not always constant), butt©
uroxanthin.
Before concluding, I purpose saying a few words upon
the oxalic diathesis, and its relation to urea, uric acid, and
urates in the urine.
Great uncertainty still exists respecting the formation of
oxalic acid in the system. That it effects an enfcranep
therein after the use of sorrel, rhubarb, tomatoes, and other
edibles normally containing it, either in the free state or in
the form of oxalates, there cannot be a reasonable doubt;
but to account for its spontaneous generation, so to speak,
in the living organism, is a problem very difficult to solve.
Liebig, Frerichs, and Wohler have obtained three dis¬
tinct products from boiling together uric acid and the pe¬
roxide of lead, namely—oxalic acid, urea, and allantoin.
They also affirm that the same play of chemical affinities,
attended by similar results, is capable of being per¬
formed in the interior of the body. Other experimenters*
less fortunate in their attempts, have failed to corroborate
the truth of this theory. M. Gallois has only once suc¬
ceeded, and that in his own individual case, to detect
oxalic acid in the urine after the ingestion of a soluble
urate into his stomach. Oxalic acid may then be formed
in the system by the oxydation of uric acid in contact with
some agent like the peroxide of lead, capable of yielding
up its surplus, or feebly-retained oxygen; but, inasmuch as
the presence of one or both these organic substances, either
in the free or combined state, is incompatible with the
alkalinity of the blood, and the consequent decomposition
of sugar into water and carbonic acid, the question inevi¬
tably rises—what becomes of the sugar that is constantly
poured into the general circulation through the hepatic
veins. It must either suffer decomposition or combustion,
or be eliminated by the kidneys. But we know it cannot
be destroyed in the blood unless the alkalies abound in
sufficient quantity for that purpose; and I am not aware
that oxaluria and diabetes are ever concomitant affections.
All the elements to which the nitrogenous constituents
of the food and tissues of the body may be reduced by ulti¬
mate analysis are capable of being oxidized under certain
favourable conditions, to their highest possible degree.
Thus carbon, sulphur, and phosphorus, become converted
in the system into carbonic, sulphuric, and phosphoric
acids. Why may not nitrogen also be changed into nitric
acidj by the synthetic power of animal chemistry? By
once admitting the possibility of the formation of this
acid in the economy, we could readily account afterwards
for the production of oxalic acid and oxalates in the sys¬
tem, and for the simultaneous absence of sugar in the
urine, when otherwise we should reasonably expect to find
it in that liquid.
The fact that oxalate of lime is found much more abun¬
dantly in the urine after a copious meal, than in that
passed in the morning, would seem to lend additional
force to the hypothesis that oxalic acid is formed in the
blood from the oxydation of hepatic sugar; for were it
to originate from imperfectly assimilated food, or from dis¬
integration of the elements of the tissues, the so-called
urina sanguinis would, doubtless, contain the latest
proportion of it. That the oxydising agent is nitric
acid, or one of the same chemical series, is rendered pro¬
vable when we reflect that free nitrous acid has been de¬
tected in the urine after the administration of the urate
and other salts of ammonia, and, as the condition of sys¬
tem generally accompanying oxaluria, is also that in which
the urate of ammonia is found in greatest quantity, and as
this substance decreases, pari passu , with the diminution
of the oxalate of lime in the urine, the proofs in favour of
the hypothesis advanced become the more cogent and con¬
vincing.
According to Lehmann, oxalic acid and the oxalates «n
formed in the system, through the agency of the alkaline
carbonates, vegetable salts, and carbonic acid, contained in
many articles of food and drink, aided by certain conditions
which morbidly affect the respiration. He considers,
moreover, that the excessive amount of carbonic add tWs
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MORGAN’S SUMMARY OP CASES.
July 29, 1868. 96
introduced from without, as well as generated in the body
by the substances alluded to, prevents the absorption of
oxygen, and the consequent oxydation of certain principles
(which, however, he does not specify) existing in the
blood ; and, hence, he concludes the increase of oxalic
acid in the urine. In proof of the hypothetical soundness
of this theory, he cites the examples of emphysema and
pregnancy, in which the oxalate of lime is occasionally
found to exist in the urine as an adventitious product.
As to the formation of oxalic acid being due to a de¬
ficient oxydation, I would merely state that this assump¬
tion is opposed to the views of most other chemists, who
traoe its origin to an oxydation of uric acid. An alkaline
condition of the blood, moreover, is unfavourable to its de¬
velopment. As to the presence of oxalate of lime in the
urine of pregnant women (which Lehmann attributes to
impaired respiration, from pressure of the gravid uterus),
I deem it, at best, a mere coincidence ; or it may possibly
result, in such circumstances, from the death and decom¬
position of spermatozoa. Wolff, of Bonn, Doun£, and
more recently Bence Jones, and Ch. Robin, have drawn the
attention of physicians to the somewhat novel but impor¬
tant fact, that oxaluria is a very common collateral com¬
plication in persons afflicted with spermatorrhoea. Indeed
the latter goes so far as to declare in his lectures that the
existence of the characteristic octahedral crystals in the
urine is not only a concomitant, but even a pathognomonic,
symptom qf this affection. But whether oxalic acid re¬
sults in such cases from the decomposition of the semen, or
is generated in the system by reason of a special cachectic
modification of the nutritive functions, induced by the loss
of so vital a fluid, is very difficult to determine in the pre¬
sent state of medical science. Dr. Walshe has observed
that the quantity of oxalic acid and its compounds is often
increased in the urine during convalescence from typhus,
rheumatism, and many other acute and chronic diseases in
which the process of digestion had been seriously deranged.
For my own part, I am strongly disposed to believe that
the dyspeptic symptoms, the lassitude, debility, palpitations,
and the whole train of nervous phenomena, so commonly
met with in cases of oxaluria, are neither an elect nor a
cause of that ailment, but are to be traced directly to the
profound impression made upon the system in general, by
the long continued loss of sperm, whether that waste had
been induced by a voluntary act, as in masturbation, or
byan involuntary sexual erethism, as in nocturnal emissions.
- Dr. Schmidt, of Dorpat, altogether denies the pos¬
sibility of oxalate of lime traversing the epithelial cells
of the kidneys, and, therefore, has recourse to an in¬
genious explanation to account for its presence in the urine.
According to him, the acid urine contained in the bladder
and renal ducts, decomposes the soluble oxalate of albu¬
men lime secreted by the mucous membrane of the parts,
thereby disassociating the albumen, and precipitating the in¬
soluble oxalate. In the same manner, he says, oxalate of lime
is formed from the mucous secretion of the gall-bladder.
The assertion that oxalate of lime, as such, cannot over¬
step the barrier offered to its passage by the renal epithe¬
lium, seems opposed to the views of other competent and
candid observers. Garrod has detected crystals of the
oxalate of lime in the blood ; and Golding Bird, while
acknowledging the absolute insolubility of this substance
in water, emphatically pronounces its solution in the urine,
from the fact of its crystals presenting a transparent,
lustrous form. He adds, moreover, that the epithelial
edit have been found distended with the crystals of oxa¬
late and uric acid in certain urinary deposits. According
tpKoUiker, on the contrary, the concretions of urates and
calcareous salts, which accumulate so often in the urini-
feous tubes of vertebrate animals, have not been demon-
jteted, as yet, with certainty in the renal epithelial cells.
I^fttpfere fact of Dr. Garrod’s having found oxalate of lime
1ft wft vascular system, does not prove, by any means,
gWfajfeftjy, that it subsequently makes its way through
mhtmM 4 Hto the urine. It would be quite sufficient,
lft% in. view of the hypothesis already advanced,
to recognise the formation of oxalic acid in the blood, and
its immediate conversion or not, into a soluble potash or
ammonio-salt, to account for its existence as an oxalate of
lime in the bladder, seeing that calcareous matter is so
abundantly met with on certain mucous surfaces, and more
especially on those of the urinary organs.
The arguments of Professor Lehmann on this subject,
are worthy of serious consideration. “That oxalate of
lime,” he says, “ is at first actually held in solution in
filtered urine, and that it does not, as C. Schmidt supposes,
proceed from the mucus of the bladder, is a view which is
supported by the experiment which I have often repeated,
that in urine, which, after thoroughly cooling and freed from
its mucus and urate of soda by filtration, the most distinct
crystals of oxalate of lime might, after a time, be recognised,
while no traces of them could either previously be detected
in the mucus of the fresh urine, or found after the residue
on the filter had been for some time in contact with water.
The oxalate of lime,” he further adds, “ does not separate
from filtered urine until after it has stood for some time.”
We thus see that the seductive theory of Schmidt respect¬
ing the formation of the product in auestion, from the de¬
composition of oxalate of albumen-lime by acid urine, is
gravely controverted, if not completely refuted, by the re¬
sult of the foregoing experiment.
In oxaluria the urine always presents a more or less
marked acid-reaction, which is not so much due to the ex¬
cess of oxalates, and acid urates, and phosphates contained
in it, as to the presence of free uric acid. The proport ion.
of urea found in such cases, varies widely from the normal
standard, being sometimes more, sometimes less, than the
quantity usually excreted in health. Its amount, however,
generally bears a fixed relation to the number and size of
the oxalate of lime crystals. Hence the density of the
urine ranges from 1010 as high as 1030, and even 1040.
The specific gravity, therefore, of oxalic urine is no crite¬
rion whereby to diagnosticate this serious affection, the only
safe and reliable means for that end being the microscope
and chemical analysis, taken in connection with the gene¬
ral condition of the patient.
A TWO MONTHS*
SUMMARY OF CASES TREATED AT THE
WESTMORELAND LOCK HOSPITAL.
By Mb. MORGAN,
SUBGEON TO THE HOSPITAL, PBOFE8HOR OF SURGICAL AND DKSCBIFTXVI '
ANATOMY B.C.B.I., AND BURGEON TO MERCKR*S HOSPITAL.
During the last two months several cases of interest have
been under treatment, as will be seen by referring to the
tabulation given. Some allowance must be made for in¬
accuracy in history, considering the class concerned, but
considerable pains have been taken to arrive at the nearest
approach to a true record of the condition and previous
history as to disease of each ; the classification I have
adopted will briefly afford some details of the phases and
variations in succession which occur.
Five cases of chronic indurated sores have been
under treatment, all presenting the same character of
impassiveness, density, smooth surface, with little or
no discharge, comparative insensibility to the applica¬
tion of escharotics, four of them being of considerable
extent, varying in size from upwards of a crown-piece to a
florin, auto-inoculation was tried on several occasions with
negative results. From the insensibility and chronio
nature of these sores, the patients endured them for a con¬
siderable time before seeking admission. One of these cases
was treated in the hospital for this same sore eleven
months previously, she left the hospital and pursued her
mode of life for three and a-half months before seekiug re¬
admission, all the time, without doubt, having this sore in
existence, and in statu quo . Nearly five months ago the
patient was re-admitted, having, in addition to the soreL
a papulo-squamous eruption in dusters over the body, and
no other constitutional sign but hardened inguinal glands
on both sides.
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06 Ths Medical Prta and Circular.
MORGANS SUMMARY OF CASES,
July J9.1M9.
The other examples of this sore are of 5, 7, 14, and 15
months 1 duration. In all there was hardening of the
inguinal glands, and in one case a slowly suppurating
dense bubo formed.
An intra-vaginal and uterine form of this sore was found
in one case ; the only external manifestation being har¬
dened inguinal glands on both sides, and alopaecia.
Amongst the cases affected by primary sores for the
first time , there have been ten of soft sores, three of which
have already presented decided constitutional symptoms,
No case of indurated sore or with accompanying density
of the inguinal glands was seen amongst those admitted as
general patients who had been previously affected on one or
more occasions, while there have been twenty-four instances
of soft sore with or without constitutional symptoms,
which, in some cases, were apparently due to the original
infection, in others to the existing.
Phagedaenic ulceration existed in three cases to an immense
extent, from sixteen to ten months being occupied in repair.
In one case, the urethra was destroyed up to its vesical
termination. In others, an extensive sheet of ulceration
was left, extending over the nates, &c. All the sufferers
appear to have sought admission directly after being
affected by the sore, which, from the first, showed a pha¬
gedenic tendency.
Two married women in the early stage of pregnancy
have been under treatment, and two syphilitic children,
whose mothers presented no sign of original or present
taint,
GENERAL PATIENTS, HAVING BEEN PREVIOUSLY IN HOSPITAL.
PHAGSDJENIC SORES.
if
At what
What
Disease.
Antecedent
Constitutional
Observations.
Periods.
Symptoms.
w|
0
Extensive soft)
sores
Soft sore and
vegetations
Soft
Soft
Soft
Soft
Soft
Soft
Soft
Soft hypertro¬
phied labia
Several soft
Soft (exten-
rive)
Soft (several)
Soft
Several soft
Several soft
Large soft
Several soft
Largo soft
Soft
6 years
14 months
15 months
2 years
1 year
3 years
6 months
6 weeks
4 years
3 years
I None
1 8 years
1 18 months
1 year
8 months
6 months
3 years
1 year
8 months
4 months
In two years
0
7J years
7 weeks
\\
1
1
i
1
4
0
1
1
None
Papular erup¬
tion
Severe joint
pains
Nono,
None
Mucous patches^
and papular
Papular
Papular and
acne facei
Nono
BuIkms suppur¬
ating
Severe pains
Hypertrophied la¬
bium and nym-
pha, operated on
and removed
Had bubo with
first sore
With gonorrhoea
and aphtha? uteri
Has gonorrhoea 18
months’ duration
Had gonorrhoea 2
years ago
Had gonorrhoea
18 months ago.
8everal fistula?
in ano. Oper¬
ated on
Immense vegeta¬
tions. Hyper¬
trophied Jauia.
Operated on
None
Nono
Abundant pa¬
pular eruptioi
None
None
None
None
None
Sbft 'large) | J
Soft (several; 0
Soft (large; I 1
3 years
9 months
0
2 months
Alopfocia only
None
None
Hypertrophy of
nympha. Oper¬
ated on
Gonorrhoea six
months ago
Gonorrhoea five
months since
Twins, dead bora,
4 weeks before
admission.
Primary exist¬
ing at the time.
Had gonorrhoea
12 months ago
, Had gonorrhoea
5 months since
14 months,
recovery
Phagedsenic—j
10 months,
recovery
Phagedsenic— j
16 months,
recovery
Phagedsenic—
not exten-|
rive
Extensive
and chro-
n i o — 11
months’
standing
Extensive
and ohro-
n i c — 7
month's* du-|
ration
Extensive
h a r d—1 6
months
Small hard—
6 months
Hard on
uterus and
posterior
wall of vs-
g i n a —9
weeks’ du¬
ration
Chronic sore,
extensive—
14 months’
duration
/ 1
2 years with
Gummata, ex-
foliations,
J
bubo
i 1
1 year with
bubo
nodes
1
11 months
None
1
16 months
None
I 1
17 years \
None
u
l year )
Urethra de¬
stroyed. Opera¬
ted on—plastio
operation
Most extensive
over sacrum, Ac.
Most extensive
over nates and
sacrum
Had 8 healthy
children
INDURATED BORES.
1
8 yean
Papulo-squa-
mous, pemphi¬
gus, syphiliti¬
cus
Not auto-inocu-
lable
1
18 years
None, hard in¬
guinal glands |
Not auto-inocu-
lable
1
0
8 years
0
None, ulcerated
rectum, hyper¬
trophied labia
None, hard,
slowly suppur-
ating bubo,
iritis
Alopsecia, very
hard inguinal
glands
Not auto-inooa-
lable; labium
operated on and
. removed.
Not tried
Not auto-inocu-
labla
0
0
•
Extensive ulcer¬
ation of ure¬
thra—No con¬
stitutional
signs
Not auto-inocu-
lable
1ST ADMISSIONS, NOT BEFORE DISEASED.
External Disease.
Constitutional
Symptoms.
Duration.
Observations.
3 8oft
Roseolar, ulcer
2 months
Cachectic.
tonsil
2 External soft
1 Intra-vaginal
None
5 weeks
2 Soft
Abundant papular
and pityritio
3 months
8 Soft
None
8 weeks
Had gonorrheas 8
months since.
Large vegetations
None
6 months
N o primary ob-
'\ Soft
served.
None
2 months
Seven months;
child since born,
lived 24 hours;
not syphilitic:
has intra-vaginal
growths.
1 Large soft
None
3 months
Several soft
None
5 weeks
Non - suppurate^
bubo.
1 Soft
None
1 month
8everal soft
Cachectic, papular
8 months
Laryngeal ulcer at
choraa-voeatia.
Large soft
None
2 months
None.
Large soft
None
1 month
None.
GONORRHOEA.
Disease.
At what Ante-
affected. ' cedent ttoM -
Observations.
Gonorrhoea
Do.
Do.
Do.
Do.
Do.
Do.
Do.
li
18 months ago \
9 months ago)
2 years )
18 months >
2 months )
5 months
6 months
1 (sore and 8 years
1 bubo), i
1 1 year
1 5 months
No complications.
Has abscess of labium.
No complications.
Ovarian irritation.
Profuse discharge, and ap-
tha? uteri
Debilitated and purpuric.
Large abscess posteriorly.
Ovarian irritation and tume¬
faction.
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ALISON ON CONSUMPTION.
97
COXSTITmONAL 8TMPTOM8 O.VLT.
Primary
Disease.
At what Ante¬
cedent Dates.
Observations.
Kane
None
Kane
Kane
None
None
None
None
None
1 2 years
1 18 months
1 5 years
1 1 year
1 6 years
1 1 year
1 4 months
1 2 years
1 8 months
1 4 years
1 \ 18 months
Large vegetations
Pains cachexia, threa¬
tened phthisis
Slight pains ; exfoliations of
cranium
Severe papular and ulcer tonsil
Mucous patches and papular
Deep coloured macule?, pains,
hard inguinal glands, ulcerated
Up
Rupia and ulcers
None; ulcerated larynx, epi¬
glottis ulcerated very consider¬
ably, ulcer of eyelid
Roseola and papular, no pains
MARRIED WOMEN AND CHILDREN.
Character
of Present
Diseaae.
1!
I Constitutional
! Symptoms.
Duration.
Observations.
1 Several soft
•ores
None
Roseola
6 weeks
4 months pregnant
(first time).
2 Several soft
1
1
None i
Mucous patches
6 weeks
Has had healthy
children, the last 1
year old
8 Ko primary
None
Vegetations
2 months
Pregnant first time,
4 months
4 Ulcer soft,
palate perfo¬
rating
<5 years '
None
5 months
Has a healthy child
6 months old in
arms, and three
living
Slight prolapse of
uterus
5 Discharge
leucorrhoeal
None
None
10 months
1
6 None
None
Copious papu¬
lar,severe
pains
2 months
Infected by preg-
nanoy; had mis¬
carriage 7 months
CHILDREN.
One, six weeks old, verv weak and despaired of, oovered with papules
making good recovery with mercurial treatment.
One, seven weeks, abundant papula, but a strong child, making
• good recovery with mercurial treatment.
CASES OCCURRING IN THE PRACTICE OF
J. MARTIN, F.R.C.S.I., L.K.Q.C.P.I.
being much impaired, she consulted me ; the epulis then
being about the size of a large walnut. I made her wean
the child, and put her on a course of chalybeate tonics.
Two months after I removed both teeth, and cut down,
with a saw constructed for the purpose, on each side of the
epulis, then removed the intermediate parts with a cutting
pliers. It healed quickly, and now, after 18 months, has
not returned.
This operation was performed two years ago. Since I
sent the above to press I have heard that she has had
another baby, has nursed it for four months, and that dur¬
ing the past three weeks the hypertrophy of the gums has
set in again, and slight enlargement at the seat of the
former epulis.
Mrs. Brennan, set. 28 years, Co. Kilkenny, consulted me
for an epulis, about the size- of a hazel nut, on the gum,
under the right canine and first bicusped teeth, lower jaw,
both were loosened from their attachments, there being a
general hypertrophy of the gums. She was rather de¬
bilitated from nursing during the previous 9 months. I
made her wean the child, and put her on a course of iron
and quinine. I then extracted the teeth, cut down with
Hey’s saw on each side of the epulis, and removed it with
a cutting pliers. It healed quickly, and under the use of
iod. potass, liquor arsenialis, and iod. ferri., the gums re¬
sumed their natural state, and she recovered perfectly.
This operation was performed two years ago, and the
patient has remained quite well until veiy lately. Since I
sent the foregoing for publication I have heard that she had
another baby about three months ago, and nurses it, and
that during the past three weeks some slight enlargement
has shown itself in the old seat of the disease, and that all
the gums show hypertrophy.
It is remarkable, both these cases having occurred during
the cachexia produced by nursing.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
By S. SCOTT ALISON, M.D. Edin.,
FELLOW OF THE BOTAL COLLEGE OF PHYSICIANS, LONDON, AND
FXTSICIAN TO TnK HOSPITAL FOB CONSUMPTION AND D1SEA6BS OF THE
CHEST, BROMFTON, AND THE SCOTTISH HOSPITAL.
No. HI.
Mart Byrne, ®t. 49, had a large tumour of eleven
years’ growth, of an oblong shape, about twelve by
five inches, and running from the upper edge of the
left scapula, along its posterior edge. The weight being
inconvenient, and the size of it interfering with her
comfortably lying in bed, she desired to have it removed.
This I did by two elliptical incisions; two small vessels re¬
quired ligature ; the edges of the wound,, 13 inches in
length, were brought together by iron wire sutures ; nine-
tenths of the wound were healed by first intention, and at
the end of ten days she returned home, a spot about the
size of a sixpence being unhealed. The tumour weighed,
after removal, 3 lbs. 12 ozs., pure adipose, with intersecting
fibrous hands.
Mrs. S. B., aet. 65 years, had a tumour on the hack
of the left thigh, immediately above the upper angle of the
popliteal space for 17 years, which she concealed, until
ulcerating about two years ago, it became so painful that
the wished its removal. The base being circular, and the
integument over the tumour in an unhealthy state, I re¬
moved it by two elliptical incisions, the sides of which,
however, could not he brought into apposition. No vessel
required ligature. The wound healed by granulation with
singular rapidity. The mass, when removed, weighed 18
ots. of fine white adipose.
Maay Green, Killcommon, set. 27 years, while pregnant
of her second child, was attacked with a growth of epulis
on tke .gums of the first and second molar teeth, lower
jaw, left side. Having nursed for nine months, her health
The symptoms which enable such conditions of the throat
to simulate tubercle of the lungs are many, and the physi¬
cal signs are not very few which give rise to the same
result.
Cough is one of the symptoms which is calculated to de¬
ceive in the diagnosis. This is almost always present, and
is generally frequent, occurring in the morning, and repeat¬
ing throughout the day. Sometimes it occurs at night, hut
this is comparatively seldom, and the patient may sleep
many hours uninterruptedly. The cough in its character
is generally short and dry, and is rarely marked with
long, violent, and repeated expulsions of air from the chest.
The cough-sound sometimes resembles a subdued hissing
issuing from the glottis; sometimes the sound is an abrupt
explosion one, single, or at least distinctly divided. The*
sound also combines, in many cases, a ringing, metallic^
tube character. Sometimes the cough assumes a decided
loud, snappish, dog-harking character. In cases of morbid
narrowing of the trachea, the cough assumes a constrictive
sound distinctly traceable to the trachea.
“ Hemming* is a frequent attendant of simulating throat
affections. In some cases the local voluntary muscular effort
which produces this noise is almost unceasing. From early
morning till the moment of sleep it is to be heard, and while
it seems to afford only a little relief to the patient, or serves
to bring up only a very small amount of mucus from the
larynx ana the lower part of the pharynx, it succeeds in
causing great and wearing-out annoyance to those placed
about the patient. In most cases this “ hemming” is oom-
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98 The Medioal Press and Circular.
ALISON ON CONSUMPTION.
July *d» 1M.
paratively faint, but in some others it assumes a very harsh
character, and may more properly be called “hawing,”
from the similarity of the sound of the muscular effort to
the coarse sound of this word when pronounced in the ordi¬
nary or coarse^ prolonged manner. This variety of hem¬
ming is almost intolerable to the ear at all raised above
that of the ordinary savage.
Sneezing, which I find is a rare accompaniment of pul¬
monary consumption, is not an infrequent attendant upon
throat disease, simulating the more grave affection of the
lungs
Sputum .—Sputum to some amount marks the throat
affection simulating pulmonary consumption. Generally
the sputum is moderate in quantity. It is brought up
with difficulty for the most part. Judged of by the patient’s
feelings, it appears to come from the glottis, the larynx
or trachea, or from the posterior part of the mouth—i.e.,
the pharynx. In ocular appearance it is often mere thick-
isb froth, with minute air-vesicles, and white in colour.
Very often the sputum, still scanty, is formed, so to speak,
,of so many lobules, coherent, somewhat transparent, desti¬
tute of air-vesicles, and having small points of black mate¬
rial studded throughout, the general aspect being that of
.washerwoman’s prepared starch, but presenting a certain
npdulated appearance. It may be said also to resemble
prepared or boiled sago. This sputum is the secretion of
the glands situated in the trachea, and at the bifurcation
of that tube. The black particles are not composed merely
of soot and other extraneous bodies deposited from the
inhaled atmosphere, but is in part an organic production—
fe carbonaceous corpuscle, much larger than the mucus one,
.well worthy to be submitted to the microscope by the
student.
% In some cases the sputum is pretty copious, and consists
of mucus of a gelatinous or glutinous character, having
only very few air-vesicles. The colour is usually faint
yellow, or green. This is expectorated with a full, easy
cough. The tubercle corpuscle and the elastic curly lung
fibre of course are absent.
Haemoptysis, though a form of sputum, is usually treated
of separately. For the most part, in throat disease simu¬
lating pulmonary consumption, the haemoptysis is slight,
and appears continuously for some days to intermit and
..then to appear again. It seldom comes on without cough¬
ing or hemming exertions. It is usually scanty, appearing
in quantities sometimes amounting to a drachm, of a florid
colour, and in a liquid form. Generally the blood is of a
bright arterial colour, and simply tinges frothy mucus, or
• streaks yellow or green mucus. In some cases of throat
affection simulating tubercle of the lung which have been
treated by me in the hospital, blood has been expectorated
•to the extent of an ounce or two in that institution, and
under close inspection; and in some of the cases, more
especially of young women in whom the catamenia had
been irregular, it has been stated that, on one or more
occasions several ounces of blood have been expectorated.
In the case of some young men with- highly congested
fauces the same thing has been related.
The discharge of blood from the throat and adjacent
parts has generally taken place at the time of coughing;
but in some examples the blood has come without any
* respiratory effort, and this, too, takes place chiefly in the
morning, on awaking. The blood is generally arterial, but
I have seen it dark and coagulated. When dark and
coagulated inspection of the fauces has not unfrequently
detected dark clots adhering to the posterior wall of the
pharynx, and the mucus membrane itself in a highly
roughened and congested state.
The blood issues from various parts ; in most cases it
proceeds from the highly injected mucous membrane of the
trachea, often, I believe, near its bifurcation. I have fre¬
quently heard fine crepitation over the trachea in such
cases. The tonsils are sometimes the seat of the discharge.
More frequently the blood come3 from the pharynx. In
.such cases the blood may sometimes be observed in, situ.
I have, at the present moment (Feb. 4), a young woman in
the hospital, affected with chronic hemiplegia, suffering
from throat disorder simulating phthisis, on the posterior
wall of whose pharynx I observed, on the first examina¬
tion, a large clot of black blood resembling a fungous
growth. This was got rid of in a day or two. The patient
had been sent to the hospital under the impression that
she was suffering from lung disease, a certain amount of
emaciation, cough, and general debility, leading to this
idea. No evidence whatever of departure from the healthy
condition of the chest signs was procurable, in this case,
excepting a moderate amount of harsh respiration at the
apex of the lung, and a certain amount of unduly prolonged
expiration in that quarter, all due to disorder of the
trachea and adjoining parts.
The discharge of blood in many cases is greatly pro-
moted'by a morbid state of the circulating mass.
The Voice .—The voice has been generally affected in the
class of cases under consideration, but this has usually
been to a moderate extent. In a few cases, however, the
change iu the voice has been very great. Sometimes the
change in the voice has been only occasional, but in some,
and in the more grave examples, it has been almost per¬
manent.
The conditions of the voice most frequently noticed in
these cases are weakness, huskiness, indistinctness, con¬
tinuous hoarseness and discordance. There may be almost
total loss of it.
The weak voice is often connected with mere congestion
of the trachea and larynx, some tumefaction and dryness
of the parts. The loss of voice is generally mixed up with
oedema of the glottis, paralysis of the muscles and ulcera¬
tion.
A total but temporary loss of voice is liable to occur in
the case of females, when they have been exposed to
mental excitement, and this condition is occasionally
remarked under mere moderate changes of temperature,
and moisture of the atmosphere, and under the influence
of moral causes. I have now in the Rose Ward
(May, 1868), a young woman sent to the hospital for chest
disease, who has no appreciable disease there, whose voice
is scarcely audible, and this depends merely on a dry con¬
dition of the larynx and glottis, and some temporary de¬
bility of the muscles of the larynx. The laryngoscope
shows no organic alteration. Galvanism has been employed
but without any beneficial result.
The general health in the cases of disorder of the
trachea and adjacent parts which simulate pulmonary con¬
sumption is generally disturbed, and this disturbance is
one of the chief reasons for the entertainment of the
opinion that tubercle of the lung is present. The chief
forms of disturbed health with which I have met, are the
following :—
Emaciation .—Emaciation is generally present and to
some material extent. In some cases the patient is merely
rather thinner than before, but in others the loss of flesh is
marked ; the roundness of the body is lost, and is replaced
by obvious angularity and stringiness. It is this loss of
flesh, conjoined with cough, which first suggests to the re¬
latives and friends of the sufferer the suspicion of consump¬
tion, and it is this which causes the medical attendant to
fear the presence of tubercle in the lung. In most, but by
no means all, the examples of disorder of the trachea and
other parts of the air-tube apparatus, which have seriously
simulated consumption of the lungs, this loss of flesh has
been present. It is right, however, to say that cases of
simulated tubercle of the lungs have come into the hospital
in wliich not only no emaciation was observable, but cases
have been admitted from time to time in which the patient
was not only in fine condition, but in respect of muscle and
fat above the average.
The loss of flesh in such cases is less remarkable than the
almost sudden regaining of it in the hospital. Very few
of the patients have remained above a very short ,Ume
under treatment without gaining a great increase of
w eight. Two or three pounds in weight have been gained
in the course of a week or two by young females. As
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HOSPITAL REPORTS.
July 29, 1866. 99
much as a stone in weight has been the increase in the
Course of two months. It was only a few days back that
a young girl, sent in as consumptive, affected only with
tracheal congestion, marked by cough, huskiness of voice,
and some loss of flesh, was found to have acquired no less
than 17 lbs. This great increase of weight forms a valu¬
able piece of testimony in favour of the healthy condition of
the lungs, and of the restriction of disease to the air-tube
apparatus. But it is never to be forgotten that this
testimony is not conclusive by itself, for I have known
cases of tubercle of the lung, with cavity, to be marked by a
very great increase of weight, as much as two stone in the
course of a few weeks. The perma)iency of the increase of
weight in disorders of the upper air-tube apparatus is
worthy of note. The improved weight remains, but in
cases of tubercular excavation it is otherwise in general.
Within a week or two of leaving the hospital it is common
for the tubercular patient to lose many pounds, and I have
commonly noted, on the re-admission to the hospital of
tubercular patients, who had gained much increase of
weight, a remarkable and obvious emaciation and that the
period of a year of comparative exposure, inferior diet, and
non-attention to exhausting symptoms, had sufficed to
cause a loss in weight of one or two stone, not now to be
readily rectified for the_second time, or at all to be re¬
placed.
There is seldom present, in the class of cases under con¬
sideration, a material increase in the rate of respiration.
But there is a difficulty of respiration both in the act of in¬
spiration, and in that of expiration; and this is referred, with¬
out hesitation by the patient, to the throat.. The act of in¬
spiration is prolonged, and so is the expiration through the
trachea. In tubercle of the lung the respiration is gene¬
rally quickened.
The Circulating Organs .—The heart’s action is seldom
accelerated, and the pulse is usually of moderate rapidity,
and is regular. In tubercle of the lung the pulse is usually i
quickened, and the heart more or less excited, except in
chronic cases.
Digestive and Supplementary Organs .—In mere dis¬
order of the trachea and adjoining parts, the digestive
organs are seldom morbidly affected. The vomiting in
early tubercle of the lung, and the persistent diarrhoea of
the same disease in its latter stages, are seldom simulated,
but these conditions are sometimes present.
The Skin. —The integument of the body in the simula¬
ting disorders, is generally healthy. There is no ap¬
proach to the harsh and dry condition of the chronic
form of tubercle of the lung in the wasted patient, nor to
the moist, and soddened, and heated skin of the lung-
tubercnlated patient, suffering from the disease in its
active form, and accompanied with irritative fever.
The hair, in examples of disease described above, simu¬
lating pulmonary consumption, seldom suffers, which is
different from what is observed in phthisis, in which dis¬
ease it is seldom long unaffected, becoming weak, and falling
out to a great extent, especially in acute cases, to the great
vexation of the patient, particularly the young female.
The temperature of the surface of the body, in the simu¬
lating disorders, is seldom heightened, and in this respect
we note a difference in connection with tubercle of the
limfk lor in this disease the temperature is usually in¬
creased, as has been recently very fully established by
tn#ny pains- taking physicians.
wnerative Organs . —The disorders of the generative organs
COttimon in tubercle of the lung, are seldom noted in mere
. simulating complaints of the trachea. The catamenia are
comparatively seldom suppressed, less frequently than they
in tubercle, and the debility of the male sex, common
* "fA itfbdrcle, is also seldom or never observed in the minor
disorders.
' -- - - t-t : -=s
* v** Pascras. New Ikfirmaby.—T he Poor-law
»ve given their sanction to the plans for the St. Pan*
a lnfinnary at Higbgate, and have empowered the
t# Ms# a loan pf £40,000 for building the same.
itosgital
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Anemia. —J. D., ret. 25, prostitute. Admitted March 1 j
discharged April 13. In hospital 43 days. Much relieved .
Has drunk freely for last 2 years; very anaemic ; basic
systolic bruit over heart ; occasional attacks of pain in
chest. Never had rheumatism.
Iron, aperients, belladonna plaster.
An.emia.— Frances F., ret. 16, bookfolder. Admitted
May 24; discharged June 1. In hospital 9 days. Very
much relieved. Previously ill, 14 days; faintness, palpi¬
tation, and dispnuea on exertion'; pallor of skin and mucous
membranes. Faint basic systolic bruit; tongue furred ;
appetite bad. Herpes zoster on right side.
Liq. aramon, acetatis, chloric ether, and liquor cinchonre
(7 days). Then quinine and iron.
Cephalalgia — Anaemia. —H. G., ret. 36, dairymaid.
Admitted November 9 ; discharged November 10. In
hospital 1 day. Made out-patient. Frontal head¬
ache, 3 years ; pain in lumbar spine, 2 years ; giddiness
and shortness of breath on slight exertion ; basic systolic
bruit ; sleeps badly ; tongue furred.
Quinine, sulphate of iron, sulphate of magnesia, dilute
sulphuric acid, and inf. of quassia.
Cancer of Liver (?).—W. C., ret. 53, innkeeper. Ad¬
mitted July 13; discharged August 13. In hospital 31
days. Unrelieved. Has lived freely; sores on outer side of
left foot 12 months; has lost flesh slightly of late; liver
enlarged, slightly nodulated near gall-bladder; slight
jaundice ; no dropsy ; tongue red.
Dilute nitric acid and bark. Haust sennre co.
Tubercular Peritonitis. —J. J., ret. 20, druggist’s
assistant. Admitted January 7 ; discharged January 9.
In hospital 12 days. I Vorse. Always temperate; pre¬
viously ill, 5 months ; pain, swelling, and tenderness of
abdomen ; costive bowels and loss of flesh ; subject to
piles. (Edema of feet and ankles, 1 week. Appetite good
up to time of admission. Dullness on percussion tfll over
abdomen ; urine loaded with lithates ; traces of albumen ;
no cough, haemoptysis, or night sweats ; no hereditary
predisposition ; 12 days later, has lost flesh much, and
vomited constantly since admission ; vomit now coffee
ground. Pulse 125, thready. Is evidently sinking. Dis¬
charged at his own request.
Carbonate of soda and dilute hydrocyanic acid; aromatic
spts. of ammonia, chloric ether, and decoction of bark;
ice ; effervescing mixture ; brandy 4 oz.
Phthisis.— F. W., ret. 39, carman. Admitted, March
26. Died on April 16. In hospital 21 days. Cough 4
years; worse in winter; diarrhoea and night sweats 2
months ; loss of flesh 3 weeks. On admission much
cough and greenish expectoration; great dyspnoea; constant
purging ; flattening; dulness ; prolonged expiration and
bronchial breathing under left clavicle ; elsewhere coarse
crepitation, rhonchus, and sibilus ; legs slightly oedematous;
urine turbid with lithates ; 6 days later, gurgling and pec¬
toriloquy at left apex ; 11 days later, dulness and ampho¬
ric blowing over left infra scapular region.
Quinine and Iron. Cod-liver oil. Syrup of iodide of
iron and cod liver oil. For diarrhoea, opium, sulphate of
copper, and extract of logwood, and opiate enemata.
Phthisis. —W. R., ret. 33, bricklayer. Admitted May
29. Died on June 26. In hospital 29 days. Acute rheu¬
matism 9 years ago. Almost constant diarrhoea for 8 years,
cough and shortness of breath 6 years; two years ago
lumbar pain and hreinaturia recurring once or twice since;
worse 10 days. On admission rather thin; breath short;
liver tender ; pulse 104 ; respiration 36 ; physical signs
of emphysema ; dulness and fine crepitation under left
clavicle ; large crepitation over lower posterior half of
left lung, with dulness at base j elsewhere rhonchus and
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HOSPITAL REPORTS.
July M, IMS.
100 The Medical Press and Circular.
sibilus. Pus and phosphates in urine ; no albumen ;
occasional lumbar pam ; diarrhoea. Became weaker, and
died on June 26.
Post-mortem. —Left apex adherent; two vomicae in its
posterior part; abundant miliary tubercle in left apex and
right upper lobe ; scattered tubercle elsewhere in lungs ;
recent lymph on pericardium; tubercular cavities filled
with pus in left kidney.
Chloric ether, squills, and carbonate of ammonia (17
days). Opium and logwood (8 days). Then chloric ether
and sesquichloride of iron.
Phthisis. — S. H., a?t. 24, footman. Admitted August
16. Died August 22. In hospital 6 days. No family
history of phthisis ; loss of flesh 6 weeks ; dyspnoea on
exertion 4 weeks ; cough and expectoration 3 weeks. On
admission chest not very resonant ; slight comparative
dulness under left clavicle ; small crepitation over anterior
lobes of lungs, especially at left apex ; sputa frothy, viscid
and muco-purulent; slight oedema of legs ; pulse 120.
Phthisis. —Emma H. Admitted May 13 ; discharged
May 18. In hospital 5 days. Unimproved. Caries of
upper part of sternum. Early phthisis.
Quinine; sulphate of iron and sulphuric acid ; cod
liver oil.
Phthisis. —Ellen M., a?t. 12. Admitted June 29; dis¬
charged July 23. In hospital 24 days. Relieved. Bron¬
chial breathing and gurgling crepitation over back of lungs.
Not much emaciation. In King’s College Hospital before
for whooping-cough and strumous pneumonia.
Aromatic spts. of ammonia and chloric ether. Cod liver
oil.
Phthisis. —Robert E., aet. 24. Admitted March 17;
died on March 23. In hospital 6 days. Became worse
soon after discharge from King’s College Hospital in Octo¬
ber last. Vomited one pint of blood about a month ago.
Stools afterwards pitchy. On admission very emaciated;
face flushed; pulse 120, respiration 50; over front of left
lung dulness, gurgling crepitation, bronchial breathing,
and pectoriloquy; over front of right coarse crepitation,
bronchial breathing, and bronchial voice; spleen greatly
enlarged; much nausea and vomiting. Death on sixth day
after admission.
Post-mortem. —Lungs, especially the left, stuffed with
tubercles and riddled by cavities; spleen large—not tuber¬
cular—waxy (?).
Sulphuric aether and aromatic spts. of ammonia; dilute
hydrocyanic acid and mist effervescens; pepsine; brandy 6
oz.; turpentine stupes.
Phthisis. —Mary C., aet. 31, married. Admitted June
13; died on July 25. In hospital 42 days. No family
history of phthisis. Previously ill one month. Cough; rapid
wasting, aud loss of strength. On admission very ema¬
ciated, pallid, cheeks flushed; pulse 114, respiration 36;
diminished expansion of left chest, and gurgling crepita¬
tion under left clavicle and at back of lung; dulness and
harsh breathing at right apex; nummular expectoration,
■treaked with blood; tongue slightly furred.
Quinine and dilute sulphuric acid; co<f liver oil.
Phthisis. —D. J., aet. 54; laundress. Admitted Janu¬
ary 21; died on January 30. In hospital 9 days. Cough
and expectoration; loss of appetite and oedema of legs 5
weeks; erysipelas of legs 3 weeks. On sixth day after ad¬
mission scarcely any redness of legs remaining, but deli¬
rium; dry brown tongue; retching and vomiting; pulse
feeble, 126. Death 2 days later.
Post-mortem. —Much tubercle in upper lobes of lungs;
lower lobes gorged. Three or four large tubercular ulcers
with thickened edges in ileum—one at junction of upper
two-thirds with lower third of ileum, had perforated the
bowel. Pus and turbid serum in peritoneal cavity. Liver
large—very fatty.
Aromatic spts. of ammonia, chloric ether and decoction
of bark. Brandy 12 oz. Fomentations to legs.
Phthisis. —R. F., set. 30 ; wire-worker. Admitted
January 26th; discharged February 29th. In hospital
$4 days. Much relieved* No family history of phthisis.
Loss of flesh five years ; gave up work six weeks ago.
Diarrhoea one week. Pale and thin ; left chest dull all
over. Flattening ; cracked pot sound ; bronchial breath¬
ing ; coarse crepitation; and pectoriloquy under left
clavicle. Crepitation at left posterior base and apex.
Right lung normal; pulse 130 ; six days later, amphoric
breathing and metallic tinkling at left apex; gained
weight while in hospital.
Sesquichloride of iron ; dilute muriatic acid; chloric
ether, and caluinba. Cod liver oil.
Phthisis — Hemoptysis. — J. N., set. 15, butcher.
Admitted January 28th ; discharged February 8th. In
hospital 11 days. Relieved. Small-pox 10 years ago. No
family history of phthisis. Cough and expectoration three
months. No loss of flesh. Profuse haemoptysis on day
before admission. On admission, dulness ; large crepita¬
tion, and rhonchus under left clavicle ; crepitation over
left supra-spinal fossa. Free from haemoptysis four days
later.
Tannic acid and inf. rosse. co.; turpentine inhalation ;
sesquichloride of iron and quassia ; cod liver off.
Hemoptysis. —W. H. J., set. 18 ; mathematical instru¬
ment maker. Admitted February 20th ; discharged
February 27th. In hospital seven days. Recovery. A
brother died of phthisis. Cough two years; sputa streaked
with blood one month ago. Attacks of haemoptysis on
January 29th, February 16th, and February 20th. On
admission pallid ; crepitation at right base behind (two
davs); expiration at right apex prolonged ; no dulness;
pulse 84, somewhat irregular. Very faint systolic bruit,
loudest at heart’s apex. No return of haemoptysis while
in hospital.
Gallic acid and inf. rosae. co.; turpentine inhalations
and stupes ; afterwards squills, chlori 9 ether and sesqui¬
chloride of iron.
• DR. STEEVENS’ HOSPITAL.
holt’s operation for stricture : DEATH FROM PYEMIA
EXHIBITING REMARKABLE FEATURES.
Under the care of Mr. HAMILTON.
Although the treatment of stricture by Holt’s method is
now generally allowed to be a valuable addition to the sur¬
gery of this disease, still it cannot be denied that it is
attended with some risk, and in the adoption of a practice
which has many strenuous advocates, the observation of
unfortunate cases must afford a valuable lesson.
T. F., set. 62, a pensioner, of dissipated habits, was con¬
stantly in the habit of coming to hospital with retention
of urine, on exposure to cold or the commission of any ex¬
cess. On some of these occasions considerable difficulty
was experienced in passing a small catheter. A very tight
stricture was found at the anterior part of the bulbous
portion <tf the urethra. The difficulty of introducing in¬
struments was frequently much increased by spasm, and the
mucous membrane was always in an irritable condition.
Having often expressed a desire for some permanent relief,
it was determined to adopt the method of Holt He was
accordingly kept quiet in bed for some days, and the ure¬
thra dilated with cat-gut bougies, until Holt’s dilator could
be readily passed into the bladder. The operation was
performed on Saturday, June 27th, the strictures having
been burst. A catheter, No. 8 size, was passed into the
bladder, the patient was treated with quinine and opium,
as directed by Mr. Holt.
June 28th.—He has had some shivering during the night;
he complains of severe pains in the lower limbs, with
hypenesthesia and partial loss of motor power; passes'
water freely and without pain ; there is no tenderness or
fullness in the perinaeum ; pulse 120, and feeble. Ordered
wine and beef-tea.
29th and 30th—Appears better, but still complains of
soreness and complete loss of power in the lower limtte
no rigors or sweating ; no tenderness in the perinaeum.
July 1st.— Very much worse ; the pulse at wrist scarcely
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July 29,1868. 101
perceptible; complains of pain and powerlessness of the
lower extremities ; tongue dry and brown ; the surface of
the body is covered with an eczematous rash, having a dark
areola ; the mental faculties are perfectly clear; he com¬
plains of irregular pains in the chest and abdomen. The
respiration became very difficult some hours before death,
which ocoured at ten p.m. .
Autopsy, twelve hours after death, —The'eczematous
eruption still remains on the surface. The inferior wall
of the urethra has been burst at the point of stricture into
the corpus cavernosum. Some pus issued from the bottom
of the assure on pressure. The cavity of the bladder was
small, but its coats immensely hypertrophied, with
numerous sacculi leading off from it; the ureters were much
dilated; the kidneys tolerably healthy ; the surface of
the lungs was thickly studded over with an eruption
identical with that on the surface of the body ; the liver
and other intestines were likewise spotted in a lesser
degree ; no deposit of pus could be discovered in any part,
the muscular system seemed perfectly healthy ; no abnor¬
mal appearance of the joints was discernable. The features
of this case are interesting in some respects. The fatal
termination must be attributed to a form of systemic infec¬
tion, but there are many peculiarities in the symptoms, the
paralysis of the lower limbs, the sensibility of the skin and
muscular pains, the absence of rigors, sweating, or delirium,
the appearance of the eruption on the surfaces of the body
and viscera, are all uncommon. There can be little doubt
that pyaemia is the chiefest source of danger in this opera¬
tion, and the occurrence of suppuration in such a structure
as the corpus cavernosum, must be a condition specially
favourable for its development.
CITY OF DUBLIN HOSPITAL.
Cases under the care or Mb. CROLY.
Case 1.- RETENTION OF URINE IN A CHILD, CAUSED BY
A CALCULUS IMPACTED IN THE URETHRA : REMOVAL
OF CALCULUS BY OPERATION.
8. W., aged two years, a coachman’s son, was
carried to the hospital by its mother. Mr. Croly was in
the extern prescriDing-room at the time, and on inquiry
ascertained that the child (who was in great agony) had
not passed any urine for 18 hours. On examination the
bladder was found to be enormously distended, and there
was partial priapism ; the child had been treated by warm
baths, stupes, and various medicines, without relief, before
coming to the hospital. The mother also stated that the
child had been delicate from its birth ; had convulsions,
and that his water stopped three days previously, but he
got relief on that occasion from a warm hip-bath. The
child had congenital phymosis. Mr. Croly made a small
incision with a sharp-pointed bistoury (guarded by a direc¬
tor, curved near the point) at the upper part of the pre¬
puce, and was then enabled to pass a probe into the
urethra, which touched a hard substance, about an inch
from the orifice. The urethra was so very small that it
was found necessary to enlarge the orifice; this having
been done, the calculus was Beized with a small urethral
foroepe, and extracted; the stone was the size of a pea,
and consisted of lithic acid ; the nrine came out witn a
gush, to the instant relief of the little sufferer, who was
kept in the child’s ward until the following day.
Mr. Croly directed the attention of the pupils to this
interesting case, and mentioned the causes of retention of
urine in early life—congenital phymosis being the most
common ; he impressed on them the necessity of making a
careful examination in such cases, and not adopting routine
practice, which was so uselessly tried in the present in-
stance, previously to the child’s admission into hospital.
Can 2. — IMPERFORATE ANUS (ATRESIA ANl) : OPERATION.
A. C. was recommended to Mr. Croly by a medical
friend. The infant had been dosed with castor-oil, and as
WaotfitA came v from the bowels, the owe, at length,
sought medical advice. The doctor at once discovered
that there was an absence of the anus. The child cried
incessantly. On examination, a bulging was observed in
the anal region—the integument was apparently dark-
coloured, owing to the meconium. Mr. Croly placed
the child in the lithotomy position, and made a
crucial incision into the part. A large quantity of me¬
conium escaped. The case terminated satisfatonly. Mr.
Croly mentioned to the pupils that this case is an illustra¬
tion of the simplest form of imperforate anus, in which the
rectum is perfect, and merely closed by integument, only
requiring for its cure careful incision. The more serious
forms of this malformation, he said, consist of the gut
ending in a cul-de-sac, or communicating with the urethra*
bladder, or’vagiua ; the rectum being totally absent in the
worst variety of the malformation.
Case 3 . — equino-varus in both feet : tenotomy :
FEET STRAPPED INTO POSITION WITH SOAP-PLASTER.
A male child, aged six months, was admitted, with its
mother, into hospital for the purpose of having the opera¬
tion for club-foot {equino-varus) performed. Mr. Croly
divided the tendons in the following manner :—The child
was placed prone on the lap of on£ of the pupils, the left
foot was grasped, and the heel raised, to relax the tendon.
A tenotome was introduced, flatwise, at the edge of the ten-
do-Achillis, and passed superficially to the tendon beneath
the integument. When the point of the instrument was
felt (with the index-finger) to have passed the tendon, the
edge was turned towards it, and the heel was depressed; by
slight pressure on the back of the blade of the knife the
tendon was divided, and the usual crackling sound was
heard. The blade of the knife was again turned flatwise,
and then withdrawn ; a drop of blood escaped. A small
compress of lint was placed on the puncture, and fixed with
a strip of adhesive plaster. The tendo-Achillis of the
other foot was divided in a similar manner, and as the ten¬
don of the tibialis anticus was very tense, it was also di¬
vided subcutaneously (in each foot), about an inch above
I its insertion.
In three days, Mr. Croly strapped each foot into proper
position in the following manner :—Long slips of soap-
plaster were cut, the end of each piece was placed around
the dorsum of the foot, so as to get a good purchase, and
carried upwards and outwards, under the sole, and fastened
to the fibular side of the leg. Straps of figure-of-8 shape
were also alternately applied around the foot and ankle-
joint.
Mr. Croly demonstrated, in a clinical lecture, the various
forms of talipes, and the method of treatment suitable to
each case. He advised the operation to be performed
in very early life, before the bones of the foot become altered
in shape. He exhibited dried specimens of feet affected
by talipes, in which the neck and head of the astragulus
were much distorted.
The treatment by strapping was strongly recommended,
and the various boots in use were also fully explained to
the class.
- +- -
gibratim.
SPINAL DISEASE.!
A subject that has long been particularly interesting to the
general practitioner, and that has had much light thrown upon
it by those who have taken it up as a specialty, is that of
spinal disease. When, therefore, Dr. Little, who is the father
of Orthopaedy in this country, undertakes to give a risuml of
his experience in the treatment of spinal curvature and weak¬
ness, there is little for the critic to do but announce the fact*
inasmuch as the authority of the writer is such that few would
venture to question it, while to lay all its conclusions before
our readers would require too much space, and involve some
1 On Spinal Weakness and 8pinal Curvatures: their Early Reeogni-
tion and Treatment. By W. J. Little, M.D., late Senior Vbjvk&m
I London Hospital, *o. London; Longmans, Green, and Co. 180 B.
Digitized by Google
162 Th» M«dlctl Pro. and Clreulur. MOVEMENT OP TROOPS IN INDIA.
JntjsS, is#.
injustice, as too mnch of the book would have to be reprinted.
Those questions on which reasonable differences of opinion
have prevailed, are all fairly and carefully considered, and no
one will take exception to Dr. Little as the judge, who is best
able to sum np the matter. The founder of the Royal Ortho*
paedic Hospital, he is also the founder of the school of ortho-
medics in this country, and has for many years unquestionably
keen its head. From him there is, so to speak, no one to
whom to appeal, and we are consequently so much the better
pleased to have his summing up in small compass like this
well-written work. We regret that we should find our experi¬
ence coinciding with Dr. Little on a point which we commend
to our readers. He finds that the majority of medical men do
not possess clear ideas of the pathology and diagnosis of spine
affections. It is because we have so frequently found defi.
oiency of knowledge with a desire to become acquainted with
the subject that we are desirous of seeing this work very
widely circulated.
The “ early recognition and treatment ” of such cases is of
the utmost importance, since at later periods we cannot hope
for cores, though the deformities may be evident enough. We,
therefore, sincerely trust that those who may be called upon to
treat such cases vail not omit to master the lucid work before
us.
The existence of a specialty of orthopsedy is perhaps one of
the best answers to those who object to specialism. It is im¬
possible to deny that without some persons with large oppor¬
tunities making this branch a special study, it could not pro¬
gress. The general practitioner has not the time to elucidate
the points that have been so ably investigated by the specialists.
We do not say that other studies should be neglected. Dr.
Little himself is an admirable instance of the true scientific
position of the specialist. While for twenty or thirty years or
more, he has been labouring in this department, he has also
occupied himself with others. While perfecting orthopaedics,
he has been earning renown as Physician to the London Hos¬
pital, and Professor of the Principles and Practice of Medicine
at its school ; and although he has now retired from the
general hospital as well as from the special, carrying with him
the respect and admiration of colleagues and students, it is
happily only to give more time to the cares of private practice,
while he leaves the opportunity for younger men to follow in
his footsteps. When all the specialities shall be studied after
this manner, we may look for still greater progress. The
combination of extensive study and experience of disease
brought to bear upon one particular branch is the true solution
of all specialities. It is this which elevates every branch as
much as the mere routine practice of it degrades it.
We have left no room to enumerate the chief points treated
on in Dr. Little’s book. That is the less regretable since, as
the author has condensed his observations into 120 pages, we
may anticipate that all our readers will take an early oppor¬
tunity of reading the book itself.
PLASTIC SURGERY. 1
We have in a neat little volume from the United States, a
reprint from a report in the transactions of the Illinois State
Medical Society for last year, which does great credit to that
Western association. Dr. Prince has devoted much attention
to plastics, and he is anxious not only to classify the subject on
an easily intelligible plan, but so to speak of it that each divi-
eon may have an appropriate name, and be easily designated.
Certainly precision of language in surgery generally is most
desirable, and in a branch which like this has been compara¬
tively neglected, no better service can be rendered than con¬
tributing to such exactitude. Nomenclature should be guided
by some definite principles, and classification should not be
adopted in a hap-hazard way. Dr. Prince contributes towards
rendering the description of plastics more easy and more pre¬
cise. and therefore deserves the thanks of all interested. We
should add that Dr. Prince’s descriptions are profusely illus¬
trated by woodcuts, and that the essay contains a full account
of the present state of plastic surgery.
PATHOLOGICAL ANATOMY OF THE UTERUS. 2
We are glad to announce that Professor Klob’s magnum opus
will soon be at the service of the English student in his own
1 Plastics: a new classification and brief exposition of Plastic 8ur-
jeiy. By David Prince, M.D. Philadelphia: Lindsay and Blakiston.
2 Pathological Anatomy of the Female Sexual Organs. By J. M.
JDob, M.D.i Professor at the University of Vienna^ Translated by
1868 .
language. The first volume devoted to the uterus has already
appeared, and the rest will no doubt soon follow. It is oar
transatlantic cousins who have undertaken this translation,
and we are much indebted to them for it. It can be obtained
in London from Trttbner & Co. The translation is carefully
done.
MEDICAL JURI8R&UDENCE. 1
We have lately studied the new edition of Dr. Guy’s Manual
of Forensic Medicine with particular care, and have now to
pronounce upon it a very favourable opinion. Of all the books
that the student may carry home, in the holidays, to refresh
his memory on the subjects of the - summer course, this is oae
of the best, and of those that should be studied by gentlemen
preparing for their examinations, it is one of the most reliable.
The book has always been distinguished for presenting prin*
ciples in a concise form, and not over-burdened with useless
minutice. The condensation which the author achieved in his
first edition has been amply rewarded by the call for a second
and third.
In the new edition the number of illustrations are consider¬
ably increased, and some of the new ones are very striking.
As might be supposed by those familiar with Dr. Guy’s
labours, the subject of sublimation is presented very fully to
the reader in a chapter which everyone should carefully peruse.
Nearly half the manual is taken up with Toxicology, the
growing importance of which, few will be ready to deny. We
strongly recommend this portion of the work.
. The chapter on the methods of procedure gives distinct
directions, and in as small a compass as possible describes the
practical duties that have to be performed. But if about to
select as a specimen, the best chapter in the book, we think,
we should take the last, which treats of the “ Diagnosis of the
Poisonous Alkaloids and Analogous Active Principles.” Here
is a subject in which every practitioner is interested, and it is
worked out in the author’s most careful and satisfactory
manner.
1IBOI8TERED FOR TRANSMISSION ABROAD.
The Medical Press and Circular is published
simultaneously in London , Edinburgh , and Dublin ,
every Wtdnesday morning. Price bd. Stamped 6 d.
By Post to Annual Subscribers , £12 6
„ If paid in advance , 118
, # , Post-Office Orders and Cheques to be drawn in favour of
Charles Cooper, 3, Lincoln-place, Dublin.
Maclaciilan & Stewart, South Bridge, Edinburgh,
A. A. Tindall, 20, King William-street, Strand, London.
%\t §ptal $jxrss anh Similar.
“SALUS POPULI SUPREMA LEX.” * *
WEDNESDAY, JULY 29, 1868.
MOVEMENT OF TROOPS IN INDIA.
Among the movements of troops to take place daring the
ensuing winter, the military papers intimate the following,
namely:—C Battery 16th Brigade Royal Artillery, from
Barrackpore to Saugor; D Battery 16th Brigade, from
Barrackpore to Allahabad; 2nd Battalion 60th Rifles, from
Fort William to Darjeeling and Benares; a regiment fVom
England to Fort William (Cape Route corjw). There may
not at first sight be much in these brief notices to call for
remark in this place; yet in reality they have a very im¬
portant bearing upon the question of health and efficiency
of our troops in India.
Experience had, many years ago, demonstrated the im¬
propriety of retaining at Calcutta or other stations in the
lower provinces of Bengal, troops, whether as recruits 6r
entire regiments, newly landed in the country. The pfao-
tice had therefore been abandoned, and every exertion
1 Principles of Forcnnio Medicine. By William A. Chry, m!b!,£&. 9.
Third edition. London; Henry Reashaw,
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fie Medical ibeas &nd Cireultf. SPECIALISTS AND SPECIALISM. July 29,1868. 103
made by the responsible authorities to push on towards the
north-west provinces each regiment or “ draft” as it arrived.
In the days of the mutiny, when sanitary considerations
had to give place to the life-struggle for supremacy, this
very judicious rule had to give way to the necessity of the
times; but now, when profound peace reigns from one end
of the country to the other; when sanitation is a “house¬
hold word” among the authorities in India, it does seem
strange that, in ordering the retention in such places of
young and newly-arrived soldiers, they thus recur to a
practice which, as may be read by themselves in their own
official records, had already been attended by most disas¬
trous effects to health and life.
On the amalgamation of the Indian and Royal Artillery,
the two batteries just mentioned were for the first time
formed. This was in the cold season of 1862. A few old
soldiers were transferred to those batteries, and the num¬
bers filled up by young men newly landed in India. The
batteries were sent to Barrackpore, a low-lying station
immediately adjoining a large tidal river, across which
the prevailing wind blows towards them . The natural
result followed; the rates of mortality and sickness among
them speedily became so high that attention was drawn to
them, and statistics showed that a station which had
previously enjoyed a high reputation, had now the unenvi¬
able notoriety of having one of the highest death-rates of
all in the Bengal Presidency. Such is the station from
which the batteries are now about to be moved after a
continuous residence of nearly six years.
Residence in Fort William, as stated before the Royal
Commission, has for the recruit been most disastrous. No
doubt everything that can be effected is done to place the
troops quartered there in as favourable circumstances as
they can be, and an example might profitably be taken in
extending to places nearer home some of the sanitary
measures that are there employed. Those measures do
unquestionably conduce much to health, but they cannot
wholly counterbalance the effects of the hot, moist, and
exhausting climate; continuous exposure to terrestrial
malaria, unwholesome emanations wafted towards the
fort from the foul river, festering with corruption, that
glides past its walls, not to speak of those from the sur¬
rounding ditch, a part of which is used as a latrine by the
natives, and flushed by the tide. Neither can they effec¬
tually remove all risk from cholera, a disease which there
isjever present, and ever ready to be lighted into activity
under favouring circumstances ; nor can they impose suffi¬
cient restrictions upon the facilities for vice and dissipa¬
tion presented by the neighbouring bazaars and dens of
iniquity that abound in Calcutta.
Surely, then, Fort William, abandoned as it has already
been as a suitable station for young soldiers, and posses¬
sing these various elements of disease, is no better adopted
for the newly arrived and inexperienced than it has ever
been. It is quite the case that one regiment may escape
Vithput great mortality, or even two ; yet those who prac
. tically know India are well aware that even if troops in
tile lower provinces escape an actual outburst of sickness,
£Ot qply is the proportion large of men who have to be
jpivalided on account of illness, but that the constitution
jannpt $qd does not become robust in those who during
jjkSfcitiface. early manhood have lived under such
-- : i g# in those piore favourably situated.
__ _ _ijd that the system of overland transport
/jSjwes tbat regiments should now begin their
service near the sea, and u work upwards,” so as to be the
more readily despatched via Bombay on completing their
Indian tour. This reason cannot be accepted. Nor, even
had it any other circumstance to recommend it, ought it
to hold good when clogged by the dire necessity, increased
by the measure of retaining young troops in the very part
of India where their risks of mortality are greatest, and
their prospects of preserving health the smallest.
ELECTION OF THE KING’S PROFESSOR OF
PHYSIC IN DUBLIN.
On Friday, the 24th instant, this election was held in the
Hall of the College of Physicians in Dublin, the President,
Dr. Churchill, in the chair.
The candidates were—Drs. H. Kennedy, Freke, Moore,
and Foot, all Fellows of the College ; and Dr. John Maule
Sutton, of Cheltenham.
The following Fellows were present, were duly sworn by
the Rev. Dr. Lloyd, Provost of Trinity College, and voted
(by ballot) at the election :—Drs. Adams, Apjohn, Atthill,
Banks, Barker, Beatty, Belcher, Burke, Churchill, Croker,
Dwyer, M. Eustace, Foot, Freke, Gordon, Guinness,
Rev. Dr. Haughton, Drs. Hayden, Head, Hudson, Jennings,
Johnston, H. Kennedy, Law, Little, Lyons, M‘Cready,
Mollan, Moore, Ringland, Sinclair, Smith, Steele, Stokes.
The voting (we understand) was as follows:—
1st Ballot.—To select three out of five, each Fellow
voting only for one candidate—Kennedy, 4 ; Freke, 9 ;
Moore, 17 ; Foot, 4 ; Sutton, 0. Drs. Kennedy and Foot
being equal, the President gave his casting vote in favour
of the former, on the ground of seniority.
2nd Ballot.—To select two out of three—Kennedy, 3 ;
Freke, 13 ; Moore, 18.
3rd, and final ballot.—Freke, 15 ; Moore, 19.
The President accordingly declared Dr. Moore duly
elected King’s Professor of the Practice of Physic in the
City of Dublin, on the foundation of Sir Patrick Dun, and
he was immediately sworn into office.
We have no doubt of Dr. Moore proving a worthy suc¬
cessor to his excellent predecessor Dr. Banks ; and we are
satisfied that the choice of the Fellows of the Dublin Col¬
lege of Physicians will do anything but discredit to the
“ School of Physic in Ireland.”
SPECIALISTS AND SPECIALISM.
A few weeks ago we protested against the wordy war
waged by some of our contemporaries against specialism
in all its forms. We now repeat that protest, since the
unjust accusations levelled against individuals continue
to be repeated in a variety of forms. It is strange that
we should so constantly see an exhibition of personal ani¬
mosity under the pretence of discussing principles.
Nothing can make our profession so contemptible as the
personal squabbles indulged in at the expense of truth.
Nothing is more likely to deprive it of its just influence
than the continual statement of one side of a question,
and the obstinate suppression of the other. It is, indeed,
lamentable that such injustice should prevail, and that
men should be suffered to “ stab each other in the dark,”
while pretending to expound public policy.
Yet it has ever been so. Medicine as a profession is
divided against itself, and for that very reason is devoid
of influence. It is not so with the sister profession of
law. Who ever saw the same indecent rivalry and ridicu¬
lous jealousy between lawyers ? Still less is this the case
with legal writers and contributors to legal journals. The
attempt to run down men who exercise any speoial branch
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104 Tha Medical Press and Circular.
NOTES ON CURRENT TOPICS.
July 29, 186$'
of medicine is not more likely to succeed than the attempt
to ruin special hospitals which has been made by the same
parties.
Why, let us take an example or two of special institu¬
tions. Who will deny that Ophthalmic Hospitals have con¬
ferred immense benefits on humanity ?—that they have
helped to bring ophthalmology to its present state of per¬
fection. It is true that Travers, Lawrence, and other
illustrious names, show that general surgeons may do much
for a special branch, and have done much for Ophthalmic
surgery, but yet the fact remains that the greatest pro¬
gress for the last 20 years or more is to be traced distinctly
to Ophthalmic Hospitals.
Shall we then, to please a clique, shut up these charities,
and go back to the old attempt to grasp everything within
the walls of one hospital ? The public, as we have often
observed, has long ago answered this query in the negative,
and we see no reasoif for challenging the verdict.
Another example—what about Consumption Hospitals ?
Would our contemporaries destroy all the charities devoted
to diseases of the chest ? Would they deny that men who
practise scarcely anything else, are, to all intents and pur¬
poses, specialists ? Is it not a fact that these men have
contributed largely to the progress of science—that they
have even made important discoveries ? Why, then, this
hostility, this petty lealousy of every institution; and this
constant war with all specialists ?
There are reasons which it is not our purpose to-day to
dilate upon. We repeat once more our protest against the
injustice that is being perpetuated, and we challenge a
verdict on the two classes of institutions we have men¬
tioned—Ophthalmic Hospitals and Consumption Hospitals.
“NOCTES, CCEN^EQUE DOCTORUM.”
u Do what we say, but not what we do,” is a time-honoured
adage or proverb, which has been attributed to the jolly
monks of mediaeval times, who followed the rule of St.
Benedict, but who, for all that, on certain occasions, were
wont to refresh themselves at night after the professional
labours of the day ; to chant the psalm, “ Qui habitat in
adjutorio Altis8imi ,, at Compline ; and then towards the
conclusion of a good supper, to sing “We won’t go home
till morning.”
Even so is it with some doctors, learned doctors—for all
doctors are learned of course ; they solemnly warn their
patients against late dinners, and extra good dinners ;
against “ made dishes,” &c., &c. ; but few like good dinners
better, or eat them oftener (when they can get them) than
our brethren ; and must we confess it ? than ourselves !
In former days there was in Dublin a society, which was
known as “ the Medical and Philosophical but which,
for the greater part of a century, has existed as a medical
dinner club, under the same name, we believe, though in
the Dublin medical venacular it is jocosely called “ the
Philcesophageal.” Also in the last century tne Fellows of
the Dublin College of Physicians every St. Luke’s day at
their annual meeting voted £100 to the President to pur¬
chase claret for their entertainment. For many years, this
admirable custom has been abolished ; but although of
late it has been not unusual for the President of that
College to entertain his brethren, the Fellows, in his own
house, yet it is due to Dr. Beatty, we believe, to state,
that he, during his Presidency, inaugurated what promises
to be a time-honoured custom, and gave a handsome ban¬
quet to the Society of which he was the head, in the
College Hall itself.
The present President of the King and Queen’s College
of Physicians in Ireland (Dr. Churchill) maintained this
wholesome usage by entertaining in the College-hall, on the
evening of Tuesday, the 21st instant, the following Fellows:
—Dre. Adams, Apjohn, Atthill, Banks, Beatty, Belcher,
Burke, Croker, Cruise, M. Eustace, Foot, Freke, Gordon,
Guinness, Haughton, Hayden, Head, Hudson, Jennings,
Johnston, Sir Robert Kane, H. Kennedy, Law, Little,
Lyons, M‘Cready, Moore, Ringland, Sinclair, Smith, Steele,
Stokes, and Travers.
In addition, the following guests were present:—The
President of the Royal College of Surgeons in Ireland (Mr.
Porter), the Right Hon. the Lord Mayor, (Sir William Car-
roll,) Licentiate of the College; Dr. Dane, P.M.O.
Dublin; Inspector-General Mouat, V.C. and C.B.; and
Dr. Churchill, junr.
Dinner being ready, and the guests having repaired to
the Convocation-hall from the Library, which had served
for an ante-room; one of, the Fellows, the Rev. Professor
Haughton, M.D., “ blessed the board” (we use the good
old English phrase) in the language of colleges, that tongue
which is in daily use in medical practice, and which is
popularly and charitably supposed to be on the tips of the
fingers of every M.D.
The form used was partly that of Trinity College, Dub¬
lin, with an extemporaneous addition by the Reverend
Doctor, and was significant as well for the open advocacy
of the use of Latin on public medical occasions, as for tbe
wsertion of the time-honoured relation of this college to
its alma mater , Trinity College, Dublin, from which it
sprang more than 200 years ago.
The dinner, which was supplied by Mr. Murphy, late of
Mitchell’s, was of the best description; and was, to use the
cant gastronomic phrase, “ replete with every delicacy of
the season.”
At its conclusion the Reverend Dr. Haughton said Grace,
somewhat after the fashion of Lincoln’s Inn. We give
the two verses as recited by Dr. Haughton, that they may
be placed on record, and used at future dinners as “ the
Dublin College of Physicians Use.”
Dublin College of Physicians Use,
Benediction Before Meat.
Miserere nostri Te quoesumus, Domine, atque his tuis
donis quae de tud benignitate sum us percepturi, benedicito,
per Jesum Christum Dominum nostrum.— Amen .
Grace After Meat
Benedictus Dominus benedicatur, pro his atque omnibus
ejus donis, per Jesum Christum Dominum nostrum.—
Amen.
The President proposed the health of the Queen, and
afterwards that of the Royal College of Surgeons in Ire¬
land. To this hitter the President of that body responded,
and gave the health of the host, which was duly received.
Next the host gave " The University of Dublin,” which
was responded to by Dr. Stokes, who gave “ The School of
Physic, and Professor Haughton,” the latter gentleman re¬
turning thanks. The toast of “ The Queen’s Colleges”
was responded to by Sir Robert Kane, and that of the
Army by Dr. Dane, P.M.O., and by Inspector-General
Mouat, after which Dr. Beatty, by request, favoured the
company with an admirable specimen of vocal music,
“ Sicut est mos,” and the company retired after spending a
veiy pleasant evening. Floreat Collegium Medicorum
Regis et Regina? in HiberniA
- 1 -
IJjotes an famrt Scopes.
The Duke of Edinburgh.
Addresses congratulating his Royal TTighmuw on his
recovery from, the murderous attempt of the assassin,
were presented to the Duke of Edinburgh by the Ancient
Scottish Hospital, and by the Highland Society of London,
on Tuesday, the 21st instant. The addresses were pre¬
sented respectively by the Dukes of Montrose and Rich¬
mond. Many gentlemen attended, most of them appear¬
ing in the Highland costume. Amongst those present Ivero
several members of the medical profession—viz., Drs. Soott
Alison, and Ramsay, Physicians to the Scottish Hospital,
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NOTES ON CURRENT TOPICS.
H» Xedkal Fran and Circular.
July 49,1868. 105
Dr. Stuart Tolloch, and Dr. McKinnon, C.B., of Netley
Hospital. We understand the Duke, though looking some¬
what thin, appeared to be in excellent health and spirits,
and that his expression was one of great intelligence and
activity.
St. Andrews Medical Graduates* Association.
We have received the first volume of the Transactions of
this association. It is somewhat tardy in making its ap¬
pearance, but contains much interesting matter. The papers
of last year's session, some of which we reported in full,
and of the others gave abstracts, are here published, with
the revision of the authors.
It is pretty clear that the volume has been kept waiting
for one paper. This is scarcely just to other writers,
and we would advise the editor on another occasion to be
more severe, and omit altogether contributions that are not
completed within a reasonable time.
There is a list of members and their appointments, but
this we observe is not complete, as we could, from memory,
make several additions and corrections.
The Registrar-General's Quarterly Return
for Ireland.
It is but of late that registration in this part of the United
Kingdom has reached anything like a reliable condition,
and even now it is hard to say whether the returns can be,
in all cases, implicitly trusted as indicating the actual state
of things. There are feelings and influences at work which
baffle the attempt to arrive at a degree of accuracy such as
we attain in England. Still, making every concession, we
have reason to believe that vre may congratulate our Irish
readers on the present condition of their country in a sani¬
tary point of view. We refer chiefly to this, though there
are other particulars in the report of equal concern, such as
emigration, pauperism, the price of food, and others as well.
From the estimate, it appears that the deaths in the first
quarter of 1868, were fewer than in the same quarter in
each of the previous four years, and less by five thousand
than they were in the first three months of 1867. It will
be remembered that there was a great difference in the
temperature of the two winters thus compared, which may
partly, perhaps mainly, account for the favourable difference
recorded in the death-rate. Different medical men in
various districts have supplied notes from which a large
part of the return has been made up, and on their autho¬
rity, it appears that the adoption of sanitary regulations
has had its effect, in many places, in promoting the im¬
proved state of the public health. We cannot, however,
but regret to state, on the same authority, that a large por¬
tion of the population are culpably neglectful in these
particulars; exposing themselves and those who dwell
around them to* danger, by suffering every species of filth
to accumulate and rot under the very walls and windows of
their dwellings, and taking no care to avoid infectious
disease, or to check its progress when it has made its ap¬
pearance. We would urge upon every one in a position of
authority or influence to use his power with his equals and
dependants, and awaken them, if possible, to duties upon
which their own and neighbours' lives may depend.
^.vj^yention of Cruelty to Animals.
Tlnr&iiiQf Hairoby took the chair at the annual meeting
QftHrifc Kxrffetyr which was held at Willis’s-rooms on the
ItfeJWttMftx From the report, it appeared that 994 con¬
victions had been obtained, being 200 in excess of last
year. The report stated also that vivisection was decreas¬
ing in France, chiefly through the operations of the society.
The noble chairman said he did not consider the increase
of convictions as a proof of the increase of offences, but of
the increase of detection by the officers of the society. He
was glad there was a decrease of the practice of vivisection
in France, and regretted that bull-fighting should have
been introduced there. Another great scandal, he said,
was the treatment of cattle in the vicinity of London. He
hoped it was not too late, eyen in the present session, to
make at least a beginning in a better system with respect
to the slaughtering of cattle than that which for so many
years had been the scandal of the metropolis. The Earl
of Romney thought the rich and the ppor were both alike
in the matter of cruelty to animals. The one set the ex¬
ample, and the other followed it. He believed there was
great thoughtlessness in the cruelty inflicted in many cases,
and instanced driving by constantly pulling the reins and
bit, the use of the whip, and the absurd bearing-rein, which
unfitted horses for their work. Several others addressed
the meeting, remarking, among other things, on the cruelty
to cattle sent from the sister country, and to dogs by the
use of the muzzle in the present sultry weather.
Accidentally Poisoned.
In the Times of July 20th, is recorded a melancholy in¬
stance of a young lady accidentally poisoned by an over
dose of strychnine. It appeared that the deceased had
been directed by her medical adviser to take 1 at meal¬
times five drops of liquid containing strychnine, and was
supplied with a bottle in which was an ounce of liquid
containing four grains of that poison. On Thursday
evening, the lady put five drops of the liquor strychnhe
into a small bottle of water, just like the one that held
the liquor itself, then by mistake she took up, and carried
down with her this last named bottle instead of the one
containing the mixed drops, and when seated at the table,
poured out and drank off its contents, which appear to
have contained about three grains of strychnine. In ten
minutes the poor lady was dead, with all the symptoms of
poisoning by strychnine.
The coroner (Dr. Lankester), at the inquest, condemned
the practice of vending poisonous medicines in ordinary
bottles, a matter evidently still requiring attention,
although many leading chemists always dispense poisonous
remedies in bottles of peculiar shape, so that the bottle is
known if taken up in a dark room. We would for
our part venture to doubt the wisdom of allowing as
much as four grains of strychnine (t.e., one fluid ounce of
the liqnor strychnia of the Pharmacopoeia to be in the pos¬
session of any patient at one time ; surely it would be
better and safer to dilute the medicine, and give a dose
of one tablespoonful or more in such a diluted state.
A movement has comhienced for employing female nurses
in lunatic asylums where males are at present employed.
It is said that the change, so far as attempted, has proved
beneficial to the patients. Drs. Mandsley and C. Browne
support the innovation. The advocates of female labour
would do well to watch this apparently suitable opening.
Ir is arranged that a Royal Commission shall investigate
the state and operation of the laws, relating to sanitary
questions.
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The MedicA Press and Circular. FOREIGN MEDICAL Lf^EllATUfLE.
July 49,186&.
The Medico-Psychy logical Association has fixed its annual
meeting for the 4th August, at the Royal College of Phy¬
sicians, London. The same day the British Medical Asso¬
ciation meets at Oxford.
The fee for registration for members of the General Coun¬
cils of the Scottish Universities has been reduced by the
House of Lords to £1. When the Bill left the Commons
it was 30s. We believe the change is the result of the
representations of the Scottish Universities 7 Union.
On the 10th of last month, as our readers are aware, Mr.
Pirn gave notice “ that he would ask the Chief Secretary
for Ireland when he would be able to lay upon the table of
the House of Commons, the correspondence between the
Treasury, the Irish*Government, and Dr. R. McDonnell,
late Medical Officer of the Mountjoy Prison, relative to
the change in the medical management of that prison,
by which he was deprived of that office. 77
We look anxiously for this correspondence, which we
hope may clear the authorities from the suspicion of having
“ hunted down 77 a deserving public officer, merely because
he did not run exactly in the groove they desired. We
have, meanwhile, learnt with great satisfaction that,
although the Lords of the Treasury at first declined to give
Dr. McDonnell any compensation, on the ground that he
did not give his whole time to the public service, yet, on
the representation of Lord Mayo, they have reconsidered
the question and granted Dr. McDonnell a pension. We
look upon this as a good omen for the cause of the Dis¬
pensary Medical Officers, and hope that the Chief Secre¬
tary may remember that the same arguments which were
applicable to Dr. McDonnell’s case, and which caused him
to exert himself so strenuously on his behalf, are equally
Applicable to the case we have mentioned.
-♦-
PROFESSOR BAMBERGER ON
ACUTE POISONING WITH PHOSPHORUS.
(Reported by C. Arbo.)
,Tr*n*Uted from th© Norsk Magazin for Lcrjevidcnskaben, xxii. Bind.,
8 Hefte, Christiania,'.1&58, by
W. D. MOORE, M.D.Dub.etCantab., L.K.Q.C.P.I., M.R.I.A.
HONOEAEY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIAN s ; OF
THE NOEWEOIAN MEDICAL SOCIETY; AND OF TIIB ROYAL MEDICAL
SOCIETY OP COPENHAGEN; SECRETARY FOR SWEDEN, NORWAY AND
DENMARK, TO THE EPIDEMIOLOGICAL SOCIETY OF LONDON.
In the Prague Sessional Medical Report for 1866 , is a lecture
.by Profesaor Bamberger on his investigations respecting acute
poisoning with phosphorus, which, as a communication on the
subject by one of the greatest medical celebrities of Germany,
teems likely to throw some light on the rather obscure opinions
. which still surround it, and will, therefore, probably prove in¬
teresting to our readers.
Bamberger referred to the increasing frequency of these
poisonings, due to the ease with which the agent is now procur¬
able. Thus the reporter saw, during nine months’ stay in
Vienna, three cases of acute poisoning with phosphorus; the
most frequent poisonings were with cyanide of potassium, of
these, in the same space of time, eight instances occurred.
Without going further into the details in a forensic point of
view, Bamberger wished to bring forward the difficulty of de¬
monstrating the existence of phosphorus poisoning in the dead
body, indeed sometimes it is purely impossible to demonstrate
it*
When a long time had elapsed since the phosphorus had
been taken, when a part had been again discharged by vomit¬
ing, and where what remained was, by reason of the great
affinity of phosphorus for oxygen, changed into various pro-
(foots of oxjdatjottj the chemioal demonstration would be pro- .
bably very difficult, and the anatomical changes produced by
the poisoning, which might corroborate the correct diagnosis,
would not in all cases be characteristically marked, or free
from sources of fallacy. This is shown, among others, by those
cases published by Rokitansky, and expounded as acute
steatosis of the liver and kidney, as well as by the analogous
cases published by Wagner, of Leipzig. Some of these were
certainly referrible to phosphorus poisoning, while, with re¬
spect to others, this is doubtful, and it must, therefore, be left
undecided, whether such an acute degeneration of the liver
and kidneys may not depend upon other causes.
But the medical interest of the subject is still greater than
the forensic. Phosphorus poisoning is characterised, as is well
known, by a peculiar complex of symptoms : considerable de¬
pression of the nervous system, striking diminution of ths
activity of the heart, ecchymoses in all organs, jaundice ; and
fatty degeneration of the liver, kidneys, muscular structure of
the heart, and other organs. If we endeavour to discover the
cause of these phenomena, we must admit that the explana¬
tion of them is in many respects obscure and difficult. Ley¬
den and Munk, who have worked out the subject in detail,
and have instituted numerous experiments upon animals, have
undoubtedly contributed to clear up the matter, but the
results of their labours have also given rise to much doubt.
This had led Bamberger to again investigate the matter ; in
doing so he started from definite points of view, and proposed
to himself certain questions which permitted him, with some
probability, to expect a satisfactory result—namely :
1. In what chemical form does phosphorus act injuriously
on the system ?
2. What are the causes of the fatty metamorphosis of the
organs ?
3. What treatment is to be substituted for the almost wholly
inactive plan hitherto in use, with a prospect of a better result ?
Respecting the first point, physiologists had not been at sll
agreed, as the great variety of opinion expressed by the several
writers sufficiently proves. At one time phosphorus, as such,
was accused of being the poisoning agent ; at another, the
lower degrees of oxydation, as hypophosphorons and phospho¬
rous acid. Scbuchardt assumed that the phosphorus acted in¬
juriously in the system by the formation of phosphuretted
hydrogen. Munk and Leyden accused phosphorous acid of
being the injurious agent. Schuchardt’s view is, indeed, gene¬
rally given up, as it is not conceivable, that from the presence
of phosphorus in the stomach, any other than combinations
of oxygen with that element should arise.
Munk and Leyden evidently went farthest in their opinion
that the oxidation products of phosphorus, especially P0 8
acted injuriously ; they asserted plainly that phosphorus in
the stomach could exercise only a corrosive action, and had in
itself no general effect. They based their argumentation upon
the facts that
(a.) Phosphorus was not soluble in the body.
(6.) That it did not exercise any essential action upon
organic substances, for example, blood.
(c.) That it was not demonstrable in any organ after poison¬
ing had taken place.
Neither were the lower degrees of oxidation of phosphorus
injurious, as in experiments upon animals with hypophospho-
rous acid they had arrived at results, essentially different from
those obtained in phosphorus poisoning. On the other hand,
by injecting phosphoric acid into the jugular vein they deve*
loped phenomena, analogous to those in phosphorus poisoning:
diminution of the heart’s action, ecchymoses and petechbe, 4c.
They therefore assumed that the first effect of phosphorus in the
stomach was only local and corrosive , but that on the corroded
part , oxidation forthwith tonic ;dace with the formation of phos¬
phoric acid , which entered the blood in the nascent state , and dis¬
solved the blood (jlobules. The ecchymoses, the dissolved state
of the blood, and the bloody urine in persons poisoned with
phosphorus, are adduced as proofs thereof.
The starting point of these deductions was, in Bamberger’s
opinion, evidently false ; for it is established by experience that
general intoxication has occurred with phosphorus without the
slightest corrosive action having been found in the stomach and
intestines.
Neither did Bamberger, in numerous experiments upon
animals, find any corrosion of the mucous membrane, and yet
fatty degeneration in the organs existed in an extreme degree.
Neither was the second part of their assertion correct, that
the blood globules were dissolved. Bamberger took, in animals
after several days intoxication, blood from different vascular
parts, but on microscopical examination,- he found not the
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tfo Medical Press and Circular. ST. ANDREWS GRADUATES* ASSOCIATION.
July », 1888 . 107
slightest difference from the blood of healthy animal*. A similar
negative result was obtained from freshly drawn blood, left for
a long time in a cup in contact with phosphorus; not even
did the blood globules immediately surrounding the phospho¬
rus, exhibit any change. Nor, when the vapours of phospho¬
rus were passed for a long time, by means of an aspirator,
through recent blood, did the blood-corpuscles manifest any
change, the blood became only of a lighter red, which might
he regarded either as an effect of the oxygen in the atmos¬
pheric air passing through at the same time, or as the ozone
action of the phosphorus.
It is true that in dead bodies after phosphorus poisoning
the blood isfonnd less coagulable, or entirely fluid; but this is
not the case until a considerable change of the heart, liver,
kidneys, and other organs has occurred, when the whole system
is in a great degree implicated; and this alteration of the blood
is then not to be regarded as primary, but as a result of the
general affection of the organism. When the blood was taken
from the animals experimented on at an earlier period, it
was not at all changed.
L The same is also the case in the different dyscrasias, as
typhus, pysemia; the alterations of the mass of the blood met
with in the dead body are not present & priori , but are to be
regarded as the result of the manifold disturbances developed
during the course of the disease. The action of the phosphorus
is therefore not to be compared with that of arseniuretted hy¬
drogen, or of the mineral acids, which produce destruction of
the blood-corpuscles, nor with that of carbonic oxide gas, which
displaces the oxygen of the blood-globules, and enters into an
inseparable combination with the haemo-globuline, which gives
the characteristic spectral phenomena. The alterations of the
blood produced by phosphorus do not belong to the grossly
material; they ought much rather to be classed with those still
unknown changes, which the different contagions and miasmata,
or the smallest quantities of certain poisons, produce in the
blood.
With respect to phosphuretted hydrogen, hypophosphorous
acid, and phosphorous acid, he found Munk’s and Leyden's
experiments decisive.
That phosphorus, as such, should produce the well-known
effects in the system, was, as has been mentioned, denied
partly for this reason, that investigators had not hitherto suc¬
ceeded in chemically demonstrating its presence in the blood
or in the organa. This, he thought, was due to the unsuitable-
nes* of the method of investigation, and it was desirable, there¬
fore, to find one which should be reliable also for small quan¬
tities of phosphorus and such is that quoted by T. Scherer, in
his “Lehrbuch der Chemie.*’
Phosphorus, both in substance and in the form of vapour,
reduces the oxides of the noble metals; strips of paper, mois¬
tened with a solution of nitrate of silver, become rapidly black
with phosphorus with the formation of phosphuret of silver,
phosphoric acid, and the separation of metallic silver.
Now, if we have an organic fluid—for example, blood—to
examine for phosphorus, we must in the first place satisfy our¬
selves that no sulphuretted hydrogen is present, by testing it
with nitro-prusside of sodium or acetate of lead. If no sulphu¬
retted hydrogen be present, a strip of paper moistened with a
solution of nitrate of silver is fastened to the cork in the bottle
in which the fluid to be examined is, and this, if necessary, is
slowly heated in the sand-bath. If phosphorus be present the
paper is soon blackened. We may also convince ourselves
of the presence of the phosphoric acid formed at the same
time, On boiling the strip of paper in water, the nitrate of
silver also taken up is precipitated with hydrochloric acid, and
tiie residue is tested for phosphoric acid with molybdate of
ammonia, which is a very delicate test of the presence of that
acid. Fresenius and Neubauer have had to object to this
method, that all the phosphorus is not taken up, as the greater
part of it combines with the silver as phosphuret of silver,
which is insoluble in water; aqua regia must therefore be em¬
ployed, by which, however, the paper is destroyed, which itself,
#gtfn* contains traces of phosphoric arid, probably combined
jWfth time. To avoid this Bamberger employed heated asbestos,
tthefeby not only a source of error was eliminated, but also tfie
s of phosphorus obtained larger surface of contact,
srt&in the law of diffusion of phosphorus, Bamberger
[’ll series of.experiments. A cylinder was filled with
&ftd air, or with water alone ; a small piece of phos*
J.%raa introduced into it, and it was then tied over with
nbranfl (pericardium of a man, or a pig's bladder
archment), and placed,in connection with another
' wi& fftrid. Not long after the outer fluid be¬
came turbid, presented the smell of phosphorus, and exhibited
Scherer's reaction. Phosphorus, therefore, readily passes in
the form of vapour through animal membranes; but phos¬
phoric acid was also demonstrable in the fluid, when this was
well steamed in the water-bath. The lower degrees of oxida¬
tion of phosphorous were not demonstrated, but they are in
general difficult of demonstration in the presence of phosphorus
and phosphoric acid ; we can, however, scarcely doubt that the
intermediate forms are also present.
Phosphorus behaves in blood, with respect to its diffusion,
as it does in water, and Bamberger therefore expected to find
the same in experiments on animals. He gave small granules
of from 10 to 12 milligrammes of phosphorus daily, and
usually observed for the first four or six days, no other
phenomena than diminished appetite (a rabbit got even for 13
days 10 milligrammes daily, that is 130 mgrm., before it
died).
(To be continued.)
-♦-*
f'rflm&iiijgs 0f
ST. ANDREWS MEDICAL GRADUATES'
ASSOCIATION.
The General Session of this Association was held on Monday
and Tuesday, July 20th and 21st.
The Association met on Monday at the Freemasons' Tavern,
when, in accordance with the resolution of the Council, the
claims of the several candidates for the representation in
Parliament of the conjoined Universities of Edinburgh and St.
Andrews were to be considered.
On Tuesday some members visited the Church of Hemp¬
stead in Essex, where in the family vault lie the remains of
Harvey.
The transactions of the Association were ready for distribu¬
tion on the first day.
The discussion on Monday was the chief business of the
Session, and there were about forty members of the society
present.
Some preliminary business having been disposed of, the
adoption of the report of the Council was moved by Dr.
Greenhalgh and seconded by Dr. Nicholls. This report
was drawn up on the previous Saturday at a meeting of the
Council, at the house of Dr. Richardson, when ten members
were present. It declared that the representative of the two
Universities of Edinburgh and St. Andrews ought to be a
medical man, and recommended Dr. Richardson as candi¬
date.
Dr. Richardson, who as president occupied the chair, then
addressed the meeting. He said he was not very ambitions of
parliamentary life, but he believed in calls, and if selected by
the Association he should regard it as a call, and stand as a
candidate ; at the same time, he would not incur any expense.
Those who sent him must defray the legitimate costs, and he
Would not sanction expending a penny more than was abso¬
lutely necessary. As to politics, he would not side with either
Mr. Disraeli or Mr. Gladstone. He thought old foundations
which had been proved to be good, should be retained in pre¬
ference to making new ones. He believed the Association,
numbering nearly 600 graduates, had the power to return a
member if it acted unanimously, and thought that a medical
man should be returned.
Dr. Drysdalk regretted not to hear more definite views
from Dr. Richardson, especially on the great questions of civil
and religious liberty. He had heard at the preceding Council
meeting that Dr. Richardson was not prepared to support Mr.
Gladstone in the disestablishment of the Irish Church. Now,
he could not conscientiously vote for any candidate who sup¬
ported the establishment of the alien church of the minority in
Ireland.
Dr. Shorthouse said they wanted a medical man, and had
nothing to do with the Irish or any other church.
Dr. Kino objected to taking into consideration the politics
of the candidate. He wanted a representative of medicine.
Dr. O’Connor said that a medical man, a member of the
Association, had issued an address. As he saw him present,
he would like to hear his views. He referred to Dr. Prosser
James, and begged to inquire whether he was a bona fide oandi-
i date.
Dr. Prosser James replied that he was a bona fide candidate,
I and having the support of many graduates in all the faculties
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108 The Medical Ttm and Circular.
CORRESPONDENCE.
July 10, ISA
as well as of political friends, both in and out of Parliament,
hoped for success. Unlike the President, upon whose scien¬
tific reputation he passed the highest eulogium, he was a party
man. He did not think politics could be excluded from such a
contest, nor could he admit that they ought to be. He would
not detain them by repeating his medical politics, as he had
forwarded a statement to every graduate of both Universities.
He had hoped for the support of the majority of his medical
brethren on the strength of his programme for reform in the
profession. At the same time he could not forget that there
Were other faculties, and he knew he had lost some support by
givjng too great prominence to medical matters ; although he
had doctors of divinity and laws, as well as Masters of Arts
working for him. He did not believe with the chairman that
the Association could return their nominee. Why, they were
only 500 or 600, and there were perhaps 5000 members of the
University Council. Besides, this Association was not only
medical, but was for one University out of two. The sister
University was entitled to at least equal respect, and the
graduates in the other faculties could not, and ought not to be
ignored. No one loved his profession more, or would make
greater sacrifices for it; but he could not make all social ques¬
tions secondary to it. He did not scruple to remind them, that
society did not exist for the sake of medical men, but medical
men fer society. On every general question he was as liberal
as on medical ones. Indeed, it was only as a liberal he asked
the suffrages of the constituency. As the Irish Church had been
mentioned, he might repeat that he thoroughly supported Mr.
Gladstone on that question. He thought farther that all
churches would be better without State interference, and that
it would be a good thing for all States to be untrammelled by
any church.
Dr. Edwards Crisp thought general politics should not be
considered, and suggested that the medical candidate most
likely to succeed should be pushed by the Association.
Dr. Martin would not support any candidate who would
vote against the Irish Church.
Dr. O’Connor thought it was too late for Dr. Richardson.
The medical graduates could not enforce their views. He
said the other candidates ought to be considered, as he did
not think the medical ones were either of them likely to suc¬
ceed. As to Mr. Campbell Swinton, he found that his chairman
and vice-chairman were Professors Christison and Shairp,
both men most bitterly opposed to the enfranchisement of the
medical graduates, and the former of whom opposed all medical
reform. He thought, therefore, the Tory candidate had no
olaim on the profession. Professor Playfair he considered a
good candidate, liberal on most questions, and possessing such
Urge support that he believed him very likely to succeed.
He, therefore, asked the meeting to support him, and not by
division let the enemy of the profession and the Conservative
creep in.
Dr. Rogers regretted that Dr. Richardson’s views were not
like his own, advanced Liberal, but would support him.
Dr. Sedgwick said many had promised to support Dr. Lyon
Playfair under the mistaken notion that he was a medical
man.
Dr. D CDfield gave an account of the getting up of a re¬
quisition. Nearly 200 signatures were gained.
Dr. Richardson said he did not come forward sooner lest it
should imperil the enfranchisement. He could not consent to
taking a wedge out of the constitution by disestablishing the
Irish branch of the Church. But for the clergy of that Church
we should have had no literature. He then put the report to
the meeting.
Dr. Sedgwick counted the hands held up, which were 26.
The contrary was then put, and as no one held up a hand the
motion was declared to be carried.
The meeting then broke up, some of the friends of Dr.
Richardson remaining to concert measures on his behalf.
FORFARSHIRE MEDICAL ASSOCIATION.]
The tenth annual meeting of this Association was held, on the
19th ult., at Forfar, Dr. Smyth in the chair. The following
were presentDrs. Smith, Steel, Murray, Maclagan, and
Alexander, Forfar; Drs. Nimmo, Arrott, Christie, Crockatt,
Begg, J. W. Miller, Rorie, Pirie, Petrie, Allan, Steven, and
James Duncan, Dundee ; Dr. Park, Broughty Ferry ; Drs.
Lawrence, Johnston, Officer, Watson, and H. Steele, Mon¬
trose ; Drs. Alexander Guthrie, Mackie, sen., Hammond, J.
Guthrie, and Mackie, jun., Brechin; Dr. Grant, Glamis; Dr.
Simpson, Marykirk ; Dr. P. Heron Watson, Edinburgh ; and
Dr. Andrew Smith, Staff-surgeon, Aberdeen.
It was decided to present a memorial to the Home Secre¬
tary, showing that it would be advantageous if the office of
Poor-law Medical Officer were put on the same footing towards
the parochial board as that of inspector—namely, the power of
removal to be exercised only with the sanction of the Board of
Supervision.
It was agreed to hold the next annual meeting in Dundee.
Dr. Steel (Forfar) moved the appointment of the following
office-bearers, who were unanimously elected :—President,
Dr. Arrott (Dundee) ; Vice-presidents, Drs. Nimmo and Gib¬
son (Dundee) ; Secretary, Dr. James Duncan (Dundee); Trea¬
surer, Dr. Allan (Dundee); Council: Drs. Christie, Crockatt,
Begg, J. W. Miller, Pirie, and Rorie (Dundee) ; Local Secre¬
taries : Dr. Lawrence (Montrose); Dr. John Guthrie (Brechin);
Dr. Alexander (Forfar) ; and*Dr. Dewar (Arbroath.) Dr.
Smith, President of the Association, brought forward notes of
interesting medical cases. Dr. Lawrence (Montrose) read an
exceedingly interesting paper ** On Traumatic Cerebral Ab¬
scess.” A discussion ensued, in which several members pre¬
sent took part. On the motion of Dr. Arrott, the thanks of
the meeting were cordially awarded to those gentlemen, and
to the President, for his conduct in the chair. The member!
afterwards met and dined in the County Hotel.
- + -
RULES FOR REGISTRATION IN THE SCOTTISH
UNIVERSITIES.
1. All Graduates of either of the four Universities may
enrol as members of Council of their respective Universities.
2. All persons may also enjoy the privileges of Graduates
who, previous to 1861, attended four sessions at any Scottish
University, or three at one and one at another University,
provided that two of the four sessions were spent in attendance
at general classes. Four purely medical sessions will not suf¬
fice, and in makings claim for registration under this heading,
it is necessary that a record as to years of attendance should
be sent to the registrars.
3. All applications must be addressed to the registrar, and
accompanied by a post-office order for 20s.
4. All those graduates who have hitherto paid annual sub¬
scriptions in lieu of composition fees, must now make up their
previous payments to 20s., all such payments being allowed in
deduction.
5. Electoral privileges give power to record votes by voting
papers, at all University elections, including those for members
of Parliament, chancellor, and assessors.
6. The register will be dosed on the 1st of October.
-»-
&Qtxn$Qubtntt.
THE GENERAL COUNCIL OF MEDICAL EDUCA¬
TION AND REGISTRATION.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —On Wednesday, the 15th of this month, I called your at¬
tention to the partial statement made by your reporter of the
proceedings of the General Council of Medical Education and
Registration, on Saturday, July 4, on which day Dr. Apjohn
brought no less than three separate and distinct charges against
my report of the visitation in reference to the examinations
in Trinity College Dublin for the Degrees of B.M. and Mag.
Chir., held in December, 1867, as being “ untrue,” which I re¬
plied to on the instant before the Council, oompletely to my
vindication, of which your reporter takes no notice. Dr.
Apjohn’s first charge was that the candidates were recalled
after’the close of the examination, and the names of the success¬
ful and unsuccessful candidates were announced. In explana¬
tion, I replied, all the candidates were called in, the names of
the successful candidates were announced; what became of the
unsuccessful ones ? Surely their being paraded before those
who were present and their names not called, was equivalent
to a public announcement that they had not passed. The
second charge was the Professors were the only examiners, by
which I made it to be understood that no non-professional
examiners not connected with Trinity College were appointed
for that duty. Such was the fact up to December, 1807, when
I visited that Institution as a Member of the Irish Brandi
Council of the General Council of Education and Registratfcm,
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CORRESPONDENCE.
July 29,1060. 109
but tinet then the University has commenced setting its medical
house in order, ahd selected two other examiners in Surgery—
Mr. Butcher and Mr. Wharton, from the Fellows of the Royal
College of Surgeons in Ireland.
The third charge against my report being 44 untrue” was
that the candidates were not tested in writing or dictating
prescriptions ; a^ain I affirm, such was the fact when they were
examined orctUy m the practice of medicine and surgery, and
the oral or viva voce examinations which my report specially re¬
ferred to, requires to be corrected in all future examinations
for the medical and surgical degrees of Trinity College.
From my experience of the last meeting of the Medical
Council, the word 44 untrue” is a favourite expression of Dr.
Apjohn, and from a Member of the Council (July 1) to whom
he used the same expression, he received a reprimand which
he most justly merited and will not soon forget.
As the reporter of The Medical Press and Circular is
silent on this subject, affording me no information'for ignoring
my reply, I have consequently been obliged to vindicate ray-
self from those most unmerited aspersions of Dr. Apjohn on
my report of the examinations for conferring the degrees of
B.M. and M.C. of Trinity College Dublin, in December, 1867.
As a public journalist you will at once see the justice of inser¬
ting this in the columns of the next number of The Medical
Press and Circular.—I remain, sir, your obedient servant,
Willi ah Hargrave,
Representative of the Royal College of Surgeons
in Ireland on the General Medical Council of
Registration and Education.
50, Upper Mount-street, Dublin,
July 24, 1868.
MEDICAL REFORM.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir, —The questions raised in your columns deserve all the
attention of medical men.
It is plain that something must be done. Either the expen¬
sive and difficult reform urged by Dr. # Andrew Wood and the
Medico-Political Association must be effected, or else the easy
and inexpensive proposal of Dr. Prosser James must be ac-
X ' d. The beauty of this latter is that it would bring many
privileges with it.
It would be a reform of the corporations as well as of the
Council.
Dr. Ashe is too trenchant by far, and when he uses the word
44 hoodwink,” does injustice. For my part, I like the indirect
plan, and thank our excellent representative. Dr. Paget, for
taking it up in the Council. Although the plan had been fully
explained by Dr. Prosser James, it would, perhaps, not have
made the sensation it has, had not Dr. Paget leaned to it in his
speech. Perhaps for that reason he should have given the
author the praise due to him. This much I would urge—let
the other universities and corporations be as liberal as Cam¬
bridge, and the indirect method would be fully established.
Dr. Ashe talks of the Senate here as if it were controlled by
a committee.
No such thing; it is open and fair. Nothing can be done
without the oonsent of the Senate, which includes all M.A.’s,
and all doctors who keep their names on the books. Like Dr.
Williams, in his letter in your last impression, I think the more
medical men in the House of Commons the better; and I, too,
wish Dr. Prosser James and his plan of indirect representation
shcoMs,—I am, Ac., Cantab.
ON DINING.
44 Ding goes the dinner-bell,
Tingle, ding dong,
Pray what can the matter be—
Dinner’s so long.
Five minutes more to wait
For turkey and ham,
The juice of the ruddy grape
Is better nor jam.”— Old Song.
TO THE BOTTOB OF THE MEDICAL PRESS AND CIRCULAR.
SlB,—I agree witb “ Sanitas,” dinner a la mode is Verily dinner
ab ——• Ah 1 I won’t say it, bat it verily is. I like to
however—who doesn’t ? A great wit, you remember—
t fyf* jfoptxnr who said, “ come, let us walk down Fleet-street,”
Tag asppt, hit opinion on dining. “ I like to dine,” was his
i mnigf ^ould hardly stand a “ bolting” process of two
though, at a temperature of 212° in the
,“hig|i.pressure” all round. The term “dinner”
It is a barbarous, luxurious, luscious
term, whose very sound as it strikes the tympanii, causes a tickle
in the “ inside,” from long habit. I would humbly suggest that
the term 44 compensatory process” be substituted, and that the
“ compensatory” should be availed of just as the promptings
of nature suggest. 44 Man is the only animal that dines by
rule,” thanks to, well, say civilization ; but we know there are
44 parties” so civilized by the process as not to be able to stand
it to the end, and who become prostrate under its applica¬
tion.
It will be difficult, no doubt, to upset the universal dinner-
table. There are, even in our very midst, thousands of persons,
exclusive of Aldermen and T. C.’s., who would cling to dining
table legs to the very death, were a bold attempt made to dis¬
joint them.
44 A meat tea,” as “ Sanitas” wisely suggests, repeated ad
lib. t I meekly respond, would do very well to begin witb;
and no evening coats with morning continuations. “ Crusty”
old bachelor Perkins, who reads as I write, snamblingly adds—
But who will commence this reform movement ?
44 Mr. Chairman”—Mr. Editor I mean, “ I move that 4 Sani¬
tas,* whose mighty intellect and brilliant pen mooted the
great question ‘ On Dining,* do give a ‘ compensatory pro¬
cess/ and thereby practically illustrate the point he has so
sumptuously/no! not sumptuously, there is too much of the
pungenoe of the dinner-table about that term), so eloquently,
yes, so eloquently, seeks to reform.”. Please second this, and
believe me to be, very faithfully yours,
Saint Pancras, Jr,
P.5.—Do you think this will “bring out” “Sanitas,” as I
like a good dinner “ on the Strand.”
THE CONTAGIOUS DISEASES ACT.
TO THE EDITOR 07 THE MEDICAL PRESS AND CIRCULAR.
Sir, —Ever since about this time last year, I have watched with
anxiety the proceedings of the different meetings held in con¬
nection with the Prevention of Contagious Diseases Act, in
order to have its operations extended to the civil population,
and I am sorry to see that nothing as yet has been proposed
for the protection of these unfortunate women, of whom so
much is said, and to whom so much blame is attached, without
considering that they are the first victims of the immorality of
men.
As it appears that it is intended to submit to the English
Parliament, plans devised according to the French system, and
as I think it right that the subject should be looked at in all
its bearings, I beg to submit to the impartial consideration of
your readers, and especially of the gentlemen forming the Com¬
mittee, an extract translated from a chapter written on the
same subject by Jules Janin—the French Charles Dickens.
44 At the top of the Rue St. Jacques there is an hospital, but
an hospital wanting both pity and respect. The surgeon him¬
self despises his patients. The diseases there assume every
kind of horrible forms, and names which are only hinted at in
a low voice ; it is more a prison than an hospital. The police
is the queen and the mistress of it. It is not the Christian
Charity but the Prefect of Police who opens the doors of this
fatal asylum.
44 1 have seen in it young men, pale and livid, with a skin of
an undescribable colour, and deprived of their senses and
reason. Next to them were fathers of families, in mourning
for their wives and children, whose death they had been the
cause.
“ A little further were some horrid old men, kept by the
Faculty as curious specimens, and shown to strangers as being
more horrible than any that they had in their own oountry—
worthy subject of pride !
44 1 was going away when some one told me that the hospital
was divided into two parts, and that upstairs were the women.
4 Do you not want to see the women, sir/ they said, as if they
were much more worthy to be looked at. In going up I met
nurses infected by the babies they had taken to nurse. Some
poor young country girls weeping, knowing nothing about their
disease, and hiding their faces with their coarse apron.
44 At the door of a ward was a young innocent-looking
woman, the miserable victim of her husband. She was there,
immovable, like a statue, waiting for a place in a bed by the
side of some old prostitute. What! the woman nursing a
baby. What! the young girl who gives herself up to her
lover or her husband, they also are contaminated by this
horrible disease. Poor women, hundred times more to be
pitied than these other inmates downstairs.
44 1 entered a large room, there I found many women, some
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CORRESPONDENCE.
July 29,1868*
old habitudes, who make the hospital their homes, and turn it
into a bouse of pleasure and of rest; they were all laughing
and playing at different games. Some were ornamenting
themselveB with a veil, or some bright morning gown. The
youngest, half dressed, were comparing their youth and their
beauty ; others were uttering fearful oaths, or singing with a
harsh voice some drinking Bongs of debauchery. The greatest
part of these women were still young and handsome. Poor,
miserable women ! handsome enough to be still handsome in
such a place, unfeeling enough to laugh and sing. They
might have been the pride of a young man, the honour of a
happy home, the companion of a strong man, and his help in
his old age ; but no. At the instigation of men they have
given away all that, they have sold themselves for nothing. No !
not for nothing ; but for ulcers and diseases, all the precious
gifts which they had received from God—comeliness, youth,
cheerfulness, health, and happiness, they have lost all. Oh, it
is horrible ! horrible !
“ At a given signal, all the games ceased, and a mournful
silence succeeded to all the noise. Every woman fell in, and
all walked in a line to the place where the surgeon was wait¬
ing for them. It was a small, low room, lighted by a single
window, opening at the back of the house, the walls of it are
of a dirty greenish hue, strangely ornamented with obscene
figures, drawn either by the patients or the students. On a
bedstead is a small paillasse, coveted with a black cloth ; by
the side of the bed were, here and there, every kind of cut¬
ting instruments, and a small stove where several pieces of
iron are getting red hot.
“ Around the bed were several old women, who by their
services had deserved to be present at the show, and on the
only chair in the room sat the elegant operator, talking with
his pupils about actresses and the news of the day. I joined
these young rivals of Esculapius, and I may say, that I was
the only one there moved and attentive.
. • “ Through the half-open door, I was looking at all these
women so thinly dressed, and waiting for their turn, with an
impatience as if they had been at the door of an opera-house.
Amongst them, were charming, youthful faces, with a melan¬
choly smile on their lips, others with strong, marked features,
black eyes and hair, it was a strange and varied assemblage of
beauty.
“ At the name of Henriette, I saw coming forward a young,
handsome girl, keeping her head erect and a disdainful look
in her eyes. She threw herself on the bed—everybody was
silent ; the operator took some curbed scissors and began cut¬
ting m the sound flesh.
“ When overcome by the pain, the poor girl either moved,
or uttered a faint moan, she was answered by words of anger
and oontempt; as for myself, I was admiring so much beauty
reduced to such a degradation ! When the operator had done
with the scissors, he took the red iron, and burned, without
any signs either of feeling or pity, all these bleeding sores,
occasionally looking at his work as a young painter looks at
Ids, first landscape ; then, with a harsh, unfeeling voice, he
cried : get away you wretch and do not let me see you here
again.
“ She rose, pale, suffering, walking with difficulty, and dis¬
appeared.
“ After a while, when I left the hospital, there, outside of
the gate, on a heap of stones, sat two women, one was
Henriette, the other the young married woman whose decency
and grief had struck me. Both cured, as it had been said, both
had been put out of the hospital, half-naked and dying with cold
—Henriette without a home, the other not daring to go to her
own. Henriette went back to the licensed house, where all
the police regulations had not been able to save her from the
infection, and likely to fall the victim of it again.
“ At the same instant, several other girls came out; they
were all laughing and talking aloud. At seeing them so gay,
nobody would have imagined what these unfortunate girls
had Buffered.
“Touched with pity, and perhaps curious to see the
house of the poor married woman, I took a cab, and asked
her to get in.
“ She was in such a state of mind as not to hear me at
first; at last, she Bakl: * Oh, sir ! my husband lives very far
from this, I asked him to come and take me out of this
miserable house, but he did not come ; and without you I
might have died of cold and shame.’ Then, she got into
the cab, but the nearer we came to her house, the more sad
and anxious she became.
“ ‘ What is the matter V said I. ‘ Why do you tremble so/
‘ Alas,’ she said, * my husband ! how will he receive me ? How
will he forgive the wrong he did to me ?’ and she looked so
pale and livid. At last we arrived at the house. We went
upstairs and knocked at a door on the second floor. A coarse
voice said ‘ Come in.’ I went in first. A man surrounded with
boxes and papers stood up. He looked at his wife as if he had
seen her a few hours before, without saying a word either of
kindness or regret. Oh, the brutal man! He had red eyes;
his hair fell flat on his neck and face, which was covered with
large pustules.
“ ‘ Oh! miserable woman,* said I, 1 what are you coming
here for ? you would be better where you come from.* She
began to cry, and looked at me as to say, ‘ I know what awaits
me here. Before long I will be again where vou found me
this evening.* Poor woman ! Poor woman ! who will protect
and defend you ?”
Now, sir, I think it is evident from the foregoing article, that
the French themselves are of opinion that something is wanted
besides this infamous police system.
Judging from the measures either proposed or already in
activity in this country, one would say that everything is clone
to induce every class of men to addict themselves to their
passions without impunity. If inquiries are made, it will be
found that the most substantial support of these unfortunate
women comes from married men, and although it is easy to
guess what amount of misery it must infiict on the families of
these men, yet nothing is proposed to counteract it. Perhaps,
if special constables were appointed to do duty about the
dwellings of these unfortunate women—they are generally
congregated in some few streets—so it would not be difficult to
have them watched, this simple measure would deter many
men from frequenting these houses, in fear of being known or
remarked.
At all events, it is to be hoped that the Committee will re¬
commend such measures as will protect these unfortunate
women, and prevent them, if possible, becoming the miserable
subjects of the disgusting scenes so powerfully described by
Jules Janin.—I have the honour, Ac., E. L.
POISONOUS EFFECTS OF “CYTISUS LABURNUM.*
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —As Physician to the Cashel Workhouse, I was lately
called upon to treat a number of cases suffering from the
poisonous effects of the “ Cytisus Laburnum,” which I send you
an account of, with a few practical remarks, that may be use¬
ful to other medical men.
On the evening of the 9th instant, sixteen female school
children, inmates of the Workhouse, ate a quantity of the
laburnum-seeds. The ages ranged from three to twelve years;
they were healthy children, and in good condition. None of
them could tell how much they ate.
The symptoms that presented themselves were vomiting,
anxiety, quick and weak pulse, paiu in epigastric region,
twitchings of the muscles of the face, eyes rolling, surface of
the body oold, tendency to sleep, and drowsiness. All these
symptoms did not appear in each case, though some did. I
have therefore grouped them, as it answers my purpose at
present.
I lost no time in getting the children away from confusion,
and that excitement that naturally runs through numbers when
they hear of a number of children having been suddenly
poisoned. I had them sent to the infirmary at once, and doing
all I cou}d to allay their anxiety, treated them all with emetics.
I selected mustard; it answered my purpose well. In some of
the cases the aromatic spirits of ammonia, held to the nose for
some time, was very grateful.
They all recovered. I kept them on milk-diet for two days,
and discharged them from hospital quite well on the 11th inst.,
with the exception of one child I retained, who had slight
ulcers on the arm.
4 The important points to be kept in view in such cases are—
firstly, to remove as soon as possible the poisonous matter
which is causing embarrassment of the system; and secondly,
closely to watch any symptoms that may index the approach
of the cerebro-spinal system becoming affected; and, whilst -
watching, all anxiety should as much as possible be allayed,
for the use of the physician, as well as his patients* and others,
that his judgment may be cool and calm, and that all perturb¬
ing emotions and influences may be put aside. Unfortunately,
in all cases this cannot be accomplished, for you will sometimdt
find or meet with an obstinate parent, or other pereoii, who
will think they have a right to interfere, and as you hav6 not
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ib* Medical fttm tad Circular.
MEDICAL news.
July », mi. Hi
time to teach them of their ignoranoe, yon most endeavour to
mind them as little as possible, and not allow your attention
to be taken off your cases. Steady, dose attention is invalu¬
able in such cases, and well the physician is repaid when he
sees his little patients recovering from the deleterious influ¬
ences of what he dreads will destroy them; and whilst closely
watching, light increases, which assists him in comforting and
cheering, as well as having relieved.
Here is a group of cases which show the necessity and the
eoonomy of attending to the general health and strength of
children as they grow up, when we find them subject to such
accidents and influences (often epidemic) that are liable to
seine upon them in numbers*—I remain, sir, your obedient ser¬
vant, Jambs Graham, M.D.
Jptal gfrfos.
Royal College op Surgeons of England.—
The following gentlemen having undergone the necessary exa¬
minations for the diploma were admitted members of the
College at a meeting of the Court of Examiners on the 23rd
inst., via.:—Messrs Brandford Edwards, L.R.C.P., Ipswich ;
J. D. Mason, Lewisham, Kent; T. J. Gittins, Barbadoes,
West Indies; Francis Lett, Woolwich; Edward Colson,
Great Hormead, near Buntingford; Richard Banks, Cocker-
mouth, Cumberland ; and C. E. Wing, Bury St. Edmunds,
students of Guy’s Hospital; Herbert Boyd, St. John’s, New
Brunswick, of St. Mary’s Hospital ; Leonard Smith, Cam-
bridge-street, of St George’s Hospital; William Morris, Bir¬
mingham, of the London Hospital; M. W. W. Chorley, Leeds,
of the Leeds School of Medicine ; David Brown, Dublin, of
the Dublin and Belfast Schools ; Daniel Ainley, Halifax, of
St Bartholomew’s Hospital; W. J. Scott, Cape of Good Hope,
of University College Hospital ; Robert Patrick, Bolton, Lan¬
cashire, of the Manchester Royal School of Medicine and
Surgery ; Tom Bates, L.R.C.P., Edin., Worcester, of Paris
and Glasgow ; and G. S. Walker, Islip, Oxon, of St George’s
Hospital. It is stated that seven out of the twenty-four can¬
didates failed to acquit themselves to the satisfaction of the
Cpurt, and were referred to their hospital studies for a period
of six months.
Royal College op Physicians op London.—
The following is the list of members nominated by the Council
for election as Fellows (July 30th, 1868)William Ogle,
ALD., Cantab., Derby ; Charles Alexander Lockhart Robert¬
son, M.D., Cantab., County Asylum, Hayward’s Heath ;
Thomas Harrington Tuke, M.D. St Andrews, Manor-house,
Chiswick ; John Deakin Heaton, M.D. Lond., Claremount,
Leeds ; John Edward Morgan, M.D. Oxon, St. Peter’s-square,
Manchester; Walter Moxon, M.D. Lond., Finsbury-circus;John
Pfughlings Jackson, M.D. St. Andrews, Bedford-plaoe, Russell-
square ; Reginald Edward Thompson, M.B. Cantab., South-
street, Park-lane ; and Edmund Symes Thompson, M.D. Lond.,
Upper George-street, Portman-square.
Collegedf Physicians (London).— The following
isalist of office-bearers proposed for election on the 30th inst.:—
Censors: Drs. Risdon Bennett, Wegg, Quain, and Barclay.
Treasurer : Dr. F. J. Farre. Registrar : Dr. Pitman. Libra¬
rian : Dr. Munk. Members of Council: Dr. Handfield Jones
(hi the room of Dr. F. J. Farre), Dr. Walshe (in the room of
Dr. J*. R. Bennett). Examiners—Anatomy and Physiology :
Drs. J. W. Ogle and Hyde Salter. Chemistry, Materia Medics,
and Practical Pharmacy : Drs. Sieveking and Marcet. Mid¬
wifery and the Diseases peculiar to Women : Drs. C. B. Brown
and. Priestley. Medical Anatomy and the Principles and Prac¬
tice of Medicine: Drs. Owen Rees and E. L Birkett. Surgical
Anatomy and the Principles and Practice of Surgery : Messrs.
J. Birkett and T. Holmes. Curators of the Museum : Drs.
Hamilton Roe, F. J. Farre, W. Wegg, and F. Sibson.
The Public Health.— The returns of the Re-
gistrar-Oencral are again beginning to excite more interest.
We have not been able for the last week or two to make the
fCTOMIfeble remarks on the public health which had become
afrnciqt rotUdne work. That our readers might know the exact
we have consequently reprinted the more important
wmi of the weekly returns, we continue this plan in the
^ jqturn of the last week:—In the w^ek that
July l$, 4222 births and 3483 deaths were
registered in London and in IS other large towns of the United
Kingdom. The annual rate of mortality was 28 per 1000
persons living. The annual rate of mortality last week was
27 per 1000 in London, 25 in Edinburgh, and 19 in Dublin
22 in Bristol, 28 in Birmingham, 33 in Liverpool, 39 in Man¬
chester, 28 in Salford, 38 in Sheffield, 30 in Bradford, 28 in
Leeds, 24 in Hull, 30 in Newcastle-upon-Tyne, and 28 in
Glasgow. The rate in Vienna was 26 per 1000 during the
week ending the 11th inst., when the mean temperature was
1*5 Fahrenheit lower than in the same week in London, where
the rate was 25. Under the influence of the present sultry
heat and drought the annual rate of mortality in the 14 large
towns of the United Kingdom has, week by week, steadily
increased from 22 per 1000 in the beginning of June to 28 last
week. The increase has been greatest in London, Liverpool.
Manchester, Birmingham, and Sheffield, and has been almost
entirely due to the fatal prevalence of summer diarrhoea, prin¬
cipally infantile. Of the death-rates per 1000 from all causes,
11 were referred to diarrhoea in Manchester and Salford, 7 in
Sheffield, Leeds, and Liverpool, 6 in London, and 5 in Bir¬
mingham. The deaths registered in London during the week
were 1642. It was the twenty-ninth week of the year, and
the average number of deaths for that week is, with a correc¬
tion for increase of population, 1458. The deaths in the pre¬
sent return exceed by 184 the estimated amount, and are more
by 137 than the number recorded in the preceding week.
The deaths from zymotic diseases were 677, the corrected
average number being 521. 87 deaths by choleraic diarrhoea
or cholera were registered in the week, 29 being children
under four years of age. 7 cases in adults appear to be ordi¬
nary instances of summer cholera; another adult is returned
as having died of “ rheumatic fever (13 days), and choleraic
diarrhoea (10 days).” 340 persons died of diarrhoea, and
of that number 19 were adults. It must not be assumed
that the mortality from diarrhoea or summer cholera is higher
in London than it is in Continental towns. The reverse will
be found generally to be the case. At the Royal Observatory,
Greenwich, the mean height of the barometer in the week was
29*848 in. The barometrical reading decreased from 29*96 in.
at the beginning of the week to 29*85 in. by 8 f.m. on Mon¬
day, July 18 ; increased to 29*93 in. by 9 A.M. on Tuesday,
July 14; decreased to 29*75 in. by 3 p.m. on Wednesday,
July 15 ; increased to 29*89 in. by 9 p.m. on Friday July 17,
and was 29*88 in. at the end of the week. The mean tempera¬
ture of the air in the week was 70*7 deg., which is 8*5 deg.
above the average of the same week in 50 years (as determined
by Mr. Glaisher). The highest day temperature was 92 deg.,
on Thursday, July 16. The lowest night temperature was
52*7 deg., on Tuesday, July 14. The entire range of tempera¬
ture in the week was, therefore, 89*8 deg. The maximum
temperature of the air observed on Thursday, July 16—via,
92 deg., is a higher value than has been recorded since July
18, 1859, when the maximum temperature was 93 deg., and
the mean temperature (75*9 deg.) is higher than all other mean
daily temperatures as far back as the 16th of June, 1858, when
76*9 deg. was obtained. The mean of the highest tempera¬
tures of the water of the Thames was 68*5 deg.; that of the
lowest was 07*9 deg. The difference between the mean dew
point temperature and air temperature was 12*9 deg. The
mean degree of humidity of the air was 64, complete satura¬
tion being represented by 100. Rain fell on Sunday and
Monday to the amount of 0*70 in. The general direction of
the wind was N.E. and S.W. Electricity was shown on every
day of the week, except Monday and Thursday. Ozone was
observed on Wednesday and Thursday. According to a return
furnished by the engineer of the Metropolitan Board of Works
the daily average quantity of sewage pumped into the River
Thames at the Southern Outfall Works, Crossness, was
48,319,036 gallons, or 219,530 cubic metres, equivalent to
about as many tons by weight.
Overdose of Laudanum.— A very melancholy
event occurred last week at Congleton. Mr. Henry Schofield,
surgeon, having a considerable practice in that town, being
much afflicted with tooth-ache, has been in the habit of taking
laudanum to mitigate the pain. Yesterday he took a larger
dose than usual, and symptoms of poisoning were immediately
peroeived. Medical aid was obtained as quickly as possible,
and every effort made to eject the liquid, but without success.
Mr. Schofield died in great agony. He was highly respected
in Congleton. He was married, but has left no family.
■ .
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TO THE MEMBERS OF COUNCIL
or THE
UNIVERSITIES OF EDINBURGH AND ST. ANDREWS.
fJENTLEMEN,—With the support of many i
^ Political and Professional friends, I offer m;
• influential
myself as a
Candidate for the honour of representing you in Parliament, and
your support at the next election.
I have always advocated an increase in the number of University
Constituencies.
When the Scotch Reform Bill was proposed, I spent much time in
urging upon those who might influence it, the Claims of the Scottish
Universities to at least one Member each.
When two Members were offered between the four Universities, I
collected and circulated statistics showing that this would give a much
less prportionate representation than that enjoyed by the Universities
of Oxford, Cambridge, and Dublin.
More recently, when it was proposed to give only one Member
between the four Universities, I organized an active opposition to this
unfair reduction. #
At a later period when three extra Members were placed by the
Committee of the House of Commons at the disposal of Government, I
pointed out how just it would be to give two of them to the Scottish
Universities, and thus provide one Member for each of those impor¬
tant seats of learning.
As a Doctor of Medicine of one of the Universities I aspire to repre¬
sent, I retain a lively interest in their welfare.
My plan of Medical Reform has received the emphatic approval of
some of the most distinguished Practitioners of the day, and if carried
out would tend to enhance the value of our University Degrees.
As a resident in London throughout the year, I should be able to
devote much time to Parliamentary duties, and it would always give
me pleasure to confer with any of my constituents,
I am,
Gentlemen,
Your faithful servant,
__ PROSSER JAMES.
UNIVERSITIES
OP
EDINBURGH AND ST. ANDREWS.
ELECTION OF A MEMBER OF PARLIAMENT.
THE Committee for promoting the Election of Dr.
-*- PROSSER JAMES, will feel greatly obliged to all who
may kindly intimate their intention of supporting him, or their willing¬
ness to have their names added to hia Committee.
The Electoral Committee consists of members of either General Coun-
gfl, and gentlemen qualified to register as such, who support Di.
Prosser James.
All Graduates of either of the Universities, and all Students who
prior to August, 1861, attended four Sessions in either of the Univer¬
sities, or three Sessions at either and one Session at any other Scottish
University, two of such Sessions having been in the course of study
in the Faculty, of Arts, are qualified to register as life members of
Genexwl Council before 1st October, 1868, on payment of a composition
fee of £1.
The Medical Committee consists of Members of the Profession (of all
shades of politics) who, whether Electors or not, desire to see the medical
element in the House of Commons increased, and who consider Dr.
Prosser James a suitable Candidate.
^The Medical Committee will be pleased to receive suggestions or
criticisms on the plan of Medical Reform proposed by Dr. Prosser
James, from any one interested in the subject.
The General Committee includes the above, as well as other supporters
of Dr. Prosser James.
Communications may be addressed to either of the undersigned
(Honorary. Local Secretaries to'the different Committees)
J. HOWARD HINTON, A.M., Reading.
A. MORTON BROWN, LL.D. Cheltenham.
n A RYsn»T'p M vn’Si L J“ e ?l och ' p . Iaoe ’ Eai r nbur «:I>.
tTmi 99, 8outhampton-row, London.
S’ t’ an ^ *£- 8 - Lon< *-> Old 8teyne, Brighton.
O Army
Bamaey ’ Y0rl “-
R* E. B. HORNIBLOW, M.D.Edin., Leamington.
W. R. BAXTER, LL.D., Emsworth.
ALB ERT HIND, Gravesend.
THOS. SIMPSON, Coggeshall.
A. KenaiBgt0n -
j: 2 : ajmmsjvld er "* treet ’ London> WC -
A H. JACOB. M.D., T.C.D., P.H.G8.X., J3, Ely-place, Dublin.
0 * liaplr to the Cnoumi, 18 , Dorer-ftrwt, RcoodiUr, Vf.
THE MEDICAL PROFESSION.
T he albert life assurance company.
Established 1838—Annual Income £380,000, accepting
healthy and invalid lives, is prepared to enter into special and liberd
arrangements with members of the Medical Profession acting aa private
Agents of. the Company.—Apply to the Secretary, FRANK EA8UM,
at the Chief Office, 7 Waterloo-place, Pall-Mall, London.
HA T IONAL AS SIT EANCE C 0MPANY
OF IRELAND,
Established 1822, and Incorporated by Royal Charter.
For Fire, Life, and Marine Insurance, and granting Annuities.
Principal Option :
8, COLLEGE GREEN, DUBLIN.
Capital One Million.
Directors—
John Barlow—Samuel Bewlet—Robert Callwbll—Mauucb
Cane—Thomas Crosthwait—Alexander J. Frrrirr—Nathaiikl
Hone—William Hoog—Thos. Lapfan Kelly—George Ejnahap—
David C. La Touche—W. Dioos La Touche—Charles Leslie—Lues
John M*Donnell—Richard Man debs—Hugh O* Connor—Thomas Pm
—George Pim—Patrick Swkbtman—Hbnrt Thompson—Richard
Williamson.
FIRE DEPARTMENT.
T HE Directors call the attention of the Public to tbfc
new Table of Life Rates, in which a considerable reduction
has been made, particularly in the younger lives for whole term, iff cod¬
ing to the Assured the utmost advantage consistent with security.
A Quinquennial, instead of a Septennial, division of Bonus has been
adopted; the first Bonus averaged Two per Cent, per Annum on the
Sum Insured, and the result of the Actuary’s Investigation forth®
Five Years ended 81st December, 1862, is still more favourable,*
shown by the following Example:—
Date of
Policy.
Age.
Amount
Insured.
Annual
Premium.
1
Bonus
Added
Dec. 1867.
Bonus
Added
Deo. 1862.
Trial
£
£ s. d.
£
£
£
1861
58
500
82 5 0
86
96
186
1862
60
8000
186 2 6
407
416
888
1863
40
1000
82 18 4
97
107
8M
1864
65
600
82 11 0
60
90
140
1866
67
600
29 9 2
29
77
106
At the option of the Assured the Bonus may be commuted foe a re¬
duction in the Annual Premium, or a payment in money.
The Assured are allowed, in time of peace, to pass from one port in
Europe to another. in steam or other decked vessels; and residence fa
other parts of the World allowed on very moderate terms.
No charge for Life Policy, Stamps, or Entrance Money. Age ad¬
mitted at any time, on satisfactory proof of same being furnished. A
liberal return of premium allowed for surrender of Life Polities. «a
which Four Years’ premiums have been paid. Loans granted o n life
Policies to the amount of their surrender value. Thirty Days allowed
for renewal of Life polities.
FIRE INSURANCES at the Lowest Rates. Fifteen dayi of
grace allowed for pa ymen t of Fire Premiums.
MARINE INSURANCES at current rates of the Day.
In addition tc security, not exceeded by any similar institution in the
empire, the utmost facility is afforded in transacting Insurance bad¬
ness, from the fact of the Head Office being in Dublin, and the drily
attendance of a Commitee of Directors for the purpose.
By Order, JOSEPH TODHUNTER, Secretary.
The business of this Company is restricted to Ireland.
SIX POUNDS PER WEEK
while laid np by injury, and
£1000 IN CASE OF DEATH
caused by accident of any kind,
May be secured by an annual payment of from £8 to £6,5a.
to the
RAILWAY PASSENGERS ASSURANCE COMPANY,
For particulars apply to the Clerks at the Railway Stations, to the
Local Agents, or at the offices,
64, CORNHTLL, and 10, REGENT-STREET,
___ W. J. VIAN, Sec retary.
FIELD’S “WHITE PARAFFINE” SOAP
in tablets 8d. and Is., is exquisitely perfumed, and imparts a grate¬
ful softness and suppleness to the hand. It is especially adapted
for warm weather as it exerts a cooling influence on the skin pecu¬
liar to itself. See came on each tablet and wrapper.
Wholesale—
J. C. & J. FIELD, 36, UPPER MARSH, LAMBETH, &
FIELD’S “OXFORD & CAMBRIDGE” SOAP.
(Registered 14th April, 1868.)
This beautiful soap is made in six varieties, via.. Cherry, “White and
Brown Windsor, Lavender, Honey and Glycerine, each tablet
having a distinctive tint and prefume, the whole forming a combi¬
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CONTENTS.
ORIGINAL COMMUNICATIONS.
Morbid Conditions of the Throat in .
their Relation to Pulmonary Consump¬
tion: their Diagnosis and Treatment.
No. IV. By 8. Scott Alison, M.D.. Edin. 113
Punratic Fever. By John H. Benson.
M:B. t L.K. Sc Q.O.P.I., L.R.C.8.I.,
Assistant-Physician to the City of
Dublin Hospital. 114
On the Anatomy and Physiology of the
Coronary Arteries of the Heart. By
Alexander Macalister, L. R. C. 8..
L.KO.C.P.!.! 117
Short Notes on Nice.—No. IV. By James
Btannus Hughes, M.D., F.fc.C.S.I. 118
HOSPITAL REPORTS.
Knro*s Colleqk Hospital—
Cases under the care of Dr. Beale, F.R.S. 122
"CSitt of Duntv Hospital—
Cases u n d e r the care of Mr. Croly. 122
ESDAY, AUGUST 5,
PAOE
Db. Stebvbxs’ Hospital—
Cystic Bronchocele : Recovery; Acute
Inflammation of the Thyroid Body:
Recovery. Under the care of Dr.
M‘DonneU, F.R.S. 123
LITERATURE.
Elements of Chemistry. By William
Allen Miller, M.D. Part II., Inorganic
Chemistry. 4th Edition. 123
Watts’ Dictionary of Chemistry. 6 Vols. 124
The StockfeedePs Manual. Ac. By C. A.
Cameron, M.D., Professor of Hygiene,
R.C.8. 124
LEADING ARTICLES.
Thb 88th Regiment at thk Mauritius.. 124
Emolish Poor-law Medical Okpiceus*
Association . 125
MKDtCAL Degrees in* the U. 8. or
America. 126
The Medical Element in Parliament... 127
NOTES ON CURRENT TOPICS.
Figures not Fears.—The Public Health.— 127
1 868 .
FA.OS
LECTURE.
The Use and Abuse of ** Stimulants.**
By W. Jackson Cummins, M.D., Phy*
sician to the Cork South Infirmary and
County General Hospital, Fx-Prusideiit
Cork Medical Society, Ac. 128
FOREIGN MEDICAL LITERA¬
TURE.
Professor Bamberger on acute Poisoning
with Phosphorus. Translated by W.
D. Moore, M.D., Dub. et Cantab.*
L.K.Q.C.P.I., M.R.I.A. 183
CORRESPONDENCE.
Hutchinson on the Oxford Meeting of
British Medical Association. 133
Reid on Underpaid Poor-law Medical
Officers in England. 133
Griffith on Urea and Uric Acid. 133
Butler on the Treatment of Acute Rheu- *
matism. i33
An Hospital Physician on 8ick dubs. 134
Medical News, Ac ~. iM
^ripiial CflmmttiriolitfiTS.
MORBID CONDITIONS OP
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
Bt S. SOOTT ALISON, M.D. Edi!c.,
FELLOW OF THE ROTAL CpLLBOE OF PHYSICIANS, LONDON, AND
nrrSlCIAX TO THE HOSPITAL FOB CONSUMPTION AND DISEASES OF THB
CHEST, BBOMPTON, AND THE SCOTTISH HOSPITAL.
No. IV.
With these local affections of the upper air-tube appara-
' tus there have been associated, in a large proportion of
. cases simulating pulmonary consumption, certain morbid
conditions of the whole system. The scrofulous, the syphi-
*. litic, the gouty, the hysterical, the anaemic, and the scor¬
butic conditions have been found in many cases.
In examples of enlarged tonsils the scrofulous taint has
been conspicuous, and in such cases there have often been
ftsgdci&ted a full state of the soft parts at the angles of the
jaw, enlarged cervical glands, a thickness and indistinct¬
ness of speech, some dulness of hearing, and a certain
amount* of stupidity of expression. The scrofulous cachexia,
associated with simulated pulmonary consumption, has
frequently presented the local manifestations of humpback,
curved spine, and the prominent sternum found m the
pigeon-breasted.
Cases of throat disease associated with the humpback
* and the pigeon-breast have often perplexed me, but I have
most generally found reason, to believe that no tubercle of
the lung had ever existed. It has usually been obvious,
after long observation, that the cough, even the haemop-
and the difficulty of respiration, were due to tracheal
bronchitic congestion, together with that impediment
to'sespiration and to the circulation of the blood neces-
fe&rffy incident to the deformed, and the compressing con¬
formation of the thorax.
Tins syphilitio taint has prevailed in cases of atrophied
^obliterated uvul®, wasted velum palati, sometimes
Smiated with foramina, of hoarse and discordant voice,
inetal deterioration of health, and copper-coloured spots
«We.ytw.hent of the chest, in young men and
gnt has shown itself in connection with
DM of the pharynx, and conjoined witit
rather free secretion of yellow or green sputum. Ecze¬
matous and herpetic eruptions of the skin have marked
these cases, as have also arthritic complications, and an
excessive amount of lithic acid in the urine.
The hysterical or quasi-hysterical condition has evinced
itself chiefly in connection with young persons, not always
females, suffering from tracheal congestion and natroWihg
of the trachea, marked by some occasional dyspnoea, vaty-
ing hoarseness of voice, and loud snapping and barkteg
and shrilling cough, accompanied with only very little
sputum. The patients have been weakly and delicate,
excitable in mind as well as body. Constipation and
limpid urine have frequently marked these cases.
Aphonia, dependent upon partial or complete paralysis
of the muscles of the larynx, has been conspicuous in the
hysterical, but with improving general health and with
local stimulation, the voice has generally been restored*
sometimes gradually, sometimes suddenly.
The anaemic state has been very commonly observed
associated with rough conditions of the pharynx, scanty
sputum, pallid lips and cheeks, and velum palati, venous
thrill ana murmur, systolic murmur at base of heart, palpi¬
tation of that organ, oedematous feet, red, polished tongue,
gastric irritation and vomiting, and scanty, irregular, or
arrested menstruation. The anaemic state has, in a large pro¬
portion of cases of simulated pulmonary consumption, been
associated, not only with internal morbid conditions of the
upper or cervical part of the air-tube apparatus, but it has
been conjoined with an enlarged and flabby state of the
thyroid body in females. This has formed, as it were,
a cushion, placed pretty well round the entire throat, most
prominent in front, but in no inconsiderable proportion in
the lateral regions. In many cases the swelling has been
uniformly soft, but in some it has presented comparatively
firm nodules, chiefly in front. Such examples of associated
enlarged thyroid body have come from all parts of Eng¬
land, but most have come from the Midland Counties. One
example came from Aberdeen, in Scotland.
We recognise the anaemic condition by the pallor of the
surface of the body, the lips, soft palate ; the conjunctive
of the eyes ; thrilling and murmuring or hissing in the
veins of the neck, and by gentle blowing at the base of the
heart. But we are not to conclude that anaemia is not
present because we find no murmur, or hissing, or hum¬
ming in the neck, for anaemia, to a great degree, may hold
when these signs are absent. The pallid lip and velum
palati, and conjunctive over-glistening, alone m y be ao-
Digitized by vjiOOQLC
BENSON ON PURPURIC FEVER.
Algo* 5,180.
114 The Medical Press End Circulir.
oepted as evidence of this condition. The venous murmur
In the neck, and the basic systolic blowing of the heart are
more especially found in the young ana excitable with
active hearts, conducing to rapid currents 1 , of blood, while
in the older and more passive patients, with feeble, inactive,
flabby or fatty hearts, conducing to slow currents of blood,
an equally great amount of anaemia is seldom signalised by
these adventitious sounds. We must, therefore, not con¬
clude, because an elderly pallid female, with slow heart,
does not present the venous murmur, that she is not
anaemic, or withhold suitable constitutional treatment.
Taken all in all, in cases of doubtful pulmonary consump¬
tion, marked by throat symptoms and signs, I regard the*
presence of the venous murmur and basic blowing as a
weight in the balance—it may be a small one—in favour
of the patient, for I have not found this sign to prevail
markedly— i.e., with marked frequency, in well-ascertained
cases of pulmonary consumption.
I have to-day (July 4th) examined, at the Brompton
Hospital, sixteen of my female patients, all that were in
the wards at the time, with a view to the discovery of
venous murmur. I have found only two patients present¬
ing the venous murmur out of ten suffering from pulmonary
consumption in its second and third stages. Out of six
patients not tubercular, I find four who present the venous
murmur well developed. Five of these non-tubercular
patients suffer from various moderate disorders of the
upper air-tube apparatus. The sixth suffers from obstinate
haemoptysis, and ulcer or malignant disease of the stomach,
marked by thorough intolerance of food on the part of the
stqmach, necessitating the daily employment of Liebig’s
extract of meat by enema. Two of the patients suffering
from disorder of the throat and anaemia present enlarge¬
ment of the thyroid body. Two patients with pulmonary
consumption, in its third stage, offer the thyroid body also
enlarged, one very voluminous reaching nearly round the
entire neck, and mounting to the vicinity of the lower jaw.
These examples of venous murmur out of five patients
suffering mainly from throat affection, give the percentage
of 60 ; while two examples of venous murmur, out of ten
patients suffering from pulmonary consumption in the
second and third stages, give the percentage of 20 only.
The comparative absence of anaemic signs in pulmonary
consumption, which I have ascertained, coincides with
another fact which I made out many years ago when I was
a student of King’s College Hospital—viz., that the blood
of the consumptive, as proved by analysis, is, in most cases,
unusually rich in red globules, and super-abounding in
fibrin and albumen. The patients whose blood was
examined were advanced in phthisis ; the conjoined in¬
flammatory affections of course would increase the fibrin.
Another morbid condition of the system, but more
particularly applying to the blood, viz.—the scorbutic or
scurvy state, is sometimes associated with these local dis¬
orders, simulating pulmonary consumption. This state is
found in cases marked by general deterioration of the
health, emaciation, purplish state of the surface and local
haemorrhages. This condition has more generally been
found in cases marked by haemoptysis, and has pre¬
vailed in sailors and in young persons who have been
utterly neglected in respect of diet as well as of pure air
and cleanliness. In such cases the blood is more than
usually liquid, from a deficiency of fibrin and of coagul¬
ability. The catamenia in these examples has usually
been copious.
When such constitutional conditions are associated with
disorders of the upper air-tube apparatus simulating pul¬
monary consumption, I have observed a fixedness of the
local disease, more particularly when the general condi¬
tions have not early met with special treatment. On the
other hand, when the local treatment has been reinforced
by remedial measures addressed to the special general
state, the relief of the patient has, for the most part, been
early and very satisfactory. This offers an excellent prac¬
tical reason for the physician, in all cases, to make himself
acquainted with the general habit of the patient to be
gleaned by his aspect, and by his individual and family
history. Such a knowledge and such an inquiry are
more particularly imperative in obstinate cases.
It need not be added that local means in cases associated
with such general conditions as have been above referred
to, demand co-operation from the general treatment indi¬
cated by the special associated - state.
PURPURIC FEVER.
By JOHN H. BENSON, M.B., L.K. & Q.C.P.I., L.R.C.S.L,
ASSIST AXT-PHY8ICI AN TO THE CITY OH DUBLXM HOSPITAL.
The subject of purpuric fever still continues to excite
much interest among the profession, owing to its compa¬
rative novelty in these countries, to its usually intractable
course, to the high rate of mortality which attends it, and
to the difference of opinion as to its nature and origin.
In The Medical Press and Circular for April 24th,
1867,1 published a case of this disease, with the results
of the post-mortem examination. It was found on that
occasion that there was not the least trace of inflammation
of the membranes of the brain or spinal cord—neither
capillary congestion, lymph, nor pus.
Early in this year I had the honour of laying before the
Surgical Society of Ireland another case of the same dis¬
ease, accompanied with cerebro-spinal meningitis, which
appeared in the numbers for Jan. 22nd and 29th of Ths
Medical Press and Circular. In my observations upon
that case I expressed myself strongly opposed to the
opinion that the disease in question was primarily or
essentially a cerebro-spinal meningitis, or by any means
necessarily accompanied with that inflammation, although
they were frequently found associated together, as in the
case then before the Society.
Since that time two cases have occurred in my prac¬
tice at the City of Dublin Hospital, of which the post¬
mortem examinations remarkably corroborate my view—
the one by the total absence of the inflammation, the other
by a remarkable condition of the blood, which affords a strong
presumption that there was something of more serious im¬
port than mere inflammation.
I will briefly narrate the most prominent features of the
cases.
F. W., set. 26, an Englishman, had resided for some
years in Ireland as coachman to a gentleman living in one
of the best suburban roads of this city.
On Saturday, May 23rd, he felt indisposed, but notwith¬
standing that he went through his business as usual
On Sunday he felt considerably depressed and ill, and on
Monday he was unable to rise, and was brought to the
City of Dublin Hospital.
When put to bed there he was found to be in a state
bordering on collapse. The pulse at the wrist was imper¬
ceptible, and the first sound at the apex of the heart some¬
what diminished. His face was pale, the surface of his
body cold, his lips tvere quivering, some subsultus was
apparent in the flexors of the forearm; his eyes had a wild
and restless expression, the pupils were natural, but not
obedient to the stimulus of light; there was a peculiar red¬
ness of the conjunctive, and some left internal strabismus;
the tongue was slightly furred,''but not tremulous; ques¬
tions Were answered hurriedly, but intelligently; respira¬
tion was natural; sometimes he complained of pain in the
head, at other times he denied its existence. When
allowed to rest for a few moments he rapidly lapsed into
a semi-comatose state, when his respiration became embar¬
rassed and stertorous.
A sinapism was applied to the precordia, and hot iars to
his feet, and an enema of diffusible stimulants and beef-
tea was ordered to be administered every second hour, as
he refused to take anything by mouth.
Three p.m. —Pulse 80, tolerably regular, but weak and
small; subsultus less; temperature more normal ; he
would answer questions, and when roused would now take
medicines by month.
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BENSON ON FURFURIC FEVER.
August 5,1868. 115
Six p.m. —Surface again cold and damp, with a cold,
clammy sweat. Pulse of the same frequency as at three
o’clock, but weaker, and more irregular. Respiration was
of a peculiar blowing character, but showed no tendency
ta the ascending and descending form. Hot jars were
ordered to his sides and between his legs, as well as to his
feet, and sinapisms were applied to the back of the neck,
and calves of the legs. His stimulants, at the same time,
were increased in quantity. On making a careful examina¬
tion of the surface of the body, we discovered now, for the
first time, several purple, well-defined spots. They existed
chiefly on the lower extremities and back. They were
irregular in shape; and varied in diameter from one to
three or four lines. A particularly large spot was dis¬
covered on the inside of the right knee simulating remark¬
ably a bruise.
I £&ve directions to have his head shaved, and at the
suggestion of my colleague, Mr. Croly. I ordered ten grains
of the unguentum hydrargyri to be ruobed into each axilla,
and three grains of quinine to be added to each stimulant
enema ; as the bowels had acted regularly up to the day
before no purgative medicine or enema was given.
Seven p.m. —Pulse 100, considerably stronger and more
regular than at six o’clock, though still somewhat small;
respiration continued blowing, and slightly stertorous at
time*. He would not swallow anything, but took into his
mouth whatever was offered, and after a minute or two
inymiably spit it out. He was on the whole very obedient,
but would make no attempt to answer questions. There
was no evidence of urine in the bladder, though he did
not pads water since he came in, about twelve hours pre¬
viously. Extreme hyperaesthesia was evinced by the
piailent whenever he was rubbed, pinched, or percussed on
any part of the body, but especially on the spine and legs.
At ekfeh percussion he started violently, and the intensity
of the shock seemed to be in direct proportion to the
nearness of the part struck to the spine.
It was ordered, at Dr. Benson's suggestion, to have five
sprains of blue pill rubbed up with each injection, and to
nave the patient’s head blistered with Tichbome’s vesi¬
cating collodion.
Tuesday.—The patient was perfectly unconscious, and
incapable of being roused ; the pulse feeble, intermitting
and remitting, and extremely difficult to count; its fre-
qnenoy was about 160 ; respiration was puffing and blow¬
ing, and very laboured ; pupils rather contracted, and not
obedient to stimulus of light. The surface of the body
was warm, and a general purplish hue was now visible
over the greater part of the body, especially on the legs
and nates.
^ Hot jars were applied still to the feet and the inside of
lus thighs. The firing button was applied along the spine,
from the occiput to the sixth dorsal vertebra, so as to pro¬
duce three parallel rows of vesications, each blister being
about an inch from the one above and below, and each
row being about half-an-inch from its fellow, a proceeding
suggested by my colleague Mr. Tufnell. After this, which
seemed to cause but little, if any, pain, be appeared some¬
what roused from the completely comatose condition in
winch he was previously, but yet he showed no evidence of
intelligence. Respiration, however, became deeper and
more nee. No urme was found in the bladder. He had
not passed anything from either bladder or bowels since
he came into hospital. Coffee-ground matter now began
to be vomited, or rather it welled up through the mouth
acinose, and about two o’clock the same day the patient
i retraction of the head existed at any time during the
life illness, nor stiffness of the muscles of the neck.
* were no well-marked convulsions, though convulsive
startings were frequent.
jRosZntorUm .—About twenty hours after death the post¬
mortem examination was made. Rigor mortis was well
es t ibB ehe d. "That peculiar plum-purple discolouration so
fief tpubsemdin these cases, was well-marked on the legs,
mpeSmfy tbefr posterior aspects, on the back, nates, back
and sides of the neck and ears. Those parts of the body
which pressed on the table, such as portions of the backs
of the shoulders, nates, calves of legs, and heels, were pale
and almost free from discolouration. The purple spots
differed from their appearance during life only m having
become more red in colour. A slightly greenish tinge was
observable on the abdomen, and a large bulla on the outer
maleolus. On making an incision through the scalp from
ear to ear, to examine the contents of the skull, a hissing
sound was heard, as of gas escaping through small orifices,
followed immediately by a very foetid odour. When the
calvarium was removed, and the dura mater exposed, the
sinuses and veins of the latter were seen to be considerably
distended. On removing the dura mater about one ounce
of clear fluid escaped from the cavity of the arachnoid.
The larger veins ramifying on the surface of the brain were
seen to contain, besides some dark blood, a very remark¬
able quantity of gas, so much so that in some parts the
blood was entirely displaced to a considerable extent, and
the veins assumed the appearance of semi-transparent,
multilocular, inflated tubes. In removing the brain from
the skull, when the vertebral veins were divided, gas and
blood issued slowly from the proximal extremities of each,
causing, thereby, a welling up of bloody froth to the ex¬
tent of about the measure of half a fluid drachm. Thete
was, here and there, a trace of recent opacity of the arach¬
noid, at the base of the brain, and slight capillary con¬
gestion, but no appearance of lymph or pus. The sub¬
stance of the brain was healthy. In each lateral ventricle,
about ten minims of clear redish serum was found.
The spinal cord was next to be exposed, and in doing s6
a very remarkable phenomenon presented itself. When
the muscles were cleared away from each side of the
spinous processes of the vertebra, so as to allow the
laminaB to be divided, the deep furrows so made
became rapidly filled up with bloody froth, exactly
similar to that which accumulated about the proxi¬
mal ends of the divided vertebral veins. At two or
three points in|these grooves large bubbles of gas rose to the
surface, and burst with a succession of audible snap*.
When this froth was wiped away with a sponge, the grooves
became quickly refilled with similar contents, and this was
done several times with the same result. When the theca
of the cord was exposed, its large veins were seen to be con¬
siderably congested. When this covering was slit up, and
the cord exposed, a very slightly reddish blush was ap¬
parent over the greater part of its surface, but no lymph
nor pus was found.
When the chest was opened, the lungs were found to bo
very much congested with dark venous blood. Under the
pleura, in many places, considerable collections of gas were
seen forming large bullae. These were situated, particu¬
larly in the angles of the fissures where the pleura is re¬
flected from one tube to the other, and resembled the sub-
pleural form of emphysema. No other form of emphysema,
however, was present. In the cavity of the pericardium
about six ounces of turbid bloody serum was found.
Wishing to separate the heart from the lungs without re¬
moving the latter from the body, I proceeded to divide
the great vessels. In doing so a great quantity of bloody
froth issued from both extremities of the divided pul¬
monary artery, and from the superior and inferior vena
cava. No froth was found in tne aorta, nor in the pul¬
monary veins. From the cavse there flowed, besides this
froth, a great quantity of dark blood mixed with exces¬
sively black tary clots. The right cavities of the heart
were found distended, with very black, loosely clotted
blood, mixed with some froth. The structure of the heart
was remarkably healthy. In the cavity of the peritoneum
about ten ounces of bloody serum were found. Between
the layers of the omental peritoneum a considerable quan¬
tity of gas was found, but not in connection with any other
part of that membrane. The liver, spleen, stomach, kid¬
neys^ and bowels were all congested, but presented no
special appearance worth recording.
Caw %— R. T., set. 42, a commercial traveller, was ad*
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^16 The Medical i»ress and Circular. BENSON ON PURPURIC FEVER. August B/ttk
znitled into the City of Dublin Hospital by the Purser- | ance, and when this covering was slit up, the cord itself
Student on June 14th, 1868. The man was suffering from was found to be equally healthy. Not the least trace of
severe diarrhoea, accompanied with intense vertigo, and inflammation or vascularity was visible anywhere. Even
was placed under the care of Mr. Croly, as there was no the larger veins, which, in almost every case are congested,
medical vacancy. were, in this case, perfectly natural, and the whole cord
On Sunday, 15th, I saw him in consultation with my might be shown as an excellent specimen of a healthy one,
colleague, Mr. Croly. I then learned that he had been pale in colour, and firm in consistence,
subject for the previous eight months to repeated and un- When the chest was opened about half a pint of clew
controllable attacks of epistaxis, the last attack being fluid was found in the cavity of each pleura, slight hepati-
about ten days before his admission. He had been a hard zation at base of each lung, and splenization of the lower
drinker for many years also. When I saw him on Sunday half of the left lung. About an ounce of clear fluid was
evening, about nine o’clock, I found that the diarrhoea had found in the pericardium, but no appearance of inflamma-
been checked since the previous day. He was then lying tion. The right cavities of the heart were distended with
tranquilly on his back; his eyes had a wild expression, ana dark fluid blood mixed with coagula. The left ventricle
he complained of slight headache. When addressed, he was hypertrophied ; and on opening this cavity, very
answered perfectly rationally, and with great intelligence, extensive aortic valve disease was discovered, vegetations
but presently, by his incoherent expressions, he showed of enormous size adhering to the flaps of the valves. Some
that his mind was wandering. His pulse was 98, very thickening of the curtains of the mitral valve existed also,
small, and but slightly irregular. Respiration was some- The liver was considerably enlarged, and presented a good
what laboured and frequent. His temperature, too, was example of the nutmeg form of the disease. Spleen,
slightly above the healthy standard. kidneys, and bowels were all congested ; a few small spots
Several purple spots were seen on the buttocks, thighs, were found on the surface of the parietal peritoneum,
legs, and feet. These spots varied from the size of the Observations. —From Case 2 one obvious inference at
head of a pin to three or four lines in diameter. They were least can be drawn, viz.—that whereas the patient pre-
very irregular in shape, and were of a much brighter purple sented quite the appearance, and many of the symptoms, of
than is usually seen in cases of fibris purpurea. No spinal the epidemic disease under consideration, he did not die
tenderness existed in any part, nor was there any retraction from the effects, whether primary or secondary, of any
of the head or stiffness of the muscles of the neck. At the inflammation.
'base of the left lung there was some dulness, and imme- With reference to Case 1, the first question that natu-
'diately above this was heard a fine pneuifionic crepitus, rally arises is, what was the cause of that excessive quantity
extending over the lower half of the left sije of the chest, of gas found in the veins, and appearing in the grooves
At both base and apex of the heart was heard a loud sys- made at each side of the spinal column during the autopsy?
tolic bruit, and a slight diastolic murmur at the former That the gas in the vessels had its origin in some change
position. There was also evidence of a considerably en- in the blood cannot be questioned, But wliat was tne
larged liver. nature of that change ? was it decomposition, or a process
The patient was ordered bark and chlorate of potass, analogous to fermentation? As to tne first hypothesis—
with diffusible stimulants, and a large linseed-meal poultice the patient had been dead only twenty hours, and bad
.was applied to the back of the left side of the chest. been lying during that time in a cool, dry mortuary, the
After this he passed the night well, and slept tranquilly, weather being unld, but not hot. The only other sign of
but in the morning I was told he became highly delirious decomposition was the slight greenness on the abdomen,
‘and restless, and died before I saw him. and we have all repeatedly made post-mortem examina-
Post-mortem. —About three and a half hours after tions when the patients had been dead for a much longer
death, the post-mortem examination was made. Rigor time, and where decomposition of the tissues had proceeded
mortis was then well established. There was extreme much farther, and yet where no such emphysematous con-
plum-purple discolouration on the back, except on the dition of the blood was found. It is clear, therefore, that
’ sacrum and buttocks, and on the backs of the shoulders, something else beside the ordinary causes of putrefactive
where the body pressed on the board. There was a slight, changes must have been present here,
similar, discolouration on both front and back of the thighs, Various authors have described cases in which this con¬
tend on the backs of the legs. On the back and sides of dition was found either actually preceding death, or very
the neck the same was of a deep tint. Bright purple cir- quickly following it, but in all these cases, as far as I am
cumscribed spots were scattered over face, head, legs, feet, aware, some septic or zymotic agency was at work. For
and back ; a few minute ones on the abdomen ana chest, example, Huxham observed the development of emphysema
and several very small ones on the backs of both hands, in a patient affected with putrid fever, sore throat, and
. These latter were distinctly elevated, and some of the non-coagulable state of the blood, and believes that this
former were slightly so. On the conjunctiva covering the frequently happens in putrid malignant fevers. Copland
right external canthus several minute purple spots were noted the same in some cases of scarlatina and analogous
visible. The superficial veins on the neck, upper portion diseases ; while Frank, Bally, and Morgagni met with it in
.‘of the chest ana arms, were very prominent and blue, and fever. Of course I do not ascribe a septic or zymotic origin
, a bright red vascularity of the intervening skin was very to the insignificant amount of gas occasionally found in tne
apparent. On making an incision with a scalpel through veins of the meninges, as in the cases cited by Hall§,
the cuticle covering one of the larger spots on the back two Morgagni, Nysten, Lelut, and others, and more than one
or three large drops of dark fluid blood rapidly ran down example of which I have met with- myself, and teen,
] the shoulders. This happened flrtth all the elevated spots through the kindness of niy colleague, Dr. Hewitt. In
whose cuticle was incised, but not with the non-elevated. these cases it is highly probable that the external air may
’ The internal appearances in this case were of a very have entered the divided extremities of the vessels, as sug*
negative character, but yet important. gested by Dr. W. H. Walshe. If, therefore, we consider
The veins on the surface of the brain, and the sinuses, the gas to be a product of decomposition, we must suppose
were but slightly congested. About one ounce of clear the blood to have been so altered in its nature before death,
fluid was found in the cavity of the arachnoid, and a con- as to favour early and rapid putrefaction. Mere inflam-
siderable quantity of similar fluid infiltrated the meshes of rnation, of such nature and extent as existed in this case,
the pia mater on the vertex. Not the least trace of in- could not do that, it must have been some tonic agebt.
flammation was found ia any part of the membranes of the As to the second hypothesis—that of the gas being a
. brain. The substance of the brain was firm and remark- product of a process analogous to fermentation, no one, I
ably healthy. A trace of reddish serum was found in the think, will deny that the process was set up by the zymo-
lateral ventricles. On opening the spinal cankl, the theoa of tic agency of some poison in the blood.
, the cord was seen presenting a pale, perfectly healthy appear* These two cases then, thpugh differing widely from each
e
The Medical Prats and Circular.
MACALISTER ON THE HEART.
August 5, I860. 117
other, both tend to exaetly the same conclusion, and, when
taken conjointly, go very far to prove, even if we had no
other evidence, that the disease is not primarily or essen¬
tially an inflammation of the cerebro-spinal membranes, as
Borne maintain, and as the names adopted by many would
indicate, but originates in some grave lesion of the blood—
some epidemic blood-poisoning, the meningeal lesions
being secondary and by no means a necessary part of the
disease, any more than sore throat is a necessary part of
scarlatina.
Assuming, then, that the disease has a zymotic origin,
the inflammation of the cerebro-spinal membranes cannot
be. considered as anything else than a symptom which,
though freauent, is by no means invariable. Are we
right, therefore, in naming the disease after a symptom—
in calling it cerebro-spinal arachnitis, or cerebro-spinal
meningitis, or epidemic meningitis ? The second of these
names is used by Burdon Sanderson, while the last is pre¬
ferred by Stille, though that author speaks of “ its double
character as a blood disease and an inflammation of the
cerebro-spinal membranes. 11
In this sentence he virtually adopts the assumption I
have made above, viz. :—“ that the disease has a zymotic
origin,” and yet he calls the disease epidemic meningitis,
thus naming it after what really seems to be but a symp¬
tom. It is true, however, that he says elsewhere, “ So
constant a lesion cannot be accidental, and must be essen¬
tial. The inflammatory element and the septic element
are both necessary to constitute the disease.” He cannot,
therefore, be indicted with the charge of naming it after a
symptom, though even adopting his view, the name epi¬
demic meningijjs gives undue prominence to the so-called
“ inflammatory element,” to the exclusion of the “ septic
element.”
In using the name purpuric fever , I do so, not as being
a good one, but merely for want of a better. However, I
think I have proved satisfactorily that it would be a less
objectionable name than any of those which assume the
inflammatory element to be an essential constituent of the
disease.
ON THE ANATOMY AND PHYSIOLOGY OF THE
CORONARY ARTERIES OF THE HEART.
By ALEXANDER MACALISTER, L.R.C.S., L.K.Q.C.P.,
PKMONBTBATOR OF AW ATOMY, ROYAL COLLEGE OF 8UROKONB, IRELAND \
BURG EOF TO THE ADELAIDE HOSPITAL; HON. PROFESSOR OF
ANATOMY TO THE ROYAL DUBLIN SOCIETY.
The vascular supply of the heart substance presents many
features of interest which have not been entirely overlooked
by modern physiologists, but whilst recently ehgaged in
examining the coronary vessels and their actions, I have
been struck with several points in connection with cardiac
physiology, which have not, perhaps, received the atten¬
tion which they deserve. The descriptive details of the
position, course, and relations of the two coronary arteries
are so fully given in almost every anatomical treatise, that
I will forbear alluding to more than two points in this
respect. In the first place, it is, perhaps, not sufficiently
recognised that the vascular supply of the two sides of the
heart is to a considerable extent independent. Professor
Hyrtl,! of Vienna, was the first to demonstrate that one
coronary artery cannot be injected from the other, as no
tranks larger than capillaries unite their terminal branches
in the ventricular substance. At the same time the ex¬
periments of Schiff show indirectly that the vascular
supply of each side of *the heart is derived solely from a
single coronary vessel, and that the existence of aberrant
brandies from the right artery to the left ventricle, and
vice versa, is exceptional. The second important point in
anatomical detail refers to the point of origin of these ves¬
sels. .Among the older anatomists, as Boerhaave, Carpus
(1680) Riolan, 8 Verh eyen,3 Forsten* we find that the
1 Natural History "Review. 1861. P.821.
S Enchiridion Anatomieum. Lib. 8, p. 240.
8 Anatome. 1706. P. 259.
4 DIsMr. de quest, select, exhfb, Lug. 1774. Sect. 8.
coronary arteries are described as arising behind the semi¬
lunar valves, that these curtains, when raised, would be so
placed as to block up their mouths, and in more recent
times, Vaust, 1 Briicke, and a few others, have advocated
the same opinion ; the elder authors based their belief on
the appearance of the parts as seen on dissection after
death, but Vaust has arrived at the same conclusion from
experimental researches, as he found that by injecting the
heart through the pulmonary vessels, the coronary arteries
were not filled ; in the hands of Hyrtl, however, the same
experiment was- attended with a contrary result, for from
the pulmonary veins he was able to fill the coronary
arteries.
Sommering, Blancard, Rolfincius, and Morgagni, among
old anatomists, and Cloquet, Harrison, and Power, among
modems, describe them as being placed above the level of
the valves, so far as to be beyond the range of contact with
them. Qu&in describes the mouths of these vessels as on a
level with the top of the valves, within range, of contact,
but not of occlusion. The condition which I have found
most commonly is the last, but I have seen the second ar¬
rangement, and in many cases I have noticed the left as
beftig within contact-range of the valve, while the right
was above its level. I recollect once, when a student, see¬
ing an aorta in which the valves were perfectly capable of
occluding the arteries, but this last condition I regard as
one of great rarity. Morgagni, indeed, mentions that he is
doubtful on the true typical position of the vessels, in soma
subjects the vessels being above, and in others below the
valve-level; and Petriolus, premising that in carnivores
the coronaries arise above the valves, and in herbivores
behind them, draws the conclusion that the courage of the
former and the timidity of the latter arise from the fact of
the greater or lesser degree of nutrition of the heart.
Hence he argues that the difference between timid and
brave men depends on the relation of the orifices of the
coronary vessels to the semiunlar valves, a brave man having
hiscoronaryarteriesabovethevalves.anda timid man behind
them ! These arteries are rarely the subjects of variety.
Camper records having once seen a single coronary artery*
Similar cases are recorded by Bochdalek, Junior, of Prague,*
Thebesius, 8 and Columbus. 4 Meckel describes an example
in which four trunks arose from the aorta, and Winslow
has recorded the existence of three of these vessels. Among
animals, the number and arrangement of the coronary
vessels is subject to little variety. The elephant, according
to Camper, possesses only one artery; the cow, pig, goat,
hare, rabbit, dog, and cat—like man—have two of these
vessels; and this seems the usual number in vertebrates*
In one instance Morgagni found three in a dog.
Prof. Hyrtl, of Vienna, has described the hearts of
urodelous batrachians, and some families of reptiles, as
destitute of true nutrient arteries, with the exception of a
superficial stratum of capillaries on the outer side, as in
these the coronary artery is principally distributed to the
bulbus aortse, and mentions that these hearts are mainly
nourished by direct imbibition from the ventricular cavi¬
ties. The same disposition occurs in the hearts of many
osseous fishes, and in connection with these Professor
Hyrtl remarks that the hearts of these animals are
remarkable as being nourished by venous blood. It
was believed by some former anatomists that the human
heart received a supply of blood from the ventricular
cavities, communicating with the coronary arteries, but
injection demonstrates the fallacy of this opinion.
Closely depending on the point of origin of these vessels
is the period during which the blood enters them. Many
of the older anatomists, who believed that the vessels were
occluded by the valves, thought that blood oould not enter
into these arteries until the ventricular systole was con¬
cluded, and the semi-lunar valves were closed. According
1 Vaunt. Recherches but la structure et les mouvements de cceur.
2 Virchow's Archiv. Nov., 1867. P. 289. Sitsungberichte der
Wiene* Akademie. Vol. 88, p. 572.
8 Dias de circ sanguinis in corde Leyden. 1716.
4 This anatomist and Blancard describe one ooronary artery as the
typical arrangement.
2
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118 The Medical Press and Circular.
HUGHES ON NICE.
August 5, 1868.
to this idea, the coronary arteries would be the last sup¬
plied with blood. Morgagni was among the first to show
that if the coronary arteries were placed above the level
of the valves, there could be no mechanical obstacle to the
entrance of the blood into the vessels at the period of
ventricular systole, and hence most of the modem physiolo¬
gists teach that the heart is nourished a^the time of contrac¬
tion, and thus, is supplied sooner than any other organ. This
theory is supported by the observations of Haller, who saw
the blood coming per saltum from the cut extremity of a
coronary artery during ventricular systole, and Endeinann
observed the mercury in a monameter to be elevated
during the same period when the instrument was intro¬
duced into one of the arteries in an artificially stimulated
heart. Mierswa, 1 * * 4 in supporting the same idea shows by
experiment that the semi-lunar valves are never applied
against the wall of the sinus of Valsalva during systole,
and consequently, they can never close the coronary
arteries. Similar experiments and observations have been
made by Rudinger* and Joseph* confirming the same state¬
ment. But, while accepting this theory, that these vessels
are first supplied, we must likewise consider that an im¬
portant mechanical obstacle exists to prevent the blood
from traversing the heart wall during ventricular systole.
During that action the contracted muscular fibres compress
the blood-vessels, and so preclude the perfect nutrition of the
tissue of theorgan, forwe .know that during the prolonged con¬
traction of any ordinary muscle the superficial veins always
become distended and the arterial currents are interrupted.
If, then, the heart depended for its vascular supply upon
the quantity of blood entering it during systole, it would
be imperfectly nourished, but as the ventricle relaxes, a re¬
flux takes place with force sufficient to shut down the
semilunar valves, and the mouths of the coronary vessels
being open, receive the blood; thus a second stream enters
these arteries, impelled by the force of gravity and the
elasticity of the aorta, while the muscular fibres relaxing
relieve the smaller blood-vessels of their constriction, caus¬
ing a certain amount of vis a froute or suction force. We
thus have reason to believe that the vessels in the heart-wall
receive two blood-currents for each single stream in any
other artery, one an effluent, and the other a refluent sup¬
ply. This idea was first put forward by Professor Hyrtl,
and is one supported by many facts both of anatomy and
physiology, and in connection with it, we have to consider
what part in the mechanism of nutrition each current plays.
The Bystolic or effluent current I regard as the least efficient,
but as it is sent with great force, it will probably carry a
quantity of blood into the auricular wall, into the coats of
the origin of the aorta and of the pulmonary artery. The
diastolic or refluent current, although more copious, is less
forcible, but traverses probably the ventricular vessels, and
nourishes the tissue of this part of the organ.
The object subserved by this double current is the per¬
fect nourishment of the heart, as it requires a larger supply
of blood than any other muscle in the body. This we might
expect on k priori grounds, for we have reason to believe
the amount of chemical action taking place in a muscle to
be in the direct ratio of the amount of exertion. It is
also palpable that the amount of blood required for the
nourishment of a muscle, is in direct proportion to the
amount of material disorganized, t.e., to the amount of
chemical action in progress, and as the heart perform^
more work than any other muscle of its size, we believe
that it requires a proportionately large supply of blood.
Professor HaUghton has calculated the exertion undergone
by the heart in the course of twenty-four hours to be
equal to the raising of 124*6 tons to the height of one foot,
and as the labouring force of man averages, according to
Haughtoni and Donders, equal to the lifting of 340 tons .to
the neight of one foot a-day, it will be seen that
1 Deutsche KHn, 1860-19.
S Zva der aorten und HcrzklafTen, Schmidt's Jahrbuch,
vol. 98, p. 162. •
8 Joseph. Virchow's Archiv, vol. 18, p. 495.
4 Haughton’a New Theory of Muscular Action. Williams andNor-
gate. 1663. P. 14, et seq .
the heart does in one day more than one-third as much
as all the Other muscles in the body—hence any in¬
terference with the nutrition of the oigan produces
an immediate effect upon cardiac action, as proved
by the experiments of Erichsen and Schiff. Yon B^zold 1
more recently found that when the coronary arteries of
rabbits were temporarily occluded, the pneumogastric and
cervical sympathetica having been already divided, the
heart’s action became rapid and irregular after fifteen
seconds, and finally, after from one minute to one minute
and a-half, the ventricles ceased to act, the auricles con¬
tinuing a weak, intermitting action for a greater length of
time.
The capillaries of the heart are remarkable for their
number, and the veins are nearer the surface and more
muscular than the generality of such vessels elsewhere.
SHORT NOTES ON NICE.
By JAMES ST ANNUS HUGHES, M.D., F.R.G.&L,
PBOFEPBOR OF SUBOEBY IN THE BOYAL COLLEGE OF SURGEONS, IRELAND*,
SiytGEON TO JEBVIS-8TBEET HOSPITAL; COX8ULTINQ SURGEON TO THE
COOMBE LY1NO-IN HOSPITAL ; SURGEON TO THE LORD LIEUTENANt* C
HOUSEHOLD, ETC.
No. IY.
“ Professor Sigmund, of Vienna, specifies, among the
disadvantages of Nice, the presence of dust at all seasons
and the want of cleanliness of the streets. In these re¬
spects, however, an improvement has taken place since the
annexation—the streets are cleaner and better watered, and
the dust is only inconvenient when there is much wind. This
writer enumerates among the advantages of the place, a pre¬
vailing mild temperature in winter, the infrequency of high
and cold winds at this season, as also of rain ; the absence
of hail or srtow, a sunny dry air, the rich and varied vege¬
tation, and the favourable opportunity for taking out-door
exercise. ‘ The air,’ he observes, c is drier here than at any
other place of resort in Italy, which is very sensible in sharp
and changeable March. Sudden changes of warm and cola
dry days, with the moist evenings and night air, especially
in the suburbs.’ ” *
Smollett in writing on the climate of Nice says—** The
constitution of this climate may be pretty well ascertained,
from the enclosed register of the weather, which I kept with all
possible care and attention. From a perusal of it you will
see there is less wind and rain at Nice than in any other
part of the world that I know ; and such is the serenity of
the air, that you see nothing above your head for several
months together, hut a charming blue expanse without
cloud or speck. Whatever clouds may be formed by eva¬
poration from the sea, thev seldom or never hover over this
small territory ; but in all probability are attracted by tha
mountains that surround it, and there fall in rain or snow.
As for those that gather from other quarters, I suppose their
progress hitherward is obstructed by those very Alps which
rise one over another, to an extent of many leagues. This
air being dry, pure, heavy, and elastic, must be agreeable
to the constitution of those who labour under disorders
arising from weak nerves, obstructed perspiration, relaxed
fibres, a viscidity of lymph, and a languid circulation.
In other respects, it encourages the scurvy, the atmosphere
being undoubtedly impregnated with sea-salt ...
“ I must also acknowledge, that ever since my arrival
at Nice, I have breathed more freely than I had done for
some years, and my spirits have been more alert The
father of my (econome f who was a dancing-master, had
been so afflicted with an asthmatic disorder that he could
not live in France, Spain, or Italy, but found the air of
Nice so agreeable to his lungs, that he was enabled to ex¬
ercise his profession for above twenty years, and died last
spring, turned seventy. Another advantage I have reaped
from this climate, is my being, in a great measure, delivered
from a slow fever which used to hang ab out me, and render
1 Bezold’s Unterauchenren. 1867. P. 166. And Journal of Ana*
tomy and Physiology. Vol. ii.,p. 410.
2 “ Die Sudliche Klimatisohe Ourorte—1860."
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HUGHES ON NICE.
August8,1808. Il4
life a burden. Neither am I so apt to catch cold as I used
to be in England and France ; ana the colds I do catch are
not of the same continuance and consequence as those to
which I was formerly subject The air of Nice is so dry
that in summer, and even in winter (except in wet weather)
you may pass the evening, and indeed the whole night, sub
dio , without feeling the least dew or moisture ; and as for
fogs, they are never seen in this district. In summer the
air is cooled by a regular sea-breeze blowing from the east,
like that of the West Indies. It begins in the forenoon,
and increases with the heat of the day. It dies away about
six or seven ; and, immediately after sunset, is succeeded
by an agreeable land-breeze from the mountains. The sea-
breeze from the eastward, however, is not so constant here as
in the West Indies, between the tropics, because the sun
which produces it is not so powerful. This country lies
nearer the region of variable w’inds, and is surrounded by
mountains, capes, and straits, which often influence the
constitution and current of the air. About the winter sol¬
stice, the people of Nice expect wind and rain, which
generally lasts, with intervals, till the beginning of Febru¬
ary. But even during this, their worst weather, the sun
breaks out occasionally, and you may take the air either
a-foot or on horse-back every day, for the moisture is im¬
mediately absorbed by the earth, which is naturally dry.
They likewise lay their account with being visited by
Bhowers of rain and gusts of wind in April. A week’s rain
in the middle of August makes them happy. It not only
refreshes the parched ground, and plumps up the grapes and
other fruit, but it cools the air and assuages the heats, which
then begin to grow very troublesome ; but the rainy sea¬
son is about the autumnal equinox, or rather some¬
thing later. It continues about twelve days or a fort¬
night, and is extremely welcome to the natives of this
country. This rainy season is often delayed till the latter
end of November, and sometimes till the month of De¬
cember, in which case, the rest of the winter is generally
dry. The heavy rains ih this country generally come with
a south-west wind, which was the creberque proctitis Afri-
cus of the ancients. It is here called Leoeche, a corruption
of Lybicus ; it generally blows high for a day or two, and
rolls the Mediterranean before it in huge waves that often
enter the town of Nice. It likewise drives before it all the
clouds which had been formed above the surface of the
Mediterranean. These being expended in rain, fair weather
naturally ensues. For this reason, the Nissards observe
le Lebeche raccommode le terns .
“ I have described the agreeable side of this climate, and
now I will point out its inconveniences. In the winter,
but especially in the spring, the sun is so hot that one can
hardly take exercise of any sort abroad, without being
thrown into a breathing sweat; and the wind at this sea¬
son is so cold and piercing, that it often produces a mis¬
chievous effect on the pores thus opened. If the heat rarities
the blood and juices, while the cold air constringes the
fibres, and obstructs the perspiration, inflammatory disorders
must ensue. Accordingly, the people are then subject to
colds, pleurisies, peripneumonies, and ardent fevers. An
old count advised me to stay within doors in March, car
alors Us humeurs commencent a fe remuer. During
the heats of summer, some few persons of gross habits
have, in consequence of violent exercise and excess, been
Seized with putrid fevers, attended with exanthemata, ery¬
sipelas, ana milliary eruptions, which commonly prove
4 Wl ; but the people in general are healthy, even those that
take very little exercise: A strong presumption in favour
of the climate!”
Sir James Clark, in his valuable work on “ The Sanative
Jnfluen.ce of Climate,” makes the following interesting re¬
marks an Nice, viz.:—
"The climate of Nice approximates more nearly in its
character to that of Provence, which has just been
de s cri bed, than.to any other. Its mean annual temperature
being 9° warmer than London, 7° warmer than Pen-
1* ookler than Rome, and 5° colder than Madeira.
The BMm temperature of winter is 48° ; that is, nearly 9°.
warmer than London, 4° warmer than Penzance, 1° colder
than Rome, and 12° colder than Madeira. The mean
temperature of spring is 56° ; being 7° warmer than Lon¬
don, 6° warmer than Penzance, 1° colder than Rome, and
6° colder than Madeira. The temperature throughout the
year is more equally distributed at Nice than at any othelp
place in the South of Europe, except Rome and Cadiz ; the
difference of the wannest and coldest months being only
28°, and the mean difference of successive months only
4°*74.
“ The range of temperature for the day is also less at
Nice than at any other part of the South of Europe ; and
in steadiness of temperature it ranks next to Madeira.
“ The mild and equable character of the climate of Nice
depends in a great measure on the position of the place
with respect to the neighbouring mountains and the sea.
The maritime Alps form a lofty barrier, which shelters it
in some degree from northerly winds during winter ; and
the cool sea breeze, which prevails every day with a regu¬
larity almost equal to that of a tropical climate, moderates
the summer heat. ‘ Cet alizd M^diterran^en,’ says M#
Risso, * toujours doux, frais et tranquille, s’elfcve pdrio*
diquement vers neuf k dix heures du matin, cesse souvehj
vers les quatre heures apr&s midi, et attend dans l'intdrieur
de nos Alpes rarement au dela de buit myriam(^tres. ,,
These circumstances explain the small annual range 6t
temperature at this place, already noticed, and which i
reference to the table in the appendix will show to b4
much less than in most parts of Italy.
‘‘Notwithstanding the extent, however, to which Nice
and its environs are encircled by mountains (and it is so
in a great measure from W.S.W. to E.S.E.), it is by no
means exempt from cold winds during the winter, and still
less so during the spring. The easterly winds are the mos$
prevalent during the latter season. They range from east
to north-east, frequently blow with considerable force, ana
are often accompanied with a hazy state of atmosphere#
Sometimes this wind commences in the forenoon, at other
times not until the afternoon. When the early part of thd
day is fine, it never should be lost for exercise, as a cold
windy afternoon not unfrequently succeeds a calm inihf
morning.
“ From the north-west or mistral , which is the scourge of
Provence, Nice is pretty well sheltered. The force of this
wind seems to be broken, and directed to the southward
by the Estrelles, a chain of mountains between Frejus anti
Cannes. But although the mistral is not experienced in
its full force at Nice, or only towards its termination, when
it takes a more westerly direction (ta queue de la mistral ),
the keen, dry quality of the air is very sensibly felt whilst
it prevails. It sets in generally about two or threo o’cldck
in the afternoon, and is not of long duration. The wincf
seldom blows strong directly from the north, though the
air is very sharp when it is in that quarter. The northerly
gales, descending from the summits of the high range of
mountains which encircle the valley of Nice on the north,
are little felt; they appear to pass in an oblique direction
over the town.* The sirocco is of rare occurrence, and
when it does pay a visit in the winter, it is gentle, and
not unpleasant to the feelings of invalids in general.
“The weather at Nice during the winter is comparatively
settled and fine, the atmosphere being generally clear ana
the sky remarkable for its brilliancy. The temperature
seldom sinks to the freezing point, and when it does, it is
only during tHe night ; so that vegetation is hever alto¬
gether suspended. Indeed, at Nice, winter is a season of
1 “ * Histoire NatnreUe de Prindpales Productioua'de I’M ®rape Mfri-
dion&le, et particulierement de eellee dee Environs de Rice.* 1886. per
A. Bisso. Vol. i. p. 219. To this excellent work I beg leave to refer
those of my readers who may be desirous of information respecting the
natural history of the South of Europe.*'
2 “ ‘ On Gprouve fort rarement,’ says M. Bisso.toute aa force dans
les conches inflrieures de l'air qni environnent le plateau de Nice, l
cause du triple rang de montagnes qni l'entourent; il occupe preequo
toujours 1 m couchee suplrieurs, et descend en pente comme un grand
torrent a£rien but la mer; car on aper^oit kun kilometre du rivage qu'fl
commence k en friser la surface pour former un peuplns loin dee vagoee
qui, s’ eldvant les tinea sur les autres, vont porter lea tempdtes sur 1m cdtsb
boreal* d’Afrique.’-tfto. M. vol. i. p. 816.*’
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HUGHES ON NICE.
An** 8,m
flowers, the dryness of the air rendering the same degree
of cold less injurious to them than it would be in a more
humid atmosphere. Spring is the most unfavourable
season ; the sharp, chilling, easterly winds are the greatest
enemy with which the invalid has to contend ; and the
prevalence of these during the months of March and April
forms the greatest objection to this climate, especially in
pulmonary diseases.
“ It must not be supposed, however, that these sharp
spring winds are peculiar to Nice. They prevail more or less
over the whole south of Europe. They are equally bad at
Naples ; somewhat softened at Pisa ; and still more so,
perhaps, at Rome.
“ The climate of Nice is altogether a very dry one. Rain
falls chiefly during particular seasons. From the middle
of October to the middle of November it generally rains a
good deal; also about the winter solstice there is
commonly some rain, and again after the vernal equinox.
The quantity of rain that falls during the year has not been
accurately estimated.
“ Upon the whole, in the physical qualities of its climate,
Nice possesses considerable advantages over the south-east
of France, more especially in being protected from the
mistral.
“Nice is upon the whole a healthy place. Catarrhal
affections and inflammation of the lurfgs rank among the
most frequent diseases of the inhabitants. They are
especially common and violent in the spring, and are gene¬
rally complicated with irritation of the digestive organs.
Pulmonary consumption is much less frequent than in
England and France. Gastric fever and chronic gastritis
are very common diseases. Indeed, gastric irritation ap¬
pears to be very prevalent, and almost all other diseases
are complicated with it. Intermittent fevers are not un¬
frequent among the peasantry living or, labouring in un¬
healthy situations in the country. The flat ground on the
banks of the Var is the most fruitful source of these fevers.
The guards stationed on the bridge which crosses this boun¬
dary stream, are frequently attacked with ague during the
unhealthy season, although they are stationed there only a
few days at a time. This is a disease, however, from which
the winter resident at Nice has nothing to fear. Dr.
Skirving, during a long residence there, met with one case
only of ague amongst the strangers. Diseases of the eyes
are very prevalent, particularly amaurosis and cataract; cu¬
taneous diseases are also very common.
“ In describing the effects of the climate of Nice on
disease, I am much indebted to Dr. Skirving for the results
of his extensive experience. 1
“ In consumption, the disease with which the climate of
Nice has been chiefly associated in the minds of medical
men in this country, little benefit is to be expected from
the climate. When this disease is complicated with an
irritable state of the mucous membranes of the larynx,
trachea, or bronchi, or of the stomach, the climate is de¬
cidedly unfavourable; and, without extreme care on the
part of the patient, and a very strict regimen, the complaint
will in all probability be aggravated by a residence at Nice.
Indeed, the cases of consumption which ought to be sent to
this place are of rare occurrence. If there are any such, it
is when the disease exists in torpid constitutions, and is
free from the complications which have been just mentioned.
Even the propriety of selecting Nice as a residence for
persons merely threatened with consumption, will depend
much upon the constitution of the individual. Dr. Skirving
met with cases which left no doubt on his mind that a resi¬
dence for one or two winters often proves of advantage, as
a preventive measure, in young persons predisposed to this
disease ; and even in some instances in which there
was every reason to believe that tubercles already existed
in the lungs, the climate has appeared to be useful. But
in the advanced stage of consumption, his opinion, founded
on eight years’ experience, accords with what has been
1 “Dr. Skirving practised at Nice with great reputation for many
yean; but for tbe last ten yean he was mostly confined to his house
by a paralytic affection, which carried him off last autumn.”
already stated ; and this is still farther supported by the
testimony of Professor Foderd, of Strasbourg, who resided
six years at Nice. 1 Indeed, sending patients labouring
under confirmed consumption to Nice will, in a great majo¬
rity of cases, prove more injurious than beneficial.
“ In chronic bronchitis, which often simulates phthisis,
very salutary effects are produced by a residence at this
place. Such patients generally pass the winter with com¬
paratively little suffering from their complaint, and with
benefit to their general health. They are here able to be
much in the open air, whereas if they had remained in Eng¬
land they would in all probability have been confined dur¬
ing the greater part of the winter to the bouse. The particular
kind of bronchial disease most benefited by a residence at
Nice is that which is accompanied with copious expectora¬
tion, whether complicated with asthma or otherwise ; and
in the chronic catarrh of aged people it is particularly
beneficial. This variety of bronchial disease is directly the
reverse of that which is mitigated by the south-west of
France and of England : and I think it important here to
remark, that unless the distinctions which I have pointed
out in bronchial diseases, and their complications, are at¬
tended to, great errors must be committed in selecting a
residence for such patients.
“ The invalid subject to chronic gout may, in most cases,
escape his usual winter attack, and provided he lives with
prudence his general health may be improved, by a winter's
residence at Nice.
" In chronic rheumatism the climate is generally very
beneficial; and its advantages are also remarkable in scro¬
fulous complaints. On children the climate generally
exerts a very favourable influence, if attention be paid to
their diet.
“ In the numerous train of hypochondriacal and nervous
symptoms which often originate in dyspeptic complaints,
Nice is beneficial; but here again it is necessary to distin¬
guish the particular character of the affection. The cases
of dyspepsia most benefited are those accompanied with a
torpid, relaxed state of the system, with little epigastric
sensibility, and none of those symptoms which denote an
inflamed or very irritable state of the mucous membrane of
the stomach. Where the latter state prevails, Nice will
decidedly disagree.
“ In all cases where there is great relaxation and torpor
of the constitution, the climate of Nice is extremely useful.
In young females labouring under such a state of system,
connected with irregularities of the uterine functions, either
when these have not been established at the usual period, or
when they have afterwards been suppressed, marked bene¬
fit may generally be expected. In indicating the class of
cases alluded to as likely to derive advantage from the cli¬
mate of Nice, I would designate them to the practical
hysician as those that are usually relieved by chaly-
eates.
“ Tn a numerous class of patients, whose constitutions
have been injured by a long residence in tropical countries,
by mercury, &c., and on which a dry and rather exciting
climate is indicated, Nice will prove favourable. Some
cases of chronic paralysis not connected with cerebral dis- .
ease have also been found to derive considerable benefit
from a residence at this place.
“In stating its general influence on the animal economy,
I would say that the climate of Nice is warm, exhilarating,
and exciting, but to highly sensitive constitutions some¬
what irritating, more especially during tbe spring. It is
extremely favourable to the productions of tne vegetable
kingdom, some of which flourish here in a degree ofluxnri-
ance that is scarcely to be equalled in other parts of the
south of Europe. 2
1 “ See ‘ Voyage aux Alpes Maritime9, ou Histoire NatureUe, Agrairt,
Civile et MSdieale du Pay* de Nioe,’ Ac. Strasbourg, 1823.”
2 44 Peu de contr£e3 mdridionale* de 1'Europe offrent un tableau *uw»
varitf en v£p6taux indigenes et exotiques que les environ* de Nice*
-Dana le fond, c’est one maaee d'oliviers qui s’&end but tout** to* cot¬
lines, et dispairait inseneiblement & zncsure qu'elle •’eloigne du rivsg*
de la mer. Sur le devant. oe sont des orangers, de* big*r*dferade*
limonien, disposes en jardins qui offrent tonte la luxe 4c* Bbapowc*
Pour relever la sombre verdure de* uns et la monotonia dot auto**, 0*
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HUGHES ON NICE.
Augusts, 1868. 12l
u Invalids who pass the winter at Nice scarcely ever re¬
side in the town. Some good houses, tolerably well
situated and over-looking the terrace, are, however, now to
be had ; but in the suburb called the Croix de Marbre , and
along the sea beach, from the town to the ridge of moun¬
tains where the plain terminates on the west, the largest
and best houses are to be found; and here strangers generally
reside. At the foot of the hill on which stood Cimiez , there
are also good houses; and this is a situation preferable
to the lower part of the plain for patients very susceptible
of injury from damn ; it is also more protected from the
cold northerly winas, and altogether, perhaps, the best
situation at Nice for invalids.
K Invalids should endeavour to arrive at Nice about the
middle of October, or sooner, and should not leave it before
the beginning of May. The inconveniences experienced
from the spring winds here are felt in a much greater de¬
gree in the South of France ; and, accordingly, invalids
often suffer severely from the winds of Provence when they
leave Nice too early. The invalid may move in the direc¬
tion of Nice and Genoa at a much earlier period than it
would be advisable for him to return over the Estrelles to
Provence ; and when the climate of Nice is found to dis¬
agree, a change in the spring in the direction of Genoa may
in some cases be advisable. 71
TIME FOR GOING TO NICE, AND THE EXPENSES OF REACH¬
ING IT FROM DUBLIN I THE WAY TO GET THERE.
The invalid should, if possible, reach Nice, as pointed
otit at p. l6 by Dr. Travis, at the end of October at the
furthest, when, as a general rule, he shall avoid severe
weather on the road, and when, on his arrival at Nice, he
shall have an opportunity of selecting suitable southern
rooms in one or other of the three departments of the town.
In travelling from Dublin to Lonaon, the invalid can, if
necessary, stop at Chester on his way.
The mode of reaching Nice from London, must to a
great extent depend on the patient's state of health, his
position in life, and his means of living ; thus, if he is very
feeble, and that he can afford to do so, he ought to be ac¬
companied by some person (say a male relative or courier)
conversant with travelling, with the route and with the
language of the country; a person who, in fact, can arrange
the time and mode of conveyance from place to place, take
tickets, register and receive luggage, select rooms at
hotels, and pay bills; indeed, unless a confirmed invalid
can have all the foregoing done for him, he had far better,
in my opinion, stay at home, for the taking of tickets and
registering of luggage almost invariably occupy from
twenty to thirty minutes, generally speaking in the early
morning, and always in exposed halls or passages, full of
draughts of cold air. The receiving of luggage requires
from thirty to sixty minutes, generally in the advanced
evening or late at night, and always in cold halls, open
stations, or passages, where I have no doubt that the lives
of many patients have been shortened by the combined in¬
fluences of fatigue and exposure to cold.
In the journey from London to Paris, the invalid can,
if the weather proves rough, on his arrival at Dover, and
that he is a bad sailor, stop at the Lord Warden Hotel at
that place, and wait there for a good sea passage, when he
can cross over by the morning boat, if he has a good atten¬
dant, and that arrangements have been made for his recep¬
tion at Paris, he ought to “ go through ” to that city, and
drive to his hotel at once, leaving the charge of his luggage
to his attendant. The other evening, a friend of mine
was detained at the Paris terminus, on his arrival from
Calais, from twenty minutes past six o'clock in the even¬
ing until dose on nine o’clock, passing the family luggage
and getting it conveyed to his hotel.
From Paris to Nice, a distance of six hundred and
seventy-seven miles and a-half, the journey should, as a
general rule, be broken by an invalid three or four times
HmUm, das figoien, dec jujubiers, dea raquettiers, dea dattiers, dea
mfcaatok «t tone aocfev a’arbm fruitiers diatribuea sans ordre, en
*** Qei>r ' * ob * Ten * 4’orner *t d’embellir ce bei an¬
on the road. Many people select Dijon, Avignon, Lyons,
and Marseilles as resting places, on their way from Paris
to Nice.
At Dijon I would recommend the traveller to go to the
hotel Jura, which is next to the railway station, and is
both a good and reasonable house.
At Lyons, the Hotel de l’Europe is very well spoken of,
but I would recommend an invalid to put up at one of the
many other hotels nearer to the station. I should say the
Hotel du Louvre, or the Deux Mondes are the best.
As a general rule, but especially late in the season, an
invalid should not stop at Avignon, it being about the
coldest place a patient could select. A friend of mine,
last year, on his way to Nice for his health, who was not
able to leave Dublin until late in the season, wrote to me
from Avignon as follows:—“An invalid who survives a
night at Avignon in November is not going to die; it is
the coldest place I ever was in; the wind does not blow there,
it groans, it roars, as if it came down from a bellows, driven
by an engine over a hundred miles of snow. It comes down
the chimneys in a most frightful way. The houses are
built to be cold: flat roofs, large windows that open to the
flqprs, open fire-places as large as those in a forge, tiled
floors in the bed-rooms and passages, no curtains, doors
that wont shut; in fact I never spent such a night as I
did at Avignon, and that I escaped with my life is a
wonder." There is no doubt that Avignon is, as I have
experienced myself, a very cold place, and therefore ought,
if possible, to be avoided by a delicate person in search of
health.
The Grand Hotel at Marseilles is a very comfortable and
well-managed establishment, and is not very expensive*
considering the excellent manner in which it is conducted*
The journey from Marseilles to Nice by railway, which
is accomplished in a little under six hours, is a verV
agreeable one, the scenery along the entire line being bom
varied and beautiful.
Some physicians recommend patients who are not
wealthy, and who, therefore, cannot well afford the ex¬
pense of bringing attendants with them, to travel uninter¬
ruptedly from Paris to Nice by express train, a journey
which is accomplished in about thirty hours j but I know
by experience that even to a person in health the through
journey from Paris to Nice is a very fatiguing one, indeed,
I therefore cannot recommend it to an invalid, unless
under extraordinary circumstances, and then he should en¬
gage a coupt lit carriage, in which he can recline as often
as he is disposed to do so whilst on the road.
With regard to the hotels of Nice they are very nume¬
rous, and generally speaking well conducted, but the invalid
should, in the choice of a residence at Nice, be guided, to a
great extent, by the advice of one of the resident physicians,
who, after getting an insight into the patient’s state of
health, will point out the proper department in which he
should settle down.
The cost of travelling from Dublin to Nice by mail
steamers, and first-class express trains, including hotel ex¬
penses at the various resting-places, porterage, cab-hire,
&c., on the way, amounts, in round numbers, to ,£16.*
The expense of living at Nice will much depend on the
class of hotel or boarding-house, and the department
selected. The cost of living at a first-class hotel in the
modern parts of Nice, or at Carabacel, without a private
sitting-room, amounts to from 16 to 20 francs a-day,
whilst boarding-houses charge from 7 to 12 francs a-day,
but there are some of the latter, I am told, in the more
inland parts of Nice, where patients are boarded and
lodged tor about 6 or 6 francs a-day.
A suite of rooms, including two or three bed-rooms and
a large sitting-room, at one of the best hotels in Nice,
cost, as a general rule, from 35 to 40 francs a-day; this,
however, includes servants.
It is stated that during the four or five days pre¬
ceding the 16th ult., more than 250 deaths occurred from the
excessive heat in New York.
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182 The Mediotl Prtu tnd Circular.
HOSPITAL REPORTS.
August 6,1868.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. BEALE, F.R.S.
(From brief notea by Dr. Tonge.)
Paraplegia. — W. B., set. 32, pressman. Admitted
November 12 ; discharged December 17. In hospital 35
days. Unrelieved. Never had syphilis, or any bad ill¬
ness ; had a fit 2 years ago, convulsions and delirium,
followed by impairment of memory, pain in back, and loss
of strength, 17 months ; partial paraplegia 6 months. On
admission can walk a little ; left arm and leg weaker than
right arm and leg, no loss of sensation ; pain in occiput
and down spine ; tenderness of lower dorsal region of
spine ; feeling of constriction round upper part of abdo¬
men ; micturition difficult; bowels sluggish ; pulse 80.
Iodide of potassium, liq. cinchonas, and bicarbonate of
potass ; then dilute muriatic acid, chloric ether, quassia
and quinine ; tepid shower baths ; wet packing.
Cerebral Haemorrhage. —Anne W., set. 48, char-
woman. Admitted February 15. Died on February 17.
In hospital 2 days. Was in King’s College Hospital for
epilepsy in May 1863. Previously epileptic 6 years.
Last fit one month ago. Was suddenly seized with con¬
vulsions on morning of admission. On admission, comatose;
breathing stertorous ; pupils contracted, and insensible to
light; no palsy or rigidity of limbs, but reflex actions
more easily excited in right limbs than in left; pulse 146;
respiration 50. Coma deepened, and she died on 17th.
Post-mortem .—Calvarium very thick and adherent;
blood extravasated over upper surface of right hemisphere,
cerebellum, and base of brain ; left corpus striatum, and
optic thalamus, broken down by effused blood, which
filled left ventricle ; small clot in right ventricle; arteries
at brain’s base, and mitral and aortic valves atheromatous.
Croton oil; two enemata of turpentine and castor oil.
Hemiplegia. —Harriet P., set. 51. Admitted October
5 ^discharged December 3. In hospital 59 days. Un¬
relieved. Had a fit four months ago, with loss of speech
and loss of power in arms. On admission semi-stupid,
speechless, has lost memory; complete left hemiplegia;
sensation impaired ; reflex action in leg diminished ; arm
rigid ; face much drawn to the right; tongue put out to
the left; fasces and urine passed under her ; pulse 80.
Partial recovery of speech and power in left arm.
Aromatic spts. of ammonia and camphor water (29 days);
then chloric ether and sesquichloride of iron; cod liver
oil; brandy.
Softening of Brain—Chronic Renal Disease.—
Sarah H., set. 34. Admitted September 16. Died on
Sept. 17. In hospital one day. Intemperate. Admitted in
a semi-conscious rambling state, which had lasted since the
middle of the previous night. No convulsions ; some
rigidity of right arm, and palsy of right buccinator; pupils
dilated and insensible.
Post-mortem .—Right corpus striatum, and part of optic
thalamus, much softened, and of a red colour. Kidneys
much contracted; surface very granular; combined weight
6 oz.
Oil croton, n^iii.; e. 1. to neck ; enema of tr. serpent.,
ep. ammon. foetid., and aq. on 17th.
Delirium Tremens.— J. S., set. 30, law-writer. Ad¬
mitted December 11 ; discharged December 20. In
hospital 9 days. j Recovery. Drinks much rum and
water. On the 8th and 9th, worked all night and drank
more than usual. Delirious and tremulous on 10th ;
spectral illusions. Slept on night of 11th; rational and
free from tremor on 12th.
Tinct. opii fl^xlv.; brandy 6 oz.
Delirium Tremens. —Sarah L., set 33, needlewoman.
Admitted October 7; discharged November 5. In
hospital 29 days. Recovery. Has drunk freely during
ast 3 months. Previously ill 14 days ; tremors ; restless- 1
ness ; spectral illusions, and loss of appetite. On admis¬
sion very tremulous, excited, and incoherent; with flushed
face, creamy tongue, and pulse 96. Six days later sleeps
' well; no incoherence. Five days later free from tremor.
Carbonate of ammonia, chloric ether, and liq. ammonite
acetatis (5 days); then iodide of potassium and quassia.
Pulv. ipecac, co. gr. x. on 8th.
Delirium Tremens. —J. C., set. 38, tobacco-manufac¬
turer. Admitted June 24; died on June 28. In
hospital 4 days. Had been drinking more than usual
Previously ill 3 days. Very tremulous ; much sweating;
sleeplessness ; spectra ; tongue furred ; slight bronchitis;
became violent; died suddenly.
Post-mortem. —Heart pale, flabby, and loaded with fat;
considerable opacity of arachnoid; slight excess of sub¬
arachnoid fluid.
Aromatic spts. of ammonia, and liq. ammon. acetatis.
Tinct. opii (large doses); aperients.
Delirium Tremens. —C. A., set. 51, lawyer’s clerk.
Admitted May 9 ; discharged May 23. In hospital
14 days. Recovery. Intemperate. Subject to attacks of
tremor without (?) delirium. Pecuniary anxiety of late.
Has drunk about 5 quarts porter daily for last 3 weeks,
and eaten little solid food. Previously ill 4 days. Tre¬
mors, horrors, frightful dreams. Inclined to jump out
of window on 5th day ; violent and noisy on 11th, 12th,
and 13th days.
Large doses of tinct. opii. Brandy and porter. Castor
oil ; aromatic spts. of ammonia.
Incipient Delirium Tremens. —J. S., set. 42, laiyidress.
Admitted June 21 ; discharged June 29. In hospital 8
days. Recovery. Since death of husband, 2 years ago, loss
of memory, disturbed sleep, and constant dread of impend¬
ing evil. Subject to headache. Previously ill three days.
Anorexia, sleeplessness, and frightful dreaifis. Hysterical.
Aromatic spts. of ammonia and camphor mixture.
Chronic Delirium Tremens. —E. M., set. 41, tailoress.
Admitted June 13 ; discharged June 25. In hospital 12
days. Recovery. During last year, catamenia, bi-monthly
and profuse. Family troubles. Previously ill one month.
Disturbed sleep. Thoughts of suicide and killing her
children. Some headache and confusion of thought; low
spirits ; bad appetite; furred tongue ; frightful dreams;
feeble pulse ; occasional globus hystericus.
Opiates ; quinine and sulphuric acid ; castor oil.
Chronic Delirium Tremens. —E. M., set. 42, tailoress.
Admitted July 19 ; discharged August 6. In hospital 18
days. Very much relieved. Became worse after discharge
from King’s College Hospital. Now in much the same
state as before. Slight haemoptysis on day after admission.
Some crepitation and increased vocal resonance under
right clavicle.
Quinine and dilute sulphuric acid ; then same with
sulphate of iron ; tinct. opii. fl^xxv. h.s.s.
Delirium Tremens.— S. M., aet. 25, servant. Admitted
March 28 ; discharged April 11. In hospital 14 days.
Recovery. Leucorrhcea 3 months. Vomiting and purging
14 days ago. Since then disturbed sleep; debility ana
headache. Pulse 124. Bowels confined.
Aromatic spts, of ammonia and chloric either. Tr. opii.
IT^xxx. h.s.s.
CITY OF DUBLIN HOSPITAL.
TWO CASES~OF CANCRUM ORIS,
Under the care of Mr. CROLY.
Case 1.—J. M‘K., a boy aged 5 years, was brought by his
mother for surgical relief. His health suffered materially
of late, in consequence of successive attacks of whooping-
cough, scarlatina, and measles. He lived in an unhealthy
locality in this city. He presented an anaemic appearance.
His left cheek was much swollen and shining ; he cried
from the pain, and very foetid saliva dribbled from his mouth.
The glands of the neck were enlarged. On opening his
mouth an ashy grey-ooloured slough was observed, extend*
e
fhe Medical Press and Circular
LITERATURE.
Angost'S, 1808. 123
ing from the angle of the mouth at the left side (and in-
Vofvfng the lower lip) to behind the last molar tooth.
Treatment .—The diseased part having been dried with
lint, a piece of soft wood, chewed at the end, dipped in
strong muriatic acid, was freely applied to the entire slough.
The teeth were protected by a piece of lint, saturated with
olive oil. Chlorate of potash, in fifteen-grain doses, in
decoction with tincture of bark, was directed to be taken
threes times a-day, and a chlorate of potash gargle to be
used frequently. A liberal allowance of wine, and beef-
tea was also prescribed. In two days, under this treat¬
ment, the slough became detached ; the part assumed a
healthy appearance, and the boy recovered quickly.
Case i. —M. M*K., aged three years, sister of sub¬
ject of preceding case, was similarly affected in the
right cheek, but not so severely. The same treatment was
adopted and with great benefit.
JUmarks. —Mr. Croly explained that cancrum oris is a
serious sequela of measles, occurring in delicate children
who are ill-nourished and dwelling in unhealthy localities.
The disease, he said, has been confounded with mercurial
salivation, but may be easily diagnosed by the history of
the ciwe, and by the filet of cancrum oris attacking only
oiCs ride of the mouth, whilst the sloughing caused by mer¬
cury occurs at both sides.
The treatment must be decided. Muriatic acid is a
favourite and excellent application, and the internal ad¬
ministration of large doses of chlorate of potash in bark,
with generous and stimulating diet, constitutes the proper
treatment for this formidable disease.
The occurrence of the affection in two children of one
family At the same time, is remarkable and worthy of notice.
Noma pudendi, of which a case was recorded by Mr.
Croly in a late hospital report, is on analogous disease, and
requires the same line of treatment.
DR. STEEYENS’ HOSPITAL.
CYSTIC BRONCHOCBLE : RECOVERY.
Under the care or Dr. M'DONNELL, F.R.S.
(Reported by R. L. Swan, F.R.C.S.I., Resident Surgeon.)
John Treonly, aet. 35, a constable in the constabulary
force, was admitted into Steevens* Hospital, November
2nd, 1867. About twelve months before, he noticed a
slight enlargement in the situation of the thyroid body.
This, at first, gave him no uneasiness, but as it gradually
increased, the pressure of the stock caused him consider¬
able annoyance. On examination, a tumour, somewhat
larger than a billiard ball, was found occupying the
middle line two inches above ;the sternum. The skin
covering it was unchanged ; fluctuation was distinct; there
was no pain or local evidence of inflammation.
November 16.—The sac having been half emptied of a
fluid resembling serum, one drachm of the tincture of
iodine was injected.
17th.—Little or no inflammation produced ; the tumour
as large as before the abstraction of the fluid.
30th.—The sac having been completely emptied, two
drachms of the tincture were injected.
December 1st.—The tumour is again filled with fluid ;
some tenderness and pain exists.
5th. —Some increase in size ; the swelling has resumed
its original painless character.
21st.—Having emptied the sac, four drachms of the tinc¬
ture were now injected ; inflammation, followed by sup¬
puration, took place, and eventually, a perfect recovery.
The patient was discharged, January 9th, 1868.
We have not frequent opportunities of seeing cystic
goitre in this country. It is much commoner in central
fyqope. There is some difference of opinion as to the
Mat mode of treating it. Hamburger, from extensive ex-
pflfiettee in Bohemia, recommends the seton as the safest
ibd ; most efficacious means of curing this complaint.
FtoMbea, on the other hand, considers Hamburger’s
l hM te i highly dangerous, and recommends incising and
emptying the sac, and fastening the remaining portions of
it to the integument. The plan adopted in this case seems
to have received the sanction of most surgeons in this
country. Taking into consideration the close proximity of
the trachea, and other important organs, and the dangerous
consequences that must ensue from a violent degree of in¬
flammation being excited, it is evident that too much
caution cannot be observed in the application of a remedy.
ACUTE INFLAMMATION OF THE THYROID BODY:
RECOVERY.
James O’Neill, aged 37, a brass-moulder, was taken
into hospital, April 30th, 1868. He had been under treat¬
ment for more than three years, suffering from syphilis in
an advanced form, having had repeated attacks of inflam¬
mation of the periosteum of the frontal and parietal
bones, for which he had been principally using the iodide
of potassium, which he considered to have most power in
checking the disease. He had likewise a continual hoarse¬
ness—the result of old laryngeal implication. While at
work the day before admission, he noticed a soreness of the
anterior portion of the neck, and on going home was
seized with severe rigors, nausea, and some difficulty of
breathing. When admitted there was considerable inflam¬
matory fever ; tongue furred ; pulse 120 ; there was some
headache. On examining the thyroid body, both lobes
were found symmetrically enlarged, painful, very hard,
and sensitive to the touch. The mtegument covering the
organ, was cedematous and redder than the surrounding
skin.
Ordered—the hospital diaphoretic mixture.
May 4th.—The inflammatory symptoms have in a
great degree subsided. As the man could not bear a con*
tinuance of lowering measures, a tonic line of treatment
was now adopted.
Ordered—bark and nourishing diet.
7th.—Feeling now as well as usual, the patient left the
hospital. The thyroid body has become reduced to its
normal size.
Acute inflammation of the thyroid body is universally
admitted to be an uncommon affection. This fact will
probably account for the difference of opinion that exists
as to the class of individuals most liable to be attacked.
Dr. Macleod in his outlines of surgical diagnosis, states
that it usually occurs in a healthy person ; while Dr.
Copland asserts that it arises spontaneously in this organ
in scrofulous persons only. The rapidity of the attack ;
high constitutional disturbance ; and equally rapid subsi¬
dence of the inflammation are remarkable.
In reviewing the case the interesting question arises—
If the pathological conditions of the organ were more
completely investigated, how much further light might be
thrown on its physiological purposes, now confessedly
obscure ? It is well to add that the patient himself attributed
his attack to the inhalation of the dust raised in scraping
and cleaning the inside of a copper boiler, at which he haa
been employed for some days before his illness came on.
•iterator c*
ELEMENTS OF CHEMISTRY.*
This issue may be considered as completing an edition of this
important work—“ Part III., Organic Chemistry,” 3rd edition,
published in 1866 ; and “ Part I., Chemical Physics,” 4th edi¬
tion, published in 1867. The only discrepancy manifested is,
that in the organic chemistry of 1866, the author had not en¬
tirely discarded the old notation, and barred symbols were,
therefore, used to distinguish the new equivalents from the
old.
In the present volume there is little to report upon as new,
the general characteristics of the book are the same, if we ex¬
cept some changes iu the nomenclature, and some valuable
additions occasionally to the text.
1 Elements of Chemistry. By William Allen Miller, M.D. Part II.,
Inorganic Chemistry. 4th Edition. London : Longmans, Given}
Header and Dyer. 1868.
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124 The Hedieal {Vera and Circular. THE 86TH REGT. AT THE MAURITIUS. Anfftut 5, 1M8.
The author uses the term non-metallic elements in its sub¬
stantive sense. Although the word non-metals is a better
word than the decidedly erroneous one, metalloid, we cannot
see that such terms are .desirable additions to our chemical
vocabulary.
It is, in our opinion, almost time to discard the division
into non-metallic and metals entirely. It is quite arbitrary,
and so ill-defined, that it may be an open question to which
division many of the elements beloDg. Much better would it
be only to use the term “ metals ” in its practical sense, as
applied only to those (precious or otherwise) which are used as
such, and only when spoken of in connection with their uses
in the arts. To found a scientific division of the elements
upon such ill-defined physical properties is straining at nihility.
At page 273, Frankland’s ideas upon the luminosity of
flame are explained. As that gentleman has been lecturing
lately at the Royal Institution upon this subject, it possesses
a little popular interest. Dr. Frankland thinks that the phe¬
nomenon is not so much a matter of solid incandescent
articles as a matter of pressure. Thus in an experiment with
ydro-carbon flames, for each diminution of one inch of mer¬
cury, gave 5'1 less light, the diminution of light being directly
as the diminution of pressure.
The description of glass-making and metallurgical processes
are very complete and full
At page 457 is given what is said to be a more delicate test
for ammonia than Nessler’s, a matter of some importance, now
that so much attention is paid to the presence of that sub¬
stance in potable waters.
Not by any means the least important part of this valuable
volume will be found in tbelatter chapters viz., chapter xx., “On
some circumstances which modify the operations of chemical
attraction.” The substance of this chapter is given in Part I.,
Chemical Physics, but is here treated in a more extended form.
This chapter treats of the influence of cohesion, adhesion, and
elasticity, influence of mass, heat and cold, on chemical at¬
traction. Chapter xxi., a most interesting chapter upon the
combining numbers of the elements, and the data for deter
mining those numbers.
WATTS* DICTIONARY OF CHEMISTRY. 1
We congratulate the author on the conclusion of his
labours, the public upon the addition of the most important
Work for chemical reference extant in our language, and the
publishers upon the successful completion of a most felicitous
undertaking. The favourable augury with which the advent
of the dictionary was received, has been thoroughly endorsed
by general acclamation, as the book has proceeded through its
course of publication, a period of some seven or eight years.
The editor, instead of getting tired of his work, evidently
warmed into it, for, if a preference could be given to any of
the volumes, it would be to those published in 1867 and 1868,
which exhibit a greater unity of arrangement. We can well
understand the feeling that animated the London chemists
when they invited Mr. Watts to a banquet, commemorative
of the completion of this work.
Not that the dictionary is perfect. There are many weak
points which were almost from the mode of issue, Ac., unavoid¬
able, but if we were inclined to point out these shortcomings,
it would be of no avail, for the author meets you half way, by
alluding to them himself. If you read his own preface you
have almost every important deficiency pointed out.
Mr. Watts has promised us an occasional supplement, by
which he intends to keep the dictionary up in a measure with
the progress of science. This plan, which was suggested some
twelve months since in The Medical Press and Circular,
is one which we sincerely hope Mr. Watts will carry out.
In rapid revision we may be able to give some faint idea of
this work to such of the readers who have not seen the notices
already given from time to time.
In the first volume the articles upon acids, amins, (compound
ammonias), and alcohols, atomic volumes, atomic weights,
chemical affinity and classification, written by the editor, Prof.
Foster, and Dr. Odling, are monographs in the encyclopsedian
Style, which are perfect essays in themselves, although the article
u Atomic Weights” is hardly in keeping with other portions of
the dictionary. The other important articles, of which especial
mention may be made, are albumine, alkaloids, analysis,
balance, beer, blood, blowpipe, bone, with tables of comparative
analysis of bones belonging to different orders of the ani m al
1 Watts* Dictionary of Chemistry. 6 Vols. London; Longmans,
Green, and Co. 1808.
kingdom, and their composition per bone ; cereals with tables
of composition.
The minerals under their respective heads are given very
completely in this and the other volumes, but seem to be
chiefly compiled from Dana’s great work.
The article on cryBtallagraphy, a subject so seldom practi¬
cally understood by the chemist, is especially full, yet lucid.
The next most important articles in this volume, are elec¬
tricity and elthylene bases, the latter by Dr. Hofmann. After
these come long and elaborate articles on digestion, chemical
geology, rational formula, Ac. Vol. 3 contains elaborate
essays upon heat (138 pages), metallurgy, and light, the latter
a most exhaustive treatise. The most important of the other
long articles are, perhaps, animal nutrition (VoL 4), and
spectrum analysis (Vol. 5). C.R.C.T.
THE STOCKFEEDER’S MANUAL, Ao.l
The principles which should guide those who undertake the
rearing of animals for the food of man, are most fully and
clearly set forth in Prof. Cameron’s work, which displays
most accurate physiological as well as chemical knowledge.
Several valuable analyses and directions for the detection of
unsound food, are included in the book. Any of our rural
friends whose spare time is sufficient to allow them to engage
in stock-farming, should attentively study Dr. Cameron’i
manual.
Registered for Transmission Abroad.
The Medical Press and Circular is published
simultaneously in London , Edinburgh , and Dublin ,
every Wednesday morning . Price bd . Stamped 6 d.
By Post to Annual Subscribers , .£12 6
„ If paid in advance , 118
Post-Office Orders and Cheques to be drawn in favour of
Charles Cooper, 3, Lincoln-place, Dublin.
Maolaohlan A Stewart, South Bridge, Edinburgh.
A. A. Tindall, 20, King William-street, Strand, London.
$ptal $)r m auh Cimtlar.
“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 5, 1868.
THE 86th REGIMENT AT THE MAURITIUS.
We have good reason to believe that as regards the cir¬
cumstances under which the “ Royal County Down Regi¬
ment” was disembarked at the Mauritius, in opposition to
the protest of the medical authorities there, it may be well
to bear in mind the old adage of “ the least said the soonest
mended.” No such cause of reticence, however, exists in
reference to some of the other points connected with the
medical history of the corps during its residence in that
island. Undoubtedly had public considerations alone in¬
fluenced all concerned, the more prudent plan would have
been for the regiment to have returned to the Cape, in¬
stead of being landed at Port Louis, “ in the thick of the
malaria,” as described by a correspondent on the spot, and
when arrangements for their reception had not been made,
although submitted two months and a-half before that
time. As a result of this mistake, all who were thus ex¬
posed to the exciting causes of the fever from which they
subsequently suffered, had become tainted with it before
going to the out-stations to which they were afterward*,
sent, and where, during two months, all classes of the regi¬
ment continued to sutler from the malady. Fortunately,
the death-rate was inconsiderable, only five fatal cases hav¬
ing happened among the soldiers, although the number of
1 The Stockfeeder’s Manual, &c. By C. A. Cameron, M.D., Pro-
i lessor of Hygiene, R.C.S. Loudon : Cassell, and all Booksellers.
Digitized by vJiOO^lC
the Medical Press and Circular. POOR-LAW MEDICAL OFFICERS* ASSOCIATION. Angut 5,1868. 12$
attacks have been very great, and the amount of non-effi¬
ciency by secondary affections of the liver and spleen, such
as is familiar to Medical Officers serving with our troops in
India, and notably at the station of Peshawur.
It is to be feared that some accounts of the prevailing
epidemic which have reached this country, have been
somewhat sensational in their character, especially those
animadverting upon the supposed deficiency of some neces¬
sary medicines wherewith to treat it. We have it on
authority not to be questioned, that an ample supply of
quinine was brought from the Cape with the regiment,
and that no less than eighty pounds of that drug had by
the principal Medical Officer in the island been accumu¬
lated from various places, as the Cape, Ceylon, and Eng¬
land, from which he was able to supply not only all re¬
quirements of the military, but of the civil also.
It is very satisfactory that whatever may have been the
mismanagement on this occasion, not only is the medical
department completely exonerated, but we know that had
full operation been given to medical opinion, the 86th
Regiment would now, in all probability, have been strong
and efficient, and in one of the finest climates in which
troops can serve.
ENGLISH POOR-LAW MEDICAL OFFICERS’
ASSOCIATION.
Last Friday afternoon the annual meeting of the Metro¬
politan Association of Poor-law Medical Men was held at
Freemasons’ Tavern, when, in pursuance of the aggregate
meeting reported by us, the following resolution was
adopted:—
“ That the Metropolitan Poor-law Medical Officers’ As¬
sociation and the Poor-law Medical Reform Association
be united, under the title of “The Poor-law Medi¬
cal Officers’ Association;” and that the Council con¬
sist equally of metropolitan and provincial members, and,
if possible, of an equal number of workhouse and district
medical officers of each class.”
The consequence of this was of course that the meeting
resolved itself into the first meeting of the new society
which will henceforth be called the Poor-law Medical
Officers’ Association.
This new society, combined of old and tried, though
divergent parts, will become entitled to some ,£60, being
the balance in the hands of the greatest of poor-law re¬
formers, Richard Griffin, of Weymouth, who was treasurer
to the old Reform Society.
We have much pleasure in chronicling the fact of so
much unanimity prevailing that it has been found easy to
carry out the idea we have frequently urged, of making
the society that has done so much the organ of poor-law
doctors, not only in London, but throughout the provinces.
It was stated that some 300 officers had already given in
their adhesion, so that with a fair balance at the bankers,
and a good roll of members, a beginning has been made
which may lead to much.
We append the last report of the Council of the Metro¬
politan Society, os adopted at the meeting.
ANNUAL REPORT OF THE COUNCIL—JULY, 1868.
M In presenting their second annual report, it affords your
much satisfaction to state that the Association has
tsaoe great progress during the past year. The number of
meidbert has been nearly doubled, many provincial medical
oft oa r s having joined aB associates. The cash balance in hand,
•ttfrjBtoaent of all claims, amounts to about £25.
tfharing been frequently suggested that the Association
should extend the field of its operations and admit to the right
of membership all medical officers residing in England and
Wales, your Council have had under consideration for some
months past the propriety of submitting, at the annual meeting,
a proposition to alter the title of the Association by omitting
the prefix * Metropolitan.’ They do not doubt that Buch a
proposition would have been received with favour at any time,
but much more so at the present time after the very successful
meeting of London and provincial officers, held last month,
under the chairmanship of W. J. Clement, Esq. ,M.P., F.R.C.S.
At that great meeting—great by reason of the numbers, intel¬
ligence, and unanimity of those who attended it, many of
whom came from distant parts of the kingdom—a strong and
general wish to this effect was expressed. The actual propo¬
sition in favour of union emanated from Mr. Richard Griffin,
of Weymouth, who stated in his letter to the chairman, that if
it was carried he should feel justified in handing over the
balance of £60, of the funds of the Poor-law Medical Reform
Society, remaining in his hands as chairman. The only con¬
dition made by Mr. Griffin—a perfectly fair and natural one—
was ‘ that the Council should consist of an equal number of
metropolitan and provincial members, chosen equally, if pos¬
sible, from workhouse and district medical officers.’ A reso-
tion to this effect was moved by Dr. R. Waudby Griffin, of
Southampton, seconded by Dr. Robert Fowler, of London, and
carried by acclamation.
“ Your Council have much pleasure in recommending the
Association to accept the proposition to alter the title to ( The
Poor-law Medical Officers’ Association.’ They have very
carefully gone through the existing rules, and having been
favoured with suggestions by numerous provincial medical
officers, they have drawn up a new code, suitable to the altered
circumstances of the Association, which will be submitted for
consideration and approval at the annual meeting. As the
rules are in the hands of the members it is unnecessary to re¬
capitulate them here, but your Council may state that they
have determined, after careful consideration and with the ap¬
proval of the majority of their provincial correspondents, to
recommend a reduction in the amount of the annual subscrip¬
tion. This they propose to fix at a very moderate sum, in the
hope thereby of seeing the ranks swelled by very large addi¬
tions of new members.
“ It is, above all things, desirable that the Association should
be established on the widest possible basis, for the ju^tdemands
of so important a body as the medical officers—between 3000
and 4000 in number—must be listened to if expressed with
firmness and unanimity.
“ Your Council also propose to enlarge the * objects’ to be
attained, while restricting them more than heretofore to mat¬
ters directly affecting the welfare and the interests of the
medical officers. And there is good reason for this, because
the best guarantee for the proper treatment of the siok poor
lies in a contented state of the medical service, which can only
be secured by a fair consideration and removal of admitted
grievances. To obtain this end nothing would be more con¬
ducive than the * establishment of a real (Poor-law) Board,
with real meetings of responsible officers; and, inasmuch as
medical affairs amount to a very large proportion of the total
business of the office, the permanent chief of a properly coil*
stituted medical department ought to be a member of the Board
with voting power.’— Poor-law Chronicle^ July 7,1868. That
events are tending towards the formation of such a Board
may be fairly inferred from the action taken by the Lords’
select committee on the Poor Relief Bill, which, by a vote
(which left the President of the Poor-law Board in a minority
of one) affirmed the principle that additional medical inspec¬
tors should be appointed. Your Council heartily approve
this decision of the Lords, based, as it is, on enlightened
public opinion, which the Association has helped to form. But
they believe that the appointment of more inspectors merely
would be but a single step in the right direction, as improved
inspection would be of little avail if there were no such Board
to receive the reports of the inspectors, to consider their sug¬
gestions, and, if neoessary, enforce their recommendations.
Your Council cannot but believe that it would be for the pub¬
lic interest that all the inspectors should meet regularly for the
discussion and settlement of the various questions which arise,
and go through the country on circuit at stated periods to
inspect not merely the workhouse but the working of every
department of the local administration of the Poor-laws in con¬
nection with the sick poor; and a lay and a medical inspector
might veiw usefully make their circuit together, after the plan
followed by the Commissioners in Lunacy. But the same
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126 The If edical Press and Circular. MEDICAL DEGREES IN THE UNITED STATES. input 5, 19M.
inspector should not go twice consecutively over the same dis¬
trict. The system which attaches an inspector to a district for
a large number of years is essentially faulty. It may enable
him to earn the good will of local officials, but it affords a very
poor security for the faithful discharge of duties which must
always be onerous and, not seldom, painful or at least unplea-
sant.
“ Your Council have been led to make these observations by
a strong conviction that it is only by putting the whole system
of poor-law management upon a sound footing that they can
hope for a general removal or amelioration of the grievance
under which the medical service now labour.
“Your Council have observed with satisfaction that the
Poor-law Board have at length arrived at the opinion that
uniformity in workhouse dietary is desirable. They have
suggested a dietary for use in the metropolitan district which,
however, has not been very favourably received. This, how¬
ever, cannot be altogether a matter of surprise, as the dietary is
open to some objections, and it would not be desirable to estab¬
lish it without important modifications based on the dietary
long since drawn up by your Association. The dietary appears,
however, to be based upon that recommended by the Associa¬
tion, but the variations from that dietary are not improve¬
ments.
“ As this will probably be the last report issued by your
present Council, it may not be out of place to express a hope
that the proceedings of the enlarged Association may be
marked by the same unanimity and kindly feeling which have
distinguished those of the Metropolitan Association. Meetings
like these bring together many men with identical interests
and many feelings in common, who otherwise would have
scarcely any opportunity of becoming acquainted with one
another. ‘ From such intercourse many good results must
follow, even if material interests are not advanced with de¬
sirable rapidity. Not the least of them is the establishment
of an agreement as to the wants and wishes of the service ;
and thiB is very necessary, for the medical officers must make
up their own minds upon questions affecting their status and
remuneration before they can hope to make an impression
upon public opinion and Becure a full concession of their
claims.
“ Your Council would fain believe that the meetings held
during the last two years have helped somewhat in this direc¬
tion. They have assisted in enlightening public opinion on
various points connected with the service, and they have been
well supported by the press. Much evidence of sympathy
With the medical officers has been elicited in quarters where it
cannot fail to be of use under a new Parliament. The Metro¬
politan Poor-law Medical Officers* Association has won for
ltsdff a fair position, which it yields very willingly to its suc¬
cessor, in the firm conviction that by means of larger numbers
and more extended influence that position will not only be
maintained but'improved, and that the good work will be
carried’on to a successful and speedy issue.’*
MEDICAL DEGREES IN THE U.S. OF AMERICA.
There; is a good deal of ignorance prevalent among us
about the medical qualifications of our transatlantic
brethren, and as we have recently had the pleasure of in¬
specting what our readers will doubtless consider a re¬
markable document, we shall make a few observations on
the genuine, as distinguished from the humbug degrees,
which are openly given-—even sometimes under legal sanc¬
tion—in the United States.
In the first place, we must remember that there is no
real difficulty in almost any American medical school
obtaining the power of conferring the sole necessary quali¬
fication, that of M.D. “ The New York Homoeopathic
Medical College,” and many others of like kind, have this
right; and are, legally speaking, on perfectly equal terms
with the respectable and really learned institutions which
confer medical degrees on the first class of American phy¬
sicians, whose representatives, or members, we so often
have the pleasure of welcoming to our houses in the
mother country ; and who are professionally inferior to no
medical men in the world.
In the United States the assumption of the title of M.D.
without legal right is attended by no legal penalty. Any
one can style himself captain, or colonel there, and so he
may adopt the more learned professional title if he think
fit.
But, apart from this facility in becoming, or assuming
to have become, an M.D.,*it may be stated that a few
years ago there were in the United States no less than
thirty-seven medical schools, each of which conferred the
degree of M.D.
Some time ago Sir Dominic Corrigan astonished the
medical world by telling them that there was then an agent
in these countries disposing of medical degrees to needy or
illiterate candidates, without examination, and for a trifling
consideration. His statement was indignantly denied, but
he proved his case without any doubt.
As an instance of a certain class of “ degrees” which are
attempted to be foisted into these kingdoms under any but
true pretences, we shall give verbatim , literatim , etpunda-
tim , a copy of one which lately came under our observa¬
tion.
It was forwarded by its owner (we understand) to one
of our most respectable and time-honoured medical corpo¬
rations as a bona-fide qualification, on the ground of which
the owner sought for admission to examination for a medi¬
cal license. At the same time a similar application was
made by an M.D. of the College of Physicians and Surgeons
of New York—one of the oldest and most respectable of
the American licensing bodies; the former application W
refused, while the latter was granted.
Herewith we give the document above referred to,
merely suppresing the name of the candidate, with the
names of those who signed it, and the date:—
all mtn ‘gutting.
“Be it known that the President on behalf of the
Trustees, and we, the Faculty of the Eclectic Medial
College of Pennsylvania, incorporated by an Act of
General Assemby, of the Commonwealth of Pennsyb
vania,
do hereby testify, that-
Having made suitable proficiency in the preliminary
branches of education as preparatory to the study of the
Medical Profession, and devoted the term of three years
to the study of the several departments of Medical
Science, under the tuition of a competent Medical Precep¬
tor, and having attended two full courses of Medical Lec¬
tures, and passed a successful examination in each depart¬
ment of study before us, the Professors of the College;
therefore in consideration of his qualifications for the
duties and responsibilities of the Profession, and by virtue
of the power vested in us by the Commonwealth of Penn¬
sylvania, we do hereby confer upon the said-—
the degree of Doctor of Medicine, thereby granting and
conceding unto him all the Rights, Privileges, ana Im¬
munities belonging to that degree here and elsewhere.
We also recommend him to the confidence and patronage
of the public.
“In Witness Whereof we have caused to be affixed
our corporate Seal to this Diploma, and subscribed oar
names to the same.
“Given at the College Hall at Philadelphia, on the—
day of April, a.d. 186-—.”
At the bottom of this document was a grand seal, on
the margin of which were the words—“ Eclectic Medical
College of Pennsylvania. Incorporated 1860.” In the
centre, and amidst a “glory,” was the potential term
“Eclectic;” and around it, outside the glory, but inside
the marginal legend were these awful derivatives—
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The Medical Press and Circular. NOTES ON CURRENT TOPICS. August 5,18&. 12?
“ Chromo-thermal,” “Electropathy,” “Hydropathy,” “Allo¬
pathy,” “Thomsonism,” and “Botanic.” Close beside these
were recorded the words “ Truth,” “ Nature,” and “ Wis¬
dom,” admirable principles indeed, on which, doubtless,
M the Eclectic Medical College of Pennsylvania” professed
to conduct its operations.
THE MEDICAL ELEMENT IN PARLIAMENT.
Wn have so often urged the absolute necessity of more
medical men finding access to the House of Commons that
the subject is becoming almost trite. Now, that new
names have been brought forward, and that the Parlia¬
ment has actually, so to say, expired, we may, perhaps,
again return to a question so full of importance to the pro¬
fession. We can most heartily wish all our professional
brethren success whenever they may seek a seat, and
only regret that division is likely, occasionaly, to prevent
this.
It is certainly to be deprecated that the medical interest
should be recklessly divided, and when one medical man
has a prospect of support, it is a pity to set up another.
The first must have deserved well for the courage he
evinced in coming forward. The second may spoil his
chance without winning.
Even if won, the victory snatched from a professional
brother is of less value than the defeat endured by those
who assert the principle.
The importance of medical men being in the House is
just now so much thought about, that we add the remarks
of Dr. Mapother on the subject in his Essay, which
won the first Carmichael Prize :—
“ It must be admitted on all hands that the importance of
the profession of medicine is not fully recognised, many causes
having contributed to degrade it from the position it should
occupy. Foremost among them is the fact, that the public,
uninformed of the functions of the human body, have imper¬
fect means of judging of the comparative merits of those who
treat their derangement. The superficial and boasting prac¬
titioner is many a time the favourite with the vulgar, to whom
the honourable and well-informed practitioner will offer
neither flattery nor false hopes. Another, is the absence of
just rewards, such as elevated positions in the State, for its
most distinguished promoters, which would stimulate the
talented and refined to adopt it as their calling. It is almost
universally acknowledged that the educated and enlightened
classes are net adequately represented in our country’s senate.
It was, however, confidently hoped that this anomalous state
of things would oease as soon as the Reform Bill became law, but
that measure only enacted that the London University should
have a representative, and it is to be feared that he will not be
chosen from the medical profession. No impartial man could
then deny the importance of having members of the medical
profession, who could there be consulted on the numerous
questions relating to public health to be discussed. The other
learned professions are most amply represented in both Upper
and Lower Houses; for instance, over 100 members of Parlia¬
ment are practising barristers, and no just reason ever has, or
probably ban be, adduced why medicine should not enjoy
similar invaluable privileges. The main objections urged to
medical representation in parliament is, that no profession or
«*ll»"g is directly represented ; be that as it may, the clerical
and legal professions, and commercial and other callings, have
very many advocates there. But if the profession is not to
have special members of parliament, the licensing bodies may
fairly seek the privileges which the universities nave so long
enjoyed, and if they amalgamated, as shall be hereafter advo¬
cated, such a just concession could not be long denied. Licen¬
tiates of five years standing might share the franchise with
fellows of the colleges.
medical men, but how few of the constituents of OxfonF, Cam¬
bridge, and Dublin, are doctors of medicine, and when was a
member of the profession chosen f Even in the London Uni-
vemifcr, where Half the constituency is medical, and where
half the pfeee* on the Senate and Committee of Convocation
have bee n b est o wed on the profession, there is, it appean, no
chaaoe fqp it nyflioal representative. The inability of medical
men to make themselves heard in parliament, renders them
liable to have their interests, which are as well, in most vital
respects, the interests of every man, woman, or child, over¬
looked or despised. The intimate knowledge of mankind,
psychical as well as corporeal, which they must acquire,
would render their opinions valuable and their decisions
judicious. It may be objected that, as medical men
derive their incomes from the active exercise of the
profession, they could not afford to relinquish such
emoluments. This is assuredly, fallacious, as many, distin¬
guished and disiifrerested, would submit to such pecuniary
sacrifice for so grand an opportunity of administering to the
public good, and a leader in Dublin has already volunteered.
Besides, there are some positions in the legislature (and there
should be more) where their services could be recompensed.
In the United States, many high senatorial and other offices in
the government are filled by medical men ; for example, Dr.
Sheldon was Speaker of the House of Assembly. On the Con¬
tinent, likewise, medical men frequently fill representative
positions— e.g., Virchow. The great Haller, whose mind had
undergone a very appropriate course of training for such
duties, was the originator of many legislative sad social
improvements in Switzerland. As the sittings at Westminster
take place at night, and for but a short period of the year,
many London practitioners, who now reside in the country,
during night, might attend with but little personal or pecu¬
niary sacrifice. If precedent be asked for, we point to Rad-
oliffe, the greatest benefactor of Oxford, Friend, and Mead,
who all served their country in this position. There are at
present three retired medical men in Parliament, Sir John Gray,
Dr. Brady, and Mr. Vanderbyl ; and one practised surgeon,
Mr. Clement. It is much to be regretted that the candidature
of such distinguished members of our profession as Sir Charles
Locock and Mr. Mitchell Henry has been unsuccessful. The
latter gentleman canvassed Manchester in November last, and
many of the medical men gave him energetic support—others
declared that they preferred to follow party considerations.
“ It is unpleasant to have to record that efforts were made
some years ago by one of the largest medical corporations
against presenting a petition to the Crown for Parliamentary
representation. How different was the 'course the profession
in Dublin adopted, the influential demonstration in Morrison’s
Hotel during June, 1841, exhibits; and since then many
fellows of the College of Surgeons, and foremost among them,
Dr. Mackesy, have urged the matter. Acts of Parliament
making has been heretofore regarded as the exclusive province
of the politician and the lawyer, but many of them concerning
the duties of medical men indicate the want of intelligent
supervision which our profession alone could give. The glaring
defect of our system of legislation is, that fragmentary mea¬
sures called by some passing necessity or temporary ahum are
enacted; the Act for Controlling the Sale of Arsenic and the
Bill for the Prevention of Glanders * may be taken as examples,
from which it might be inferred that there were no other
poisons or no other contagion to be guarded against. 1 ”
-♦-
gfsies 0it Magics.
Figures not Fears.
Perhaps it is not to be wondered at, considering the long
continuance of the hot weather, the absence of rain, and the
consequent parched condition of the country, that serious ap*
prehensions should have been entertained lest cholera might
become epidemic amongst us this summer. There is cause,
however, for congratulation, on receiving the Quarterly Re¬
turns of the Registrar-General, to find that at present snch
fears are unfounded. From a reference to his figures, regis¬
tering the deaths occasioned by the prevailing epidemics
throughout the kingdom, it will be seen that, in upwards
of thirty-five places, not a single death from cholera is re¬
corded. There may have been some few cases since, but not
sufficient at present to cause any serious alarm.
The Public Health.
The following items are taken from the weekly return of
the Registrar-General;—
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128 The Medical Rress and Circular.
CUMMINS’ LECTUR&
Aagiut 5,1868.
“ In the week that ended on July 25, 4384 births and 4050
deaths were registered in London and in 13 other large towns of
the United Kingdom. The annual rate of mortality was 33 per
1000 persons living. The annual rate of mortality last week was
31 per 1000 in London, 22 in Edinburgh, and 23 in Dublin;
25 in Bristol, 38 in Birmingham^ 37 in Liverpool, 40 in Man¬
chester, 35 in Salford, 39 in Sheffield, 40 in Bradford, 85 in
Leeds, 34 in Hull, 26 in Newcastle-upon^Tyne, and 37 in
Glasgow. The rate in Vienna was 29 p* 1000 during the
week ending the 18th inst., when the mean temperature was
0*9 Fahrenheit higher than in the same week in London, where
the rate was 27. The mortality from diarrhoea showed a fur¬
ther increase during last week in nearly all the large English
towns, and was at the annual rate of 4 per 1000 in Newcastle-
upon-Tyne, 6 in Bristol, 7 in London, 9 in Liverpool and Shef¬
field, lo in Manchester and Salford, 11 in Hull, 12 in Leeds,
and, highest, 14 per 1000 in Birmingham. In London the
temperature in the shade rose to 96*6 deg. Fahrenheit, and
the mean temperature of the week was 69*2 deg.; but there
was no approach to these high temperatures in the other towns,
the highest recorded in the shade being 91*6 deg., and the
highest mean of the week 64*4 deg., both in Sheffield. It will
be observed that in the English towns the lowest mortality
from diarrhoea occurred in Newcastle, where the mean tempe¬
rature of the week was only 60*3 deg., and lower than in any
of the other towns. The deaths of 945 males and 940 females,
in all 1885 persons, were registered in London during the week.
It was the thirtieth week of the year, and the average number
of deaths for that week is, with a correction for increase of
population, 1575. The deaths in the present return exceed by
310 the estimated amount, and are more by 243 than the num¬
ber recorded in the preceding week. The deaths from zymotic
diseases were 800, the corrected average number being 681.
Seven deaths from small-pox, 35 from measles, 47 from scarla¬
tina, 10 from diphtheria, 45 from whooping-cough, and 57 from
typhus were registered. Fifty-eight deaths by choleraic diar¬
rhoea or summer cholera were registered in the week; 38 were
children under one year of age, eight aged one year, one aged
three years, and two aged five years. Four hundred and forty-
two persons died of diarrhoea, of whom 353 were children under
one year of age, 49 were one year and less than two years, and
23 were of persons aged 20 years and upwards. The mortality
from diarrhoea and choleraic diarrhoea or cholera differs little
in the London waterfields. Eleven persons died of sun¬
stroke. At the Boyal Observatory, Greenwich, the mean
height of the barometer in the week was 29*969 in. The
barometrical reading increased from 29*83 in. at the be¬
ginning of the week to 29*94 in. by 9 a.m. on Mon¬
day, July 20; decreased to 29*86 in. by 3 p.m. on the
same day; increased to 29*93 in. by 9 A.M. on Tuesday, July
21 ; decreased to 29*78 in. by 3 P.M. on Wednesday, July
22 ; increased to 30*25 in. by 9 A.M. on Friday, July 24, and
decreased to 30*03 in. by the end of the week. The mean tempe¬
rature of the air in the week was 69*2 deg., which is 7*6 deg.
above the average of the same week in 50 years (as determined
by Mr. Glaisher). The highest day temperature was 96*6 deg.,
on Wednesday, July 22. The lowest night temperature was
50*9 deg., on Friday, July 24. The entire range of tempera¬
ture in the week was, therefore, 45*7 deg. On Wednesday,
July 22, the maximum temperature of the air observed—viz.,
96*6 deg., is a higher value than has been recorded at the
Boyal Observatory as far back as authentic record extends,
and the mean temperature for the day, 77*9 deg., has only been
exceeded on the following occasions:—On the 24th of July,
1818, when the mean temperature was 79*2 deg., and on the
15th, 18th, and 19th of July, in the year 1825, when the mean
temperatures were respectively 79*1 deg., 78*2 deg., and 78*6
deg. The mean of the highest temperatures of the water of
the Thames was 70*7 deg.; that of the lowest was 70*2 deg.
The air has been dry. The difference between the mean dew
point temperature and air temperature was 15*3 deg. The
mean degree of humidity of the air was 59, and on two days
—Monday and Wednesday—it was as low as 49, complete
saturation being represented by 100. Rain fell only on
Wednesday to the amount of 0*01 in. The general direction
of the wind was variable. Ozone was observed on every day
except Sunday and Friday. According to a return famished
by the engineer of the Metropolitan Board of Works
the average daily quantity of sewage pumped into the River
Thames at the Southern Outfall Works, Crossness, was
45,822,141 gallons, or 208,191 cubic metres, equivalent to
about as many tons by weight.”
gjerfim.
THE USE AND ABUSE OF “STIMULANTS.*
Bt W. JACKSON CUMMINS, M.D.,
PHYBICIAW TO THK GOBE SOUTH IXFIBKABT AJfD OOUJTTY GRFIBAL
HOSPITAL, XX-PBK8IDBOT COBK MEDICAL SOCIETY, ETC.
(A Lecture delivered before the “ Cork Young Men's Association,”
January 7th, 1868.)
Mr. President, Ladies, and Gentlemen —The sub¬
ject under our notice this evening—the Use and Abuse of
Stimulants—is a grave one. The more I have thought
about it, the more deeply have I become impressed with
its vast importance, and with the responsibility of my
position here as its exponent.
If the use of alcohol were forbidden in any part of the
inspired pages, there would be an end to all argument on
its Dehalf, even on the plea of urgent necessity, for the wt
of disobedience would in itself constitute it a sin, which
would take its place side by side with murder, lying,
stealing, and other breaches of the commandments of God;
but after careful study, I am unable to find that any put
of the inspired record can be legitimately strained into
condemnation of the “ use” of stimulants, although their
“ abuse” is denounced in no measured terms in both Old
and New Testaments.
The sin lies in the abuse ; and just as eating may degene¬
rate into gluttony, or love into sensuality and idolatry,
so may the use of both moral and physical stimulants,
lawful in themselves, pass on into an excess which unfits
for the responsible duties of life.
We must not, however, argue against the use of any¬
thing because it may be abused, and herein lies the chief
difficulty of combating the majority of sins into which
mankind is prone to fall; for it is not always easy
to draw the line of demarcation between use and abuse—
a difficulty which is increased in the case of alcohol, by its
different effects upon different constitutions, and by the
treacherous tolerance of its immediate effects arising out
of habit.
It has been truly said that “if 1 alcohol were unknown,
half the sin and three parts of the poverty and unhappi¬
ness in this world would disappearand if this be
admitted, as I think it must be, by the most enthusiastic
advocate of stimulants, no question of the day presses
more urgently on the attention of the political economist,
the statesman, the physician, the philanthropist, and the
Christian minister ; bearing, as it does, upon the social,
political, and physical condition of man in the present, and
upon the eternity for which this life iajonly a period of
probation.
Alcoholic abuse is a monster evil which degrades and
enslaves mankind, and limits human progress. It has
be6n stated that 2 60,000 lives are annually lost in Groat
Britain through its direct or indirect effects, and this
terrible mortality is the least part of the evil which results
to the nation from its favourite vice ; for the moral and
1 “Parkes on Hygiene.”
2 “ Alcohol, its Plaoe And Power.” fcy Professor Millar*
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Tbt VUdical Trm <nd Ctreukr.
CUMMINS* LECTURE.
August 5, IBM. 129
social effects of bad example, misery, and want, and still
more, the impaired mental and physical condition handed
down to posterity from generation to generation effect a
degeneracy and degradation in the population which can¬
not be measured by figures.
The vice of alcoholic abuse is 1 hereditarily transmissible
and often leads to2 insanity after one or two generations.
The child of a drunkard is generally a dipsomania? by
inheritance, his grandchild may inherit a tendency to
epilepsy and insanity, while his great grandchild is liable
to be an idiot, brutalized and destroyed by no fault of his
own. 8 The sins of fathers have thus been visited on their
children to the third and fourth generation, and it is not
easy to say how many a noble race has thus died out, or
how many an historic name has thus become extinct.
Most of the great sewers which drain the offscourings of
mankind towards jails, workhouses, and hospitals—the
cesspools, as they have been called, of humanity—are con¬
nected in one part or other of their course with strong drink,
for crime, poverty, and disease follow hard and fast upon the
footsteps of intemperance. Can we wonder then that—to
use the words of a late author*—“ Divines have preached,
legislature has enacted laws, sanitary philosophers and
physicians have written, taught, and practised ; temperance
societies have laid down rules and administered pledges ;”
. . . “ orators and oratresses have thundered .
“ parents have whispered words of caution to the erring
■on f . . . have * commanded, threatened, punished/ and
as a last resource, prayed by his love for them, by his fear of
disgrace, by his danger of losing reputation, by all his hopes
for this world and the next, to give up the cursed indulgence.”
To all this I may add that even judges on the bench have,
from time to time, reasoned with juvenile criminals, and
earnestly endeavoured to put down this vice which limits our
national greatness, brutalises our population, and threatens
our institutions, and the only wonder is that even more
has not been attempted, for the magnitude of the evil calls,
trumpet-tongued, upon philanthropists to exert themselves.
When a physician is called to prescribe for a disease, he
fhrst sets himself to ascertain, if possible, the cause of the
symptoms presented by his patient, knowing that, as long
as it continues in operation, he can do little more than
palliate ; just so, in seeking to remove a social evil, it is
incumbent on us to seek out its cause.
Now those who are anxious to remove the great evil of
alcoholic abuse, generally not satisfied with attributing it
to habit growing out of the drinking customs of the people,
and to a certain extent they are right, but would it not be
better to go a step further back, and ascertain, if possible,
the cause or causes of the drinking customs themselves ?
It shall be my endeavour to do this, and I think I shall
be able to show that they originate in our national charac¬
ter, and are closely connected with our institutions. But
it may be said, and said truly, that the taste for wine and
strong drink long preceded the Anglo-Saxon race, and the
sources of its national intemperance, that the juice of the
grape is intertwined with the earliest records and tradi¬
tions, with the poetry and history of mankind, from its
infancy to the present day.
Father Noah, we are told, had some prescience of sani¬
tary law, and disdained to drink water because it contained
organic impurity. 8 The pretty German legend tells us that
“ an angel visiting the earth some time after the deluge,
found the patriarch sitting at noon in the shadow of a fig-
tree, looking very disconsolate. The angel inquired the
cause of his grief. Noah replied ‘ that he was thirsty, and
had nothing to drink/ ( Nothing to drink’! replied the
angeL ‘ Look around! Do not the rains fall, and the
rivers run, and is there not a spring of water bubbling up
it thy cottage-door V i It is true, replied Noah, smiting
tk breast, ‘ that there is abundance of water in which thy
t't*lConl. Quoted in Aitken’s Practice of Medicine.”
2 ** Whitehead. Adams. Quoted in Aitken's Practice of Medicine.”
in Aitken’s Practice of
. Belcher.
S u 8ee History of Fourfold Transmission
Kedfctae,” rol. t, p. 146.
4 "BtfagMAarlm for Drunkards.” By Dr
servant can bathe; but, alas ! when I think of the multi¬
tude of strong men, of beautiful women, and of innocent
children, and the countless hosts of animals that were
drowned in the flood, the idea of water becomes distasteful,
and my lips refuse to drink/ ‘ There is reason in what
thou sayest,’ replied the angel, and spreading his snow-
white wings, he flew up to heaven swift as a lightning-
flash; and while the eyes of Noah were still dazzled wita
the brightness of his presence, returned with some stocks
of the vine, which he taught the grateful patriarch how to
plant and tend, and when the fruit was ripe, to press it
into wine. This,” says the story, “ was the source of all the
beneficent and benevolent drinks which the world owes to
the grape.”
It is true that although the Anglo-Saxon race has de¬
veloped intemperance into a master-passion, there have
been drinking-customa from the very earliest times, and it
is also true that their increase has often been coeval with
the downfall of great dynasties. Nor is it to be wondered
at that strong drink should have been enjoyed among all
nations and at all times, for the sources of human imper¬
fection and human exhaustion commenced at the fall,
when mankind shared the curse pronounced on creation, and
learned that “in the sweat of his brow he should eat bread.”
There was a time when our first parents lived in a con¬
dition of peace and contentment, surrounded by every¬
thing “ pleasant to the eye, and good for food.” The fresn,
pure atmosphere of the virgin earth was untainted by the
corruption of death; the spring, clear and sparkling, was
presented to them in all its native purity and freedom from
the germs of disease. Thus their perfect vitality was-sti¬
mulated, and thus was the warm and well-nourished blood
kept circulating with vigour in its proper channels. Con¬
scious of no exhaustion after the light duties of each day,
they lay down amid earth’s choicest gifts to enjoy calm and
undisturbed repose, and awake, free from anxiety and care,
to derive nourishment from everything “ good for food.”
Let us pause and mark the contrast between man then
and mankind now ! Dwelling in a world subject to the
curse, “ thorns and thistles shall it bring forth,” man him¬
self labours under the edict which was thundered forth six
thousand years ago, “ In the sweat of thy brow shalt thou
eat bread/’ The civilized earth has become a vast grave¬
yard, full of impurities, which taint its waters and load its
atmosphere with pestilential vapours. Over-crowded cities
and over-populated countries swarm with anxious and care¬
worn men and women, seeking—many of them in vain—
for employment: suppliants for the work that “ wins a
meal,” instead of being negotiators for a fair day’s wages
for a fair day’s work—victims of excessive competition—ill-
nourished and ill-requited—too often obliged to barter the
hours of repose for less than the bare necessaries of life—
existing rather than living—famishing, perhaps, and yet
viewing other mortals wallowing in excess, and depriving
themselves of the power to enjoy what their ample means
can provide. Mental activity goes often hand in hand with
physical decay, because the battle of life has been becom¬
ing harder and harder through succeeding generations.
This is the age of mental and bodily activity, when men
travel hundreds of miles in a few hours—when fortunes are
made in a day, and lost in an hour—when news flashes in
from the ends of the earth, creating a stir and a bustle, and
a greed to be rieh, and a national and individual competi¬
tion, which keeps the energies of all who have anything to
gain or to lose in a constant whirl of excitement—high-
pressure is placed on all classes of society, and even the
rising generation has learned to live fast. Like a thorough¬
bred charger, champing the bit and pawing the ground,
with nostril dilated, and every vein swelling with restless
impatience, the young man of the nineteenth century chafes
at restraint, and when once let free starts into convulsive
life, and too often drives headlong into a mad and unre¬
flecting career.
Time vxu when “ the morning stars sung together, and
all the sons of God shouted for joy;” time t8 when “ the
whole creation groaneth and travelleth in pain together.”
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CUMMINS'LECTURE.
130 The Medical Press and Circular.
August 5,1*8.
Time was when the high physical condition of man
ministered to complete and perfect enjoyment; time is when
imperfect development, inadequate nutrition, unnatural
wear und tear, and uneasy and insufficient repose, go hand
in hand to make man restless and impatient m the present
—ever-craving for that which flies from his grasp.
What are the consequences of all these things ?
First. Exhaustion has become a common condition of
poor and rich.
Secondly. Stimulants are greedily sought for; and third,
we must make rules for men as they are, and not as we
would wish them to be.
The more we examine into this subject, the more are
conclusions such as these, drawn from a superficial and
general view, confirmed ; for there is a strange power of
adaptation to circumstances and surrounding conditions in
man, and a physiological law by which a bent given in a
certain direction in one generation, may be taken up by
the next, and still further developed. This gradual adap¬
tation to circumstances and conditions, progressing through
many generations, is a means of imparting national pecu¬
liarities to masses of men, and a variety of constitutions to
individuals. It is well-known that a temperate climate such
as that of our favoured land, generates energy of charac¬
ter, and, as a natural consequence, the rise of great cities,
and the development of industrial pursuits ; these, in
their turn, bring men together into monster communities,
and produce that over-competition, over-speculation, and
over-activity, which I have described.
It is scarcely credible to what an extent the human race
is thus deteriorated, for the causes of decay and exhaus¬
tion in large cities are almost as numerous as the houses. 1
A committee of the Statistical Society of London, found
in one lane in that modem Babylon only 90 bedsteads for
463 people, i.e., about one bed for five persons, while some
rooms had 22 persons living in them, and 2 * 4 Dr. Letheby,
in reporting on the condition of the dwellings, says, that
the air is not only “ deficient in due proportion of oxygen,
but contains three times the usual amount of carbonic
acid,” “ blighting the existence of the rising population,
rendering their hearts hopeless, their acts ruffianly and
incestuous, and scattering the seeds for increase of crime.”
The inhabitants of great cities are not as much over¬
worked since the passing of the Factory A<;t in 1802 as
they were before that time, when we are told, “ the 3 laws
of nature were wholly disregarded, and hundreds of the
most helpless and sensitive of beings were annually used
up by their remorseless task-masters, only to have their
places filled by fresh victims.”
It would take generations to efface the effect on masses
of men still living, of such an overstrain upon the physi¬
cal and mental powers of their ancestors. But even to
this day the sources of exhaustion among our people, and
especially among children in manufacturing towns are
almost incredible.4 The reports issued within the last
few years (up to 1866) contain information which i 3 most
horrifying. Children of five, ten, and even three, are
habitually overworked day and night, and denied the
repose which exhausted nature requires; worked, too,
sometimes in close confined atmospheres. Imagine girls
of 10 years and upwards, in London and Manchester, kept
at work 14, 15, and occasionally 18 hours a day, making
artificial flowers in “ dark ” and “ foeted ” rooras ; or poor
little girls in metal manufactories, blowing a bellows 14
hours a day, standing on a platform to enable their little
hands to reach the handle; girls of nine and ten wielding
sledge-hammers and forging iron-chains from morning till
night. Such are a few, and scarcely the worst, out of many
such frightful instances contained in the reports I have
alluded to.
No wonder these poor little creatures had never known
1 Quoted by |Bev. Dr. Guthrie, appendix to “ City, its Sins and
Sorrows.”
a Ibid.
8 Review in Blackwood on}Parliamentary Reports on Children’s
Labour in Factories.
4 Ibid.
the gladsome gaiety of a spring morning in the green
fields, and could not tell what flowers, fishes, birds, rivers,
mountains, or seas were.
No wonder that girls of 12 years old, when asked.
“ what is a violet ?” replied that “it is a pretty bird;*
that “ a primrose is a red-rose ;” that “a lilac is a bird,”
and were unable to tell whether a robin redbreast or an
eagle were birds. Is it not horrible to think that children
with such necessarily degenerate constitutions and minds,
should become the fathers and mothers of our population?
“Do ye hear the children weeping, 0 my brothers,
Ere the sorrow comes with yean ?
They are leaning their young heads against their mothers,
And that cannot stop their tears.
The young lambs are bleating in the meadows,
The young birds are chirping in the nest,
The young fawns are playing with the shadows.
The young flowers are blooming towards the west—
But the young, young, children, O my brothers,
They are weeping bitterly.
They are weeping in the play-time of the others.
In the country of the free.
‘ For oh 1 ’ say the children, 1 we are weary,
And cannot run or leap,
If we cared for any meadows, it were merely to drop down in
them, and sleep;
Our knees tremble sorely in the stooping,
We fall upon our fares trying to go ;
And underneath our heavy eyelids drooping,
The reddest flower would look as pale as snow ;
For all day we drag our burden, tiring
Through the coal-dark underground,
Or, all day we drive the wheels of iron,
In the factories round^and round.’ ” 1
Can we wonder that our people crave for anything
which affords even temporary relief from such exhaustion
as they acquire and inherit, and that drinking customs
prevail ?
The same reports tell also of dreadful overwork of
children in agricultural districts, and we all know that
want of proper nutriment is a fertile source of exhaustion
among country labourers, especially in Ireland.
“ The child is father to the man,” and if a child is over¬
worked or insufficiently sustained during the period when
mind and body are undergoing development, its manhood
will never acquire full vigour, its constitution will always
be below par, and it will be ready to grasp at any stimu¬
lant which affords even a temporary ana treacherous power
to sustain the burden of life.
Hours might be spent in detailing the many sources of
exhaustion among the lower orders of our overgrown cities
which lead them to intemperance, but as the time at our
disposal is brief, I shall pass on to the middle and upper
classes, upon whom the great pressing necessity for toil
through day and night does not fall.
But the Anglo-Saxon is the same in labour, in business,
or in pleasure; his energy of character leads him to impose
exorbitant exactions upon the poor material frame, and to
deny it the repose which exhausted nature demands.
Ambition lures on the middle class to exhaustion, to stimu¬
lation, and through it to premature decay, which is handea
down to posterity, almost as surely as absolute necessity
does the lower orders. Our statesmen, our divines, our
physicians, our lawyers, our men of business, are con¬
tinually exhausting their energies by over work, while
both middle and upper classes follow pleasure and excite¬
ment with such eagerness, that exhaustion speedily follows
and leads to “ habitual tippling.”
A late writer upon the increase of inebriety among the
upper classes says 2 —“ Almost everyone can plead medical
advice as the beginning of the habit,” but the truth is (as
hinted in an article which I lately saw in one of the news¬
papers) that ambitious mothers, angling for earls, and
viscounts, and eldest sons for their daughters, carry them,
nothing loath, of course, to balls and routes, kettledrums,
and dinner parties, night after night, with little inter¬
mission, through a London, Paris, and Brighton season-
excitement after excitement—exertion after exertion-
night turned into day from year's end to year's end. This
sort of dissipation soon leads its victims to “galvanise 9
1 Poetry, by Elizabeth Barrett Browning.
8 Pall-Mall Gazette.
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Ihe Medic*! Proa and Circular.
CUMMINS* LECTURE.
August 8,1868. Iji
their exhausted energies into some show of vitality with
champagne and sparkling Moselle, and when exhaustion
has gone beyond a certain limit, to send for a doctor to
sanction the use of brandy. This is, perhaps, prescribed
at regular intervals, in moderate quantities, and to carry out
the prescription accurately, the bottle is taken to the bed¬
room; private drinking thus commences, the habit is
formed, and before the victim is well aware of the pre¬
cipice which yawns before her, she has fallen from all that
was lovely and refined in a British maiden, and becomes a
candidate for admission to one of those asylums for female
inebriates which shock the readers of newspaper advertise¬
ments.
The human frame is no tone that can bear habitual disregard
of its requirements, or habitual trifling with its com plicated
mechanism. There is a limit to its power of adapting
itself to circumstances, which, when reached, everything
begins to go wrong, and disease is the result. The chemico-
vital operations momentarily taking place in the body re¬
quire for their performance a perfect adjustment of func¬
tion and structure, which brooks no interference with
impunity. Each thought, each movement, implies a waste
of the cell structure of the body ; albuminous food is
necessary to repair the breach caused by every bodily or
mental development of force, while hydro-carbons, such
as sugar, starch, and oil, supply material for the combus¬
tion which maintains animal heat. Oxygen must be received
in due quantity at the lungs, and applied to further the
changes which must take place in the debris of the struc¬
tures before they can be cast out of the system. If the
balance between waste and nutrition is equally kept up,
and sufficient repose enjoyed to enable each part of the
body in its diurnal revolution to recover itself after exer¬
tion ; if exercise of the moral, social, intellectual, and
religious faculties accords with the amount of ability,
physical and mental, which each man possesses, then life
ought to run on in an uninterrupted stream, and terminate
painlessly after a peaceful old age. But the stormy life of
adversity and toil, the vicious pursuit of sensational ex¬
citement, the accidents to which all are liable, and the
unnatural customs of civilised man, interrupt the course Of
life, disturb the equilibrium of the system, and give rise to
diseased conditions of mind and body.
Two great sources of vitality exist in every human being,
generating voluntary and involuntary force, the 'one pre-
Sding over thought and action, the other over the more
directly animal functions. It would seem that one of these
may be developed at the expense of the other, so that with
apparent physical force there may be low animal power.
It may be that the prodigious exertions in thought and
deed of the men of this generation have developed their
brains and voluntary muscles at the expense of those in¬
ternal organs which support animal life, but, however that
may be, certain it is that a condition of low vitality marks
the generation, and becomes apparent when accident or
disease have disturbed the harmonious co-operation of the
r ous functions of life. It was not without reason that
Paul wrote to the overworked Bishop of the early
Church, “Use a little wine for thy stomach’s sake, and
thine often infirmities,” for the labour of organising a new
Church amid prejudice and persecution must have been
most exhausting. But although this first recorded pre¬
scription of alcohol as a medicine proceeded from such a
high, moral, and religions authority, there are well-inten¬
tioned ihen mistaken enough to carry their extreme teetotal-
ism even to the bed of sickness.
Physiology and chemistry, aided by modern appliances
tof discovering and analyzing vital operations, have of late
j&ub explained many things which our ancestors con-
mysterious, and have thus gradually affected a
cfisup in the practice of the healing art. Now, instead of
bliiiSy groping after specifics by which to cure disease,
atuijpftr&rt nature, the physician often has to recognize in
tbfcqHHftxyim of disease, an effort of the system to free
itco|tooin something which, generated within, or received
toaqfiitotoN^ hi opposed to its operations ; he sees before
him the vitality of the sufferer engaged in mortal conflict
with a deadly foe, and instead of arawing away the life
blood, and starving out the garrison, he throws in supplies
through every available channel, and assists nature to
expel her enemy in her own way. Food thus becomes the
most important ally of the physician ; but unfortunately
the digestive organs generally share in the general depres¬
sion of the system induced by disease, and cannot further
those chemico-vital operations through which food has to
pass before it can be changed into vital force.
It is under these circumstances that alcohol, which is
directly absorbed by the veins of the stomach, and enters
the circulation in a few moments, becomes all-powerful,
and by a fourfold operation, conducts many a sick man
past the very jaws of death to a renewal of life.
It is a question still under debate whether alcohol is
food or not , 1 recent experiments would lead us to believe
that it is so, although, even as a hydro-carbon, it is much
inferior to sugar, starch, or oil; but its action in disease
is quite independent of any such assumed power, for
even if it be admitted that it adds no real force to the
system, it undoubtedly calls latent force into action through
its primary influence on the languishing nerves. Just as
in one of those boat-raco* which attract the eager and in¬
terested spectators of manly feats, emulation, ambition,
hope, and a ringing cheer for the university, without add¬
ing anything to the power of jib, freshman, or fellow
commoner, stir up the latent energy, and put on the spurt
which drives them in to victory, outdoing themselves as
well as their competitors ; just so alcohol spurs the vis-
nervosa, and tides over the critical, and what without it
would often prove the fatal day. But it does more than
this, for it tends also to rouse the dormant power of diges¬
tion, secretion, and excretion, so that food may be again
assimilated, and poisons expelled from the blood. Further,
in most acute diseases, a rapid oxygenation is consuming
the tissues, maintaining febrile heat, and burning off the
supplies of life’s garrison, this alcohol tends to cheeky for,
in common with all hydro-carbons, it has a powerful affinity
for oxygen, and by appropriating that element to itself,
makes a diversion in favour of vitality, and economises ex¬
isting supplies ; this latter object is also effected through
the secondary narcotic action of alcohol. Thus, as I said
before, alcohol is a medicine of fourfold operation in dis¬
ease, and expended as it is in accomplishing the purposes
for which it is given, it does not intoxicate, and may be
consumed with safety in much larger quantities than in
health. Just as the boiler of a steam-engine is safe while
the locomotive moves . freely along the rails, and the
mighty force within is expended in propelling the ponder¬
ous mass, but bursts if the machinery is arrested, unless
the safety-valve permits it to escape ; so when the system
is below par, alcohol expends its force in raising it to par,
and when too rapid oxygenation is consuming the tissues,
the hydro-carbon, by diverting oxygen to itself, preserves
the structures from excessive waste. But how different its
effect in health, especially during youth, when the func¬
tions are habitually above par for purposes of growth and
development, and when oxygen, the great purifier, is more
especially required to perfect the ceaseless changes oh
which rapid motion depends ! Then alcohol creates a
morbid excitement which is followed by a corresponding
depression ; that depression necessitates a further supply
of the stimulant—a hair of the biting dog—as the saying
is, for its cure. This affords temporary relief, but at what
a price ! for still greater depression soon steals over the
victim, and in time an instinctive craving for alcohol is
established, as strong as hunger, as uncontrollable as thirst.
A revolution has taken place in the nutrition of the body,
and every microscopic cell of the millions which compose its
tissues and organs thirsts for alcohol, instead of hungering
for food.
(To be continued.)_
1 See experiments by Dr. A. Fiek and Dr. J. Wislicenus, quoted in
Dr. Letheby’s 2nd Cantor Lecture on Food, Medical Pbkss axd Cib-
cular, February 26, 1868. (The author is unable to refer to the paper
in which he lint read these experiment*.)
e
'Ote Jlcdicc Pren tnd Circuit. FOREIGN MEDICAL LITERATURE.
Aognts.m
Jfarwpt gjftfrktl §tata.
PROFESSOR BAMBERGER ON
ACUTE POISONING WITH PHOSPHORUS.
(Reported by C. Abbo.)
Translated from' the Norsk Magaxin /or Lagevidenakaben, xxii. Bind.,
3 Hefte, Christiania, 1868, by
W. D. MOORE, M.D.Dub.et Cantab., L.K.Q.C.P.I., M.R.I.A.
HONORARY FELLOW OF THB 8WKD18H BOCIXTY OF PHYSICIANS ; OF
THE NORWEGIAN MEDICAL SOCIETY; AND OF THE ROYAL MEDICAL
SOCIETY OF COPENHAGEN*, SECRETARY FOR SWEDEN, NORWAY AND
DENMARK, TO THB EPIDEMIOLOGICAL SOCIETY OF LONDON.
(Continued from page 107.)
The anatomico-pathological phenomena were in general the
same as have been observed and described by others. The
animals experimented on were rabbits, whose stomachs are
almost always filled with tolerably consistent ingesta. The
mucous membrane of the stomach was often entirely intact,
which, perhaps, depended partly on the fact that the granules
of phosphorus, divided in the food, did not always come in
contact with the wall of the stomach. Sometimes circum¬
scribed hyperemias and ecchymoses were met with; never
ulcerations. The mucous membrane of the duodenum was
usually also swollen; sometimes it was suffused with blood, but
never ulcerated. The jaundice, whWh is so constantly observed
in phosphorus poisoning, must therefore be regarded as gastro¬
duodenal (as which, moreover, Munk and Leyden considered
it) if it should be shown that a similar affection of the duodenal
mucous membrane* occurs also in men after poisoning with
phosphorus. A peculiar alteration of the cells in the pepsin-
glands in the stomach, observed by Virchow, was seen by Bam¬
berger only once in his animals. The rapid occurrence of fatty
degeneration of some organs, which was often demonstrable
even after two or three days, was always striking. The liver
frequently consisted, as it were, of a single fatty mass, so that
scarcely an hepatic cell was discoverable which did not contain
drops of fat. The kidneys were also in a state of advanced
fatty degeneration; they were large, of a yellowish appear¬
ance. The urinary canals in the cortical substance were quite
filled with fat. The epithelium was, for the most part, in a state
of degeneration, and was loaded with fat. The pyramids were
less degenerated.
This degeneration gave Bamberger the idea of a passive
process. He could scarcely look upon it as active. In the
muscular structure of the heart the transverse striae were in¬
distinct, or entirely wanting. The fibrill® were studded
throughout with drops of fat. In almost all the organs haemor¬
rhages or petechiae were met with. They were particularly
numerous in the lower lobes of the lungs.
To demonstrate the presence of phosphorus in the blood, he
took at different times blood from various parts of the vascular
system, as from the carotid artery, the inferior vena cava, and
the vena portae. The first experiments were negative. It soon
appeared, however, that this negative result depended on de¬
fects in the method of investigation; for, as phosphorus in the
form of vapour is very volatile, it might be volatilized even in
the preparatory manipulations. In the examination of the
parenchymatous organs this must take place to a still higher
degree, as, for the sake of investigation, they must be intro¬
duced into the vessel in small pieces, and must therefore in
every case remain long in contact with the air, whereby eva¬
poration and oxidation are favoured. To avoid this Bamberger
introduced a small glass tube into the vessel from which the
blood was to be taken, oonnected this with an Indian-rubber
tube, into which, again, a bent glass tube was inserted; this
last was conducted into a receiver containing a solution of
sulphate of soda, to prevent the coagulation of the blood. In
this mode the blood drawn scarcely came into contact with the
atmosphere, and Bamberger then succeeded in demonstrating
the presence of phosphorus in the blood from the vena cava,
beyond the junction of the hepatic veins, which must there¬
fore have passed unchanged through the capillary system of
the liver. On the other hand, it was not possible, after the
internal administration of phosphorus, to demonstrate its pre¬
sence beyond the pulmonary circulation in the blood from the
carotid, but if the phosphorus, dissolved in oil, was injected
subcutaneously, it could be demonstrated in the blood from the
carotid—a proof that it can pass, partly unchanged, even
through the capillary system of the lungs.
From these experiments Bamberger came to the conclusion
that phosphorus volatilizes in the stomach, and that the vapour
of phosphorus there formed comes by diffusion unchanged into
the mass of the blood (as the volatilization of phosphorus takes
place with tolerable activity at the ordinary temperature, it
must be decidedly favoured by the higher temperature of the
stomach). Once taken into the blood, it circulates with the latter,
becomes gradually oxidized by its oxygen , but at the same time
produces essential changes in the organs.
This condition of the phosphorus in the system having been
discovered, the question remains as to the fatty degeneration
of the organs. This process is allied most closely to the acute
yellow atrophy of the liver, though in phosphorus poisoning the
fatty change is much more rapidly established. In this case
a specific effect of phosphorus suggests itself, and we must dis¬
tinguish between many possibilities. It is well-known that
phosphorus dissolves in fats and oils; as the blood contains
from one to three parts of fat in a thousand, it was conceivable
that the phosphorus dissolved in this fat, was separated with
it, and thus caused the fatty infiltration of the organs. Or it
might be assumed that the albuminous bodies of the blood were,
under the influence of the phosphorus, transformed into fat, as
under some circumstances a metamorphosis of albumen into
fat is observed; or, finally, the metamorphosis of the fat of the
body might be hindered in one mode or another. In the first
case the blood would become impoverished in fat; in the second
and third cases an excess of fat must be met with. To discover
the true state of the case Bamberger instituted some experl*
ments upon rabbits.
In the first place the amount of fat in the blood was ascer¬
tained in two healthy rabbits, and in one it was found to be
2*656, in the other 1*041 per mille; thus there are considerable
differences even in the healthy state, as Becquerel established
in man also a variation from 1*0 to 3*3 in health.
Further, the amount of fat in the blood of a rabbit which
had fasted for a long time v was estimated, and found to be
2*087—this result is nearly the mean of the first two value*.
(This experiment was necessary, as the rabbits to which phos¬
phorus is administered for several days do not take any
nourishment).
Lastly, the fat was estimated in two rabbits, one of which
had in four days got 40 mgrm. of phosphorus, in it 1*322 of
fat was found ; the other had in five days used 50 mgrm. of
phosphorus, and the amount of fat in the blood was 0*891.
A diminution of the amount of fat was therefore demon¬
strable, but it does not appear to be so considerable as to b*
Available for any definite theory ; such a diminution might
be explained, also, by other causes than the administration of
phosphorus. In no esse was there any increase of the amount
of fat. It may, therefore, be assumed, that the phosphorus taken
up into the blood effects such a change in the latter, that it be¬
comes quite unsuitable for the nutrition of the organs , and that
therefore the several organs fall into a state of retrogressive
fatty metamorphosis , an acute marasmus, or it may be assumed
that phosphorus supplied to the several organs , produces a nnc
formation of fat in them. Bamberger, however, considered
the first alternative to.be the more likely.
If the mode of action of the phosphorus were once ascer¬
tained, it would seem to be important to discover a suitable
mode of treatment.
If phosphorus in the state of vapour has passed into the
blood in large quantity, we can scarcely expect anything
from medical treatment; at the most, transfusion might be
tried, jus^ as it has been employed, with some advantage, in
poisoning with carbonic oxide. If in any given case it be
probable that phosphorus still exists in the stomach, vomiting
ought in every instance to be produced, though emetics sre
often of little use, as the particles of phosphorus adhere rather
firmly to the wall of the stomach, and this organ does not
always contract completely. The treatment now employed,
consisting in the administration of magnesia, is scarcely of any
use ; for magnesia can act only as an alkali against the pro*
duett- of the oxidation of the phosphorus, by neutralising
them, but these are to be considered as not injurious to the
stomach.
Buflos proposed another method, namely, to give oxidizing
bodies, and he recommended liquor chlori with magnesia usta,
it was intended thus to hasten the oxidation of the phos**
phorus, and that the products Bhould combine with the
magnesia. Some assert that they have seen favourable results
from this plan, others say that death has been at least post¬
poned by it; most observers saw no result from it. Practi¬
cally, we can scarcely promise much from this method, as the
preparations of chlorine decompose so rapidly. As phos¬
phorus acts in the system in the form of vapour, it is hn object
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lb* lfedkal Pm. and Circular, CORRESPONDENCE. August 6, 1M8. .138
to discover a remedy, capable of limiting or preventing ite
Volatilization. Bamberger found that phosphorus, brought in
small granules under water into contact with a solution of
sulphate of copper, and heated to from 77° to 88*2^ Fah.
soon acquired a black colour, which gradually extended
beneath, while the surface acquired a metallic lustre, until
Anally the whole cortical layer consisted of metallic copper.
The pieces of phosphorus thus coppered no longer shine, have
oo smell of phosphorus, and when heated (even to 99 5° Fah.)
give not the slightest trace of Scherer’s reaction.
By this coppering the volatilization is therefore to a great
extent limited. To this, it might certainly be objected, that
the system is no retort, and it might be doubtful whether the
sulphate of copper would act similarly in the stomach ; Bam¬
berger believes, however, that its action would be the same
whether the stomach were empty or full, its Contents acid or
alkaline. On the other hand, it will probably be rejected by
vomiting, and to continue its use it must be given in a rather
•dilute state, or another salt of copper, which does not produce
vomiting, must be employed. Such a salt is the carbonate,
whose effect may be promoted by the addition of vinegar and
a gradual change to acetate of copper. He would, therefore,
propose the following treatment :—
First give sulphate of copper as an emetic, after repeated
vomiting give it still in smaller doses, and if it be not borne,
substitute the carbonate in doses of from five to eight grains
suspended in water, drinking after it a teaspoonful of dilute
vinegar. At first, this dose must be given every quarter or
half-hour, afterwards at longer intervals. Between the doses
let the patient take cold things, iced water, ice in small pieces,
in order on the one hand to combat the symptoms of gastritis,
on the other, by the lower temperature to diminish the volati¬
lization of the phosphorus. After some hours, the emetic is
repeated to remove the portions of phosphorus now covered
with copper, which may still remain, and which no longer
■adhere so firmly to the wall of the stomach.
Bamberger had not as yet been able to institute satisfactory
experiments, for the animals at his disposal were rabbits and
dogs ; but the first have the stomach always filled with a
quantity of food, and the latter usually vomit every foreign
substance very rapidly, and neither, therefore, appear to be
well suited for experiment. He has as yet had no opportunity
of trying this treatment on the human subject; should this
treatment also prove to be defective, he believes, nevertheless,
that with respect to it, the proverb may be applicable : “ Inter
ocecos monoculus rex.”
-♦-
€ttTTt8$inxbtnct.
OXFORD MEETING OF BRITISH MEDICAL
ASSOCIATION—
ARRANGEMENTS FOR AN ANNUAL MUSEUM
TO THJB EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Bib, —At the meeting of the British Medical Association, to
< be held in Oxford next week, an Exhibition Room will be set
apart as a temporary Museum. It is proposed to collect in it
* say objects of professional interest recently obtained.
The following are especially contemplated :—1, Instruments
and surgical appliances; 2, Casts, models, photographs, draw-
frg*. Ac., illustrating subjects in connection with medicine or
surgery ; 3, New drugs, or pharmaceutical preparations ; 4,
1 Pathological preparations; 5, New books, especially those
.WM it ai ning illustrations; 6, Models, Ac., of inventions relating
to hygiene, Ac.
As far as may be, objects exhibited ought to be new within
the last twelve months, but this limit need not be rigidly
observed.
1 AM objects intended for exhibition sbonld be consigned to
the care of Dr. Gray, the University Museum, Oxford. The
authorities of the museum have kindly set apart a commodious
room for the purpose.
The Annual Museum will open on Tuesday morning and
remain open tiff Friday evening. Objects for exhibtion should
be removed on Saturday the 7th.
. Exhibitors must defray all the expenses of packing, oarriage,
■ Ar- ‘No object can be displayed unless accompanied by a con-
am description.—I am, dear sir, yours truly,
Jonathan Hutchinson,
, < * ' < Hon. Sec. in London for the Museum.
^Jfatifcavy Circus, B.O., July 29,1868..
UNDERPAID POOR-LAW MEDICAL OFFICERS IN
ENGLAND.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir, —Many thanks for your notice of my case ; the Poor-
law Medical Officers in England are under a debt of gratitude
to you for ‘'hitting the right nail on the head.” My friend,
Dr. Paton, who was staff-surgeon of the Turkish, Contingent,
afterwards held an appointment as Medical Officer in the
.Morpeth Union ; well, he threw it up for an increase of salary,
it was only £5. The Guardians advertised in vain, no one
would take it at that sum. They raised it to £10, but no
sooner was this done, than the Doctor found “ There was an¬
other Richmond in the field,” and more provoked than ever to
find a brother practitioner ready to oust him for this paltry
increase, he, very unwilling, solicited and obtained the ap¬
pointment. On his succeeding to the appointment of surgeon
to the workhouse, he again threw it up. By this time hUl
former rival had “ vanquished left the field,” and although a
newly fledged, single, qualified man had spread his pinions, he
would not accept the duties for £10, so the Guardians quietly
offered him £15, which he accepted. Now, sir, I say you are
right, and if it was not for the perfidy and treachery of our
own brethren, we would soon be recompensed according to our
work. “ It is true, and pity ’tis, ’tis true,” that men will in a
public capacity (such as Guardians; do and say things that as
private individuals they would be ashamed of.—I am, yours,
Ac., J. C. Reid, M.D.
UREA AND URIC ACID.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir,—A s I have long been of opinion that uric acid in the
human system is the immediate result of a deficient supply of
oxygen in the blood, and consequently, that the only rational
treatment for removing it consists in such processes as favour
its elimination, combined with an increased supply of oxygen
to the blood, and a diminution of the supply of nitrogen, which
principally enters the system in the form of animal food.
I will not now, however, enter into the best means of favour¬
ing the elimination of uric acid, as my principal object is to
show that it arises from a deficient supply of oxygen , or excess ot
nitrogen in the body, and will accordingly be found most fre¬
quently to afflict the carnivorous, and those leading a seden¬
tary existence. Now for the proof—C l0 H 4 N 4 0 8 are the
chemical equivalents of uric acid, if 4 atoms of water = 4 H, O, be
added, we have Ci 0 H 8 N 4 O 10 = C 4 H 8 N 4 0 4 + 6 (co) = 2 atoms
of urea (C, H 4 N s 0.) + 6 (co); if to this product be added 6
atoms of oxygen = C, O, we have 2 atoms of urea -f- 6 car¬
bonic acid 6 (C 0 3 ) = 1 atom of uric add -j- 4 atoms of water
+ 6 atoms of oxygen; thus showing that 6 atoms of oxygen,
in addition to 1 atom of uric acid, are required to form 2 atoms
of the soluble substance, urea, and to oxydate thoroughly the
accompanying 6 atoms of carbon. Hoping this formula, which
I am not aware has ever been presented to the profession
before, may reconvert Dr. Kelly to his. former sound opinion,
and influence medical treatment accordingly, I remain, your
obedient servant, Richard Griffith, jun., Cb. M.
Cork, July 23rd, 1868.
THE TREATMENT OF ACUTE RHEUMATISM.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —As I think many of your readers are not aware of th e
extraordinary efficacy of valerian, adminstered in the form of
a bath, in subduing the pain and inflammation attending
acute rheumatism, particularly of the arthritic form, and con¬
sider I am merely fulfilling a duty to the profession and public
by mentioning it. It was first introduced to my notice by my
friend, Dr. Adrien—a name known and honoured in the annus
of Dublin surgery—since which time I had opportunities of
testing and proving its wonderful power of arresting and cut¬
ting snort the most violent attacks of acute rheumatic arthri¬
tis. The bath is made simply by taking lb. i. of valerian root,
boiling it gently for about a quarter of an hour in one gallon of
water. Straining and adding the strained liquid to about
twenty gallons of water in an ordinary bath. The temp,
should be about 98°, and the time of immersion from twenty
minutes to half an hour. Pains must be taken to dry the
patient perfectly upon getting out of the bath. If the in¬
flammation remain refractory in any of the joints, linseed meal
poultices should be made with a strong decoction of valerian
root, and applied.—I am, sir, yours, Ac.,
N# J. Boqfb, L.CUU*, A?*
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184 The Medical Press and Circular.
Medical news.
Augusts, 106 .
SICK CLUBS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—Y our remarks (in your article “ Sent to Coventry”) upon
sick-clubs, in your issue of July 15th, reminds me that, there
are many sick-clubs in Dublin, and some especially which, if
report speaks truly (which I do not positively assert it does)
require even more revision as to tariff than those referred to in
your article.
I should like to know who are the medical officers ! What
Is the subscription ? and what are the salaries of, the members
of Certain sick clubs, which I understand exist in connection
With rank in this city ? I should also like to be informed if it
Ibe true, that Civil Service Clubs, with salaries of £500 and
£600 a-year obtain medical advice for a subscription of £1
jffir head per annum to the Civil Service Medical Attendance
Aiisodatlon T—Yours obediently,
An Hospital Physician.
Dahlia, July 1668.
gPrical’ ffefog.
Royal College op Physicians of London.—
At a general meeting of the Fellows, held last Thursday, July
30th,“the following gentlemen, having undergone the necessary
examination, were duly admitted members of the College :—
David Anderson Moxey, M.D., Edin., Edinburgh House,
Tumham-green; Joseph Frank Payne, M.B., Oxon., St
Marv*s Hospital, Paddington ; John Jones Phillips, M.D.,
Lana., Guy’s Hospital > Thomas Pigg, M.D., St Andrews,
Manchester ; Joseph Rutter, M.D., Loud., Brighton ; Robert
Temple Wright, M.D., Edin., 10, New Ormond-street.
Edinburgh Philosophical Institution. — On
Wednesday evening a meeting of the members of this Institu¬
tion was held for the purpose of electing a successor to the late
Lord Brougham as president. Mr. William Smith, vice-presi¬
dent (who occupied the chair), moved that Mr. Thomss Car¬
lyle be elected. Professor Masson seconded the motion, which
was unanimously agreed to. The Chairman then stated that
it afforded him sincere gratification to announce, on the part
of Mr. Carlyle, his acceptance of the office, and to convey the
thanks of that gentleman for the honour the meeting had con¬
ferred upon him.
Royal Medical Benevolent Fund Society of
Ireland. —A Meeting of the Central Committee of the
above Society was held on 28th ultimo. Mr. Tufnell in
the chair. The secretary read an application for relief
from the widow of a medical man recently deceased.
The husband died from pyemia, subsequent to a frac¬
ture of the neck of the thigh-bone, which he received by
a fall from his car, when proceeding at night to a patient.
He was a comparatively young man, and had been unable to
lay by anything or insure his fife ; he leaves a widow and 12
children totally unprovided for. This case was strongly re¬
commended by the Local Branch for the largest grant that,
could be given, but the hon. treasurer stated that there was
only £2 in hands. The committee should therefore have been
obliged to refuse a grant, were it not for the liberality of one
of t^e members, who advanced £15 till funds were available.
The treasurer was instructed to send this sum to the local
secretary, and a vote of thanks was passed to the member who
bo handsomely and generously came forward in this emergency.
The British Association.— At a meeting of the
representatives of the various public bodies and learned and
scientific societies in Edinburgh, held on Thursday, the Lord
Provost presiding, a committee was appointed to take the re¬
quisite steps for inviting the British Association to meet in
tnat city in 1869. Sir George Harvey, Professor Christison,
Professor Balfour, Professor Spence, Professor Duns, Sheriff
Maitland Heriot, and others took part in the proceedings.
Dipsomaniacs.—T he Lunacy Board for Scotland
in a former year’s report expressed an opinion that persons
nnable to resist the the tendency to exoessive drinking should
be allowed to place themselves under control and treatment
without authority from the sheriff. The Board have now to
state that, by the Lunacy Amendment Act, 1866, asylums are
authorized to receive for care and treatment any person who.
wpimw in writing to the Commiiwioners in Lunacy his wish,
to become a voluntary pAtient, and obtains their consent, and
that this provision was taken advantage of in 1867 in Scotland
by 17 persons ; 14 were admitted Into public and three into
private asylums. These patients, however, were not neces¬
sarily all dipsomaniacs.
At a recent meeting of some of thegentlcaeftto.
teres ted in a charity called the tl Jewish Blind” a remarkable
case was brought under the notice of president, Sir Benjamfc
Phillips. A woman (stone blind) has been in receipt of a pen¬
sion for about eight years. Daring a heavy storm that pre¬
vailed some weeks since, she became suddenly aware, as tin
expressed it, of “ a glimmer of light,” and from that time te
the present her vision has improved daily ; perfect eyesight 4i
now restored to her. The podr Woman expresses hertrifas
having been “ greatly shocked” at the thunder and lightning.
Statistics of Insanity in Scotland.—T he
Board of Lunacy for Scotland state in their tenth report,
which has been laid before Parliament* that the mortality is
Scotch asylums compares favourably with that in English and
French establishments. In the five years 1862-66 the
annual rate of mortality on the average numbers re mdmtt h
Scotch asylums was 8*24 per cent.; in English Myflttns,
10*39 per cent ; in French (1854r66), 14*03 per ceat. la
all three countries the male mortality was greater than the
female ; but the excess was less in Scotland than in England
and France. The proportion of -recoveries, from inasaityiie
also considerably more favourable among females thanamosfr
males. According to a table issued by the Sootoh Board
showing the admissions into Scotch asylums from 1856 t#
1867, it appears that of every thousand patients who ,»
covered in the 10 years, 431 were males and 569 females
In 1867 the proportion of female pauper lunatics to enty 100
male pauper lunatics was 116. The returns, however, do art
supply means of making a safe deduction of the relative tsa-
dency of the sexes to insanity. The proportion of the whole
number of pauper lunatics to population in Scotland on the
1st of January, 1866, was 1*826 per 1000; the average of tin
preceding seven years 1*742 per 1000. The proportion varied
greatly in different [counties. As a rule, it may be assumed
that there is a greater degree of mental activity among an
urban and manufacturing population than among an agricul¬
tural, and to this fact may possibly he ascribed themorafl*
quent occurrence of insanity among the former. But it unit
be taken into account that the increase of fitnacy is fend
chiefly among the lower classes, who do not display much
mental activity anywhere, but who are more exposed in urban
and manufacturing communities to overcrowding and impure
air, exhausting labour, insufficient diet, abuse of stimulant*,
and contagious diseases. Over-excitement of the intellect or
feelings is doubtless a not infrequent cause of insanity; but
among pauper lunatics in asylums the oases which originate in
this source are few in comparison with those which aa .doe
to physical deterioration. The total number of insane per*
sons in Scotland, of whom the Board of Lunacy had official
cognizance on the 1st of January, 1867, was 6762; 5594 rap*
ported by parochial rates, 1168 by privatefunds; 3178 malm,
8584 females. There were also 45 criminal lunatics in Berth
prison, making 6807; and there was a considerable number
of cases not known to the Board, maintained in private dwell¬
ings from private resources. The admissions into puhliceitoh
tishments in 1867 comprised 805 males and 900 females ; the
recoveries were 303 males and 401 females. In the ten years
1868-07 the admissions were 6199 males and 6996 femidrt;
the recoveries, 2455 males and 3242 females ; the deaths,
1927 males and 1761 females.
A considerable number of distinguished litettiy
and scientific men of New York have recently met.Jor.-Jbe
purpose of discussing the advisability of founding, an American
Academy on the model of the French Institute.
- 9 -
girty smb
BIRTH.
Kouan.-r-On August 1st. at Bagafcot, Sum
Hough, Esq., M.A., M.B., of a daughter.
DEATH.
Bbaul.—O n the 14th July, at Docking, Norfolk, B» fifiael , M*>
Burgeon, aged 7$ycaxs.
BIRTH. , »
1st. at Bagafcot, Surrey, the wife oi Bdlrtt
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 12, 1 868.
CONTENTS.
LECTURE.
The Use and Abuse of “Stimulants."
B j*W. Jackson Cummins, M D., Phy¬
sician to the Cork 8outh Infirmary and
County General Hospital, Ex-President
Cork Medical 8odety, Ac. face 185
•HOSPITAL REPORTS.
Citt or Dobum Hospital—
Luxation of Lower Jaw (double);
Luxation of Lower Jaw (single). ’
Under the care of Mr. Groly. 180
t)a. 8 teevexs* Hospital—
Exophthalmia : Recovery; Fracture of
8upta-orbital Plate by Contrecoup:
Death. Under the care of Mr. Collfie..
Xixa’s ColleokHospital—
Case* under the care of Dr. Beale, F.R.S.
139
139
FOREIGN MEDICAL LITERA¬
TURE.
Recent Contributions to the Theory of
the Innervation of the Heart and
Blood-veesels. Translated by ;W.
D. Moore, M.D., Dub. et Cantab.,
M.R.LA., LK.Q.C.P.1. 142
LEADING ARTICLE.
Army Medical Officers. 146
LITERATURE.
Lectures on Clinical Medicine. By A.
Trousseau. Translated and edited
with Notes and Appendice by I*.
Victor Bazirc, M.D..... 145
A Collection of the Published Writings
of the late Thomas Addison, M.D.,
Physician to Guy’s Hospital. Edited,
rioi
with Introductory Prefaces to several of
the Papers, byDrs. Wilks and Daldy... 145
NOTES ON CURRENT TOPICS.
Medical Honours at Oxford.—Nominda-
ture of Diseases.—Sir James Simpson.
—The late Mr. Travers.—The Cattle
Plague. — Sunstroke. — Junior Uni¬
versity Club, Dublin.—The Plague of ^
Flies.—Bathing.—Pepsine Biscuits.146-8
CORRESPONDENCE.
I. Ashe,—Letters on Medical Reform.—
No. II. 168
MISCELLANEA.
Report on Wine and ite Adulteration
No. VII. ( Illustrated ) .140
The British Medical Association. 148
Medical News,—Obituary Notices, Ac... 1&4-5
%tctnxL
THE USE AND ABUSE OF “ STIMULANTS."
fey W. JACRSON CUMMINS, Mb.,
PBYSICIAX TO TP* COBIC SOUTH IVFIBMARY AND COUNTY OR*SEAL
HOSPITAL, EX-PRESIDENT CORK MEDICAL SOCIETY, ETC.
(A Lecture delivered before the "Cork Young Men’s Association,’’
January 7th, 1868.)
(Continued from page 181.)
Man in bis natural state has voluntary power, a will which
makes him master of his own acts, being only in subjection
to those instinctive desires which are necessary to the pre¬
servation of life; but when the laws of nutrition are set
aside by the habitual use of alcohol, and natural appetite
has given place to the greed for strong drink, he becomes
bondslave to a hard taskmaster, which robs him of voli¬
tion, intellect, morality, health of body, and peace of mind,
and becomes 44 like a weed.”
“ Flung from the rock, on ocean’s foam to sail,
Where’ef the surge may sweep, the tempests’ breath prevail.’’
I have seen delirium cease under the influence of intoxicat¬
ing doses of wine and brandy during fever, and I have
seen, in the same person, much smaller quantities produce
the delirium of intoxication after the crisis had been passed
through. While the fever was present the alcohol never
accumulated in the blood as alcohol, being rapidly decom¬
posed by the union of its carbon with oxygen to form car¬
bonic acid, and of its hydrogen with another part of oxygen
to form water. As I have already told you, this union
with oxygen is beneficial when feverish combustion of the
tissues by that element is taking place; but the very oppo¬
site is the case in health, when oxygen, which is received
into the blood at the lungs is the chief source of its depu¬
ration.
It is so necessary, that if its entrance is completely shut
off, as in drowning or suffocation, carbon, a deadly poison,
generated within the body, accumulates with such rapidity
that life becomes extinct in a few minutes. Now, it is quite
that where the quantity of oxygen which can be
fahale d is limited, and where a plentiful supply is required
fct the removal of the debris of the tissues, any agent
HWtfob appropriates oxygen to itself must cause death slowly
in the same way that suffocation does quickly, by depriv¬
ing fee body of oxygen, and thus allowing hyarocerbo-
“- : —i to accumulate \a the system. Thafe who
are given to the gentle sport of trout-fishing, anathematise
the Tittle country boys who throw lime into the mountain
streams in summer, in order to catch the suffocating fishes,
as they float upon the surface of the water; but it is not
generally understood that the young poachers are only
doing for the trout what the dram-drinker does for himself,
by putting in a substance which, having an affinity for
oxygen, deprives the water in one case, and the blood in
the other, of what is as necessary to the existence of fishes
as of men.
When we consider this simple truth, we cannot be sur¬
prised that the system has a remarkable intolerance of
alcohol, and endeavours to cast it out as quickly as pos¬
sible, so that unless the dose is so frequently repeated that
one overtakes another in the blood, accumulation cannot
take place, and evil does not result. But the habitual use
of alcohol in any form first overtaxes the organs through
which it is removed, and when they fail, a gradual accu¬
mulation, not only of the poison itself, but also of the un¬
oxidised impurities generated within takes place, and in
time the body becomes a very charnel-house of corruption,
a body of death chained within the body of life.
One of the latest and best authorities of the day 1 enume¬
rates no less than twenty-six diseased conditions of mind
and body directly due to alcohol, and I told you before
that it is said that 60,000 lives are annually lost in Great
Britain through its direct or indirect effects. This is fear¬
ful to contemplate, even in a social point of view, but how
appalling when we consider the value of each immortal
soul which thus rushes with suicidal precipitancy into the
presence of its Maker ! Truly; we cannot help exdaimin
with Shakespeare— 44 Oh, thou invisible spirit of wine, if
thou hast no name to be known by, let us call thee devil!”
Time does not permit me to enter more fully into the
positive ill effects of the abuse of alcohol, and with a few
words I must pass over its negative evils. Each of ns is
accountable to our Creator for every thought and act, and
every talent committed to our care ought to gain another
talent, besides, if we would please Him who has called us
to be His stewards. Surely every one who has indulged in
more than a very moderate quantity of alcohol must feel
and know that he has unfitted himself for the performance
of his duty to God and to his neighbour, as a condition far
short of intoxication diminishes both moral and physical
self-control, as well as the full power of body and mind.*
1 Aitkin’s " Practice of Mcfiidnfc,
9 FftfMr
©ogle”"
i The Medical Kress and Circular.
CtfMMlNS’ LECTURE.
Angruttt,m
One of the ablest physiologists and physicians of the day
says that, “ If we look upon the body as an agent of work,
from which we desire to obtain as much mechanical and
mental force as is compatible with health, we must consider
the effect of alcohol as simply a means of preventing the
development of force.” Now, as responsible beings, I
maintain that we have no right to trine with our bodily
or mental powers, and that we are accountable for the full
measure of usefulness that can be derived from them.
But it may be objected, to this, that instances have oc¬
curred of individuals whose talents never show out in full
brilliancy except when they were well primed with alchol!
such exceptions, however, only prove the rule as laid down
by physiologists ,* and we may well ask ourselves the ques¬
tion—when we ponder over the history of great men,
who had so far become the victims of self-induced dis¬
ease, as to require the spur of semi-intoxication to enable
them to pour out the riches of their genius—we may
ask ourselves, I say, what such men would have been, and
how much greater benefit their less gifted fellow-creatures
would have derived from their talents; had they not
bartered the best part of their lives, and full control over
their super-human faculties for the indulgence of an
hour.
An idea that alchol in moderation is useful as a sup¬
port under prolonged exertion, or exposure to extremes of
temperature is very generally entertained, and nothing
can be more opposed to fact, as testified by those observers
who have had the best opportunities of judging. Many
trainers for athletic sports absolutely forbid wine or
spirits, and those who allow them do so only at meal
time, and in very great moderation ; from this we would
conclude that practical experience has demonstrated to a
class of men whose prejudices would rather lead them to
favour alcohol, that it impedes the developement of force.
Let a sportsman test for himself a hard day’s fagging with
water as a beverage, and another with alcohol in moder¬
ation, and he will assuredly find that his enjoyment has
been keener, his aim truer, and that he returns home less
weary,-albeit with a heavier bag, when he has left the
brandy-flask at home.
I once made a voyage in an American temperance ship,
and was greatly struck by the superior seamanship and
steadiness of the crew, as contrasted with the same
class in ships where I had seen grog regularly served outi
In the late American war it was optional with the colonels
of Federal regiments either to serve out or forbid stimu¬
lants to their men, and we are told that the difference
between the abstinent and temperate regiments, as to
courage, discipline, cheerfulness, and power, was most
remarkable.
Although alcohol is a hydrocarbon, 2 its heat producing
power is inferior to fat, in the proportion of 1 to 2 two-
third, and all experience goes to prove that in the Artie
Regions animal beat can be much better sustained without
it; so well-known is this, 3 that the Hudson Bay Company
has for many years entirely excluded spirits from the fur
countries over which it has control, 4 and among the 700
or more American ships engaged in the whale fishery,
the abstinence principle has been almost universally
adopted from a general conviction of its practical
superiority.
Sir John Richardson,5 the companion of Franklin in
his first Artie expedition, Dr. Kane, Mr. King, Captain
Kennedy, Mr. Goodsir, and other high Artie authorities,
all speak favourably of the abstinence system, so that
there can be little doubt that alcohol fails to protect the
system against extreme cold.
If we turn to the tropics we find, as we should expect,
decided testimony of the injurious effect of alcohol even
in moderation, under exposure to the influences of the cli¬
mate. To U9e the words of Carpenter—“ the advantage of
total abstinence over moderation is evidenced by the ex-
1 Farker “On Hygiene.”
2 On the Physiological Effect of Alohol, by Carpenter.
8 Ibid. 4 Ibid. 5 Ibid.
perience of our Indian army, as the Government returns of
the three classes, of teetotalers, temperate, and intemper¬
ate, authoritively proves.” . . . “ The mortality
of the intemperate was nearly double that of the temper¬
ate, while that of the moderate men was more than double
that of the total abstainers.”
This testimony is sufficient in itself to establish the
fact that neither brandy and water, nor beer, which are so
much partaken of in India, are necessary for the support
of the system under the relaxing heat of the tropics.
Figures also goes to prove that even the moderate use of
alcohol is injurious in a temperate climate such as our
own, for to quote from Professor Millar, “ there is a life
assurance office, last year, issusing upwards of 2500 poli¬
cies, which has two branches, one solely for abstinants, the
other for the ordinary business, the insured in the latter
being of course a fair average of the ‘ temperate’ men.
These two branches, abstinent and temperate, have been
in parallel operation for about seven years, and the result
is 19 per cent, in favour of the abstainer.” 1
Figures drawn from the reports of abstinent and tem¬
perate sick clubs in Preston, show also a remarkable con¬
trast in favour of the former.
I must apologise for quoting so many figures in a lec¬
ture of this kind, but really the information they convey
on an all-important subject cannot take too prominent a
place in a lecture addressed to “young men,” proving
practically as they do, what physiology and experiment
would lead us to expect, that the habitual use of alcohol
even in moderate quantities is prejudicial.
I confess, 1 cannot think, with many, that a glass or
two of the “wine which gladdeneth the heart of man,”
may not, even in health, take its place in our social
reunions, and be safely indulged in moderately, now and
then, by those who have no tendency to take too mach
or to contract a regular habit, provided, also/ they do
not inherit constitutions prone to dipsomania or drunken¬
ness ; for these latter, the smallest potation is unsafe, and
I may add that healthy children should never be allowed
to taste wine until their growth and developement are
complete. 2 In intemperate persons the mortality from 21
to 30 years of age is five times that of the temperate;
from 30 to 40 it is four times as great, and becomes
gradually less as old age advances; apply this law from
20 years back to childhood, and you will see the extreme
danger of stimulants to those of tender years. But to
return, I cannot help thinking also that, taking men as we
find them, it is not always possible to seperate between
the healthy and those who have inherited or acquired a
more or less diseased condition of body, which may be
benefitted by moderate quantities of alcohol, especially
at meal times, and that useful lives can be thereby pre¬
served. After severe or prolonged exertion, too, when the
energies of the system have been too long diverted from
the organs of digestion towards the brain or voluntary
muscles, and appetite has been thereby lost for a time, a
moderate allowance of wine helps the digestive organs to
recover themselves, and also promote subsequent repose.
Alcohol, as many are aware, retards digestion by coagu¬
lating the albumen of the food, if taken in a concentrated
form, or in quantity beyond what is likely to be absolved
rapidly by the veins of the stomach ; but within certain
limits, it tends only to stimulate the gastric secretions,
and improve the tone of the stomach. It is unnecessary
for me to enter into the many forms of indigestion caused
by.the directly irritant effect of alcohol in concentration on
the delicate mucous membrane of the stomach ; you can
demonstrate it for yourselves, more satisfactorily than
could the most eloquent words, by putting a drop of
alcohol into your eye—an organ covered by a membrane
similar to that of the stomach —and you can judge by the
pain and irritation which ensue, what the poor stomach
of the dram-drinker has to endure. .
But there i> in the system ypfrwgr of castgmg out uI
1 Xepbalisxn. 'A * -
2 Nalsoa’s Vital Statistics, quoted in Parke 1 * on Hygu*.
a
4ke Medical Pres tad Circular. CUMMINS’ LECTURE. August 12, 1868. ,
when partaken of moderately, in a dilated form, occa¬
sionally, and .thus preserving itself from injury. It is
perhaps unfortunate, however, that there is also a power
of tolerance, through which the system learns to endure
the immediate effects of the poison when habitually im¬
bibed, and to connive at those silent inroads which in
time consummate the destruction of the most healthy body.
It is against this treacherous effect of alcohol that we require
most to guard ourselves, as it permits the formation of
habit; habit, it is said, is second nature, but in this case
it is even stronger than nature. It often, no doubt, springs
out of the drinking customs of our country, whicn lure
many a man into intemperance, and if there were any hope
that the principles inculcated by total abstenance societies
could succeed in rooting out drinking customs, I would
advocate them with all my feeble power. In the back
States of America, among an unexhausted and well-
nourished population, free and independent, with a virgin
soil before them as they spread themselves towards the far
west, they may succeed, and I believe have succeeded, but
in the eastern over-populated States of the same great
Federation, drinking customs are as rife as in our own land.
I have never seen more drinking anywhere than in New
York—“sheny cobblers,” “mint julips,” “gin smashers,”
“eye opener,” “fog dispeller,” “bottledlightening,” “moral
’suasion,” “brandy coctail,” “smasher,” “illuminator,” and
other Yankee terms for strong drink, tell their own tale of
American national intemperance. There, as here, drinking
pustoms take root in social conditions closely connected
with the Anglo-Saxon character and institutions, and I
cannot help thinking that “ teetotal” principles only create
a minor evil, without any fair probability of removing the
greater.
“ Teetotalism” has been tried under the most favourable
auspioes in this country, and has lamentably failed ; com¬
menced bv a clergyman of our own Church, the Rev.
Nicholas Dunscombe, and carried into every cabin of our
Roman Catholic poor by the great apostle of temperance,
the mild and benevolent Father Matthew, it ought to have
succeeded, if it could succeed, but the circumstances and
conditions of the people were against it, and, although the
enthusiasm and love of novelty of the Celt blazed up in
temperance bands and processions and other excitments
which, for a time, substituted the master passion, the
amount of real good effected was only sufficient to make
thegloom which has followed deeper than before.
The statue of Father Matthew stands in one of our
principal thoroughfares, and beside it, on either side, a
Brilliant palace oi alcohol, 500 1 public-houses in other parts
of this chief city of his labours, also mock his memory, and
defy only too successfully the principles which he spent his
Ufe in inculcating. In other parts of the United Kingdom
the well-intentioned advocates of teetotalism have been
equally unsuccessful, no less than 168,000* establishments
for the sale of intoxicating liquors, in which 83 million of
the capital of the country are annually spent, testifying to
the practical inutility of the means by which they seek to
crush out the great efU of alcoholic abuse.
If the causes of this blot upon our nation are such as I
have endeavoured to point out, we cannot wonder that
“ teetotalism” has thus failed to keep it in check, and we
turn with more hope towards the progress of social science,
as a means of mitigating, if not eradicating, the evil.
The first and most important aim of philanthropists who
are anxious to overthrow drinking customs ought to be to
raise the religious, moral, and social character of the people,
and endeavour to impart to all classes some practical
knowledge of the physiology of common life, and the
means by which a healthy condition of mind and body are
beat maintained: moderation in business and pleasure
should next be inculcated by precept and example, and
heavy penalties should be imposed upon those who over¬
work dbildren. and deny them the physical and mental
, ITha author fa indebte d for thece figures, to Henry Humphries, Esq.,
(jUn fjm uMf llrira flUlITt.
t Botov of General How's speech in “ Blackwood," Aug., 1887.
training which are essential to the proper development of
their bodies and minds. 1
Public baths and wash-houses should stand in every
thoroughfare, and both cold and hot water should be
liberally supplied, in order, if possible, to entice the lower
orders into habits of cleanliness.
The Turkish bath, as a substitute for strong drink, is not
at all as well-known or appreciated as it should be. Its
effect is to carry out of the system those impurities which
bad air, bad water, and bad food introduce mto it, and it
is a substitute for the exercise which many of the inhabi¬
tants of large towns have neither time nor energy to enjoy.
It is, besides, a gentle stimulant to the nervous system,
which leaves behind a grateful sense of elasticity and
buoyancy, without loss of self-control.
Among the ancient Romans, the bath was used as a
place of resort and social intercourse, and is so to this day
among the Turks.
Happy would it be for the people of these countries if
such an institution were to take the place of half the
public-houses—if the Saxon and the Celt could laugh and
sing, and crack their jokes, and smoke their pipes, over a
cup of coffee in the cooling-room of a bath, instead of the
reeking atmosphere of the public-house. Surely, the con¬
trast would bring conviction to the senses, if not to the
understanding of the best boon companion, and the great
greed for whiskey and porter which costs so much money
and so many lives, which wastes so much time , and causes
such untold misery, would gradually subside, while content¬
ment, if it could become the portion of an Irishman, would
be more probably found in such an institution than in a
public-house.
Sanitary science, as yet only in its infancy, has already
improved the condition of towns, and amended to a slight
extent the dwellings of the lower orders, and public feeling
is so alive to the all-importance of a further move in this
direction that we may look forward to a gradual uprising
of the cloud of atmospheric impurities which hangs
over our own cities, blighting and destroying the energies
of the people, and leading to exhaustion and intem¬
perance.
Much has been done in this city in the cause of
temperance by the “Refreshment Rooms Company,”
which has placed wholesome, well-cooked nutriment
within reach of the labouring class. We are indebted to
the same company for cheap excursions down our beautiful
river, and into the fresh pure air of the country, enabling
husbands, wives, and children to seek pleasure in each
others company, and to escape sometimes from the ener¬
vating atmosphere^f crowded houses and narrow streets.
They have also more lately organized cheap musical pro¬
menades in the Atheneeum, which in time may be looked
forward to by the working man with even greater pleasure
than he now regards the Saturday night’s debauch in a
public house. Fenny readings have also been commenced
m our city, and cannot fail to elevate the tastes and feel¬
ings of the people, and to occupy the hours of recreation
which many are prone to waste in dissipation.
After all I have said of over-work and exhaustion as
sources of the use and abuse of stimulants, it may now
seem strange that I should speak of idleness as producing
a similar effect, but so it does, confirming the proverb, ex¬
tremes meet. As a working man once said to me, “ an
idle brain is the devil’s workshop.” Over-exertion, as I
have said, causes exhaustion, and thus leads to intemper¬
ance. Exercise strengthens the bodily powers and the
mental faculties, but idleness produces lassitude and in-
1 Since this fecture was delivered, an Act of Parliament, passed last
year (18«7), kaa been made public, entitled the “ Workshop Regulation
Act.” Cop. 146 regulates the hours of labour for children, young per¬
sons, and women employed in workshops. No child under eight Tears
of age is to be employed in any handicraft; no child is to be employed
on any one day for a period of more than six hours and a half, . . .
not at all on 8unday, or after two o'clock on Saturday, with some ex¬
ceptions. . . . No child under eleven is to be employed in grinding
in the metal trades, or ip fustian cutting. ... A sum may be paid
for schooling and deducted from wages, &c., &c. This is so far satis¬
factory, but it will be long before the present rising generation reoovers
from past overwork.
CUMMINS’ LECTURE.
August is, ltti
138 The Medical Press and Circular.
- *£ -
dolence, and these lead to every bad habit, and among the
rest to intemperance.
If a man has a happy fireside, and a well-regulated
family, there ought to be pleasure enough in his home to
keep him from the public-house ; but young people, whose
vital energies are in exuberance, require something more
of active movement, and rational excitement, and society,
to keep them from those gross and sensual pleasures into
which the very love of doing something too often leads
them. As the Rev. Dr. Guthrie says, 1 “ public amuse¬
ments, and social enjoyments are too little encouraged
among us,” and I have no doubt that one of the best safe¬
guards for young men, when setting out into the world, is
a love of rational society, especially among the ladies; as
the saying is, they must “ sow their wild oats,” and far
better is it for them to sow them in society which tends to
refine and soften, and which demands at least an outward
show of steadiness and sobriety on the part of those ad¬
mitted within its pale, than in suppers aud drinking, and
gambling, and other debasing pursuits. But there is a
vast difference between the rational and refining enjoy¬
ments I now allude to, and the idolatrous pursuit of sen¬
sual gratification and sensation from which the votaries of
fashion seek in vain for pleasure and happiness | for, as I
have already said, if we recklessly squander our vitality
and vigour in the over pursuit of either business or plea¬
sure, we must give them the spur of alcohol, and thus put an
arrow into the quiver of death. Most carefully must we
avoid indulging in pleasure to such an extent as to create
a morbid craving for excitement; for the connection be¬
tween moral and physical excitants is very close, and if
once one of the better classes acquire a habit of “ tippling,”
his downward progress is even more rapid than that of the
poor man, who finds in his empty purse a compulsory term
of sobriety from time to time. The costermonger com¬
forted his “ Sal.” when she had spent her all on the
Christmas treats, and sat biting her nails because she could
get no more to drink, with the philosophic remark,
r< drunk on Sunday, on Monday, on Tuesday, arn’t you
satisfied, do ye want to be a hangol entirely.” But the
rich man lacks the poor man’s safeguard, and can be a
“ hangel entirely,” hence his danger, and herein the neces¬
sity for some restraint being imposed upon his too easily
gratified propensity.
The question of reformation for drunkards has attracted
much attention of late years, and asylums for inebriates
have sprang up in many places ; but the legal power to
control the dipsomaniac is as yet wanting, and the good
which might be affected by such institutions is thexeby
limited. f
If the law treated inveterate drunkards as insane per¬
sons, which in truth they are, and permitted their friends
to confine them in asylums on the certificates of two, or
more, medical men, counter-signed by magistrates, clergy¬
men, &c., forbidding their discharge except on tickets-of-
leave, which could t>e recalled if the old habits were re¬
sumed ; many of those useless members of society, who
destroy themselves and their families, and disgrace their
friends, might be rescued from the destruction of soul aud
body to which their propensity, sooner or later, consigns
them. I regret that time does not permit me to enter
more fully into this important branch of my subject, and I
have pleasure in referring you for further information to a*
valuable and suggestive essay by an accomplished physi¬
cian who was once a townsman of ours, Dr. Belcher, of
Dublin.
I have only one more suggestion to add to this brief and
imperfect sketch of the means by whiclL our national in¬
temperance may be mitigated ; it is the autv of every one
who has opportunities of studying the physiological effects
of alcohol, to spread abroad that knowledge to the fullest
extent of his ability. Men are rushing blindly to destruc¬
tion, and we have it in our power to open their eyes. It
is only human nature to disbelieve moral treatises and
Appendix to the City, its Sins and 8orrows. By Eev, Dr* Guthrie*
sermons, and such like, when they war with our inclina¬
tions, but if we can succeed in opening the eyes of a man's
understanding, and showing him the peril towards which
he is running, we enlist on our side the principle of self-
preservation, which is also a part of human nature.
The medical profession incurs some responsibility in re¬
commending alcohol as a medicine, but the writings of
such men as Carpenter. Parkes, Millar, and others, moan
accepted as standard authorities , redeem the entire faculty
as a body, from the charge of originating drinking habits.
Every individual who has the honour of practising the
noble science of medicine, ought as cautiously to guard his
prescription from abuse, and as carefully protect himself
from the reproach of having led a fellow-creature into
excess.
Young men ! I have come before you as a physician,
and have accepted all the responsibility of a position which
carries with it considerable influence upon the welfare of
our common humanity. I have endeavoured conscien¬
tiously to perform the duty I have undertaken, but before
we separate, I must address a word to any young man, if
such be present, who has been unfortunate enough to con¬
tract a habit of using or abusing stimulants. Let me
entreat you to pause ere you go one step further along the
“ broad road that leadeth to destructioneven if abuse has
been carried far, it is still quite safe, in the immense
majority of instances, to give up the stimulant at once and
for ever ; and if your physician considers it safe for you to
do so, use only sufficient, religious, and moral self-control,
and you will succeed. The combat between duty and in¬
clination is tough enough at first, and requires no ordinary
resolution, but in time, habit will be found in the new
direction, and then the path of duty will become not only
the path of safety, but the path of pleasure also. There
are rare cases where long continued habits of intemperanoe
have so altered the nutrition of the nervous system, that a
sudden change to sobriety would result in insanity or
delirium tremens. Happily, the cases of the former, directly
due to this cause, are infrequent, and the latter is much
more frequently caused by persistance in the abuse of
alcohol, than by giving it up suddenly. But it must be
| admitted that there are rare cases—and sad spectacles they
present—of remorseful men striving might and main in a
spirit of self-denial and endurance to shake off the chains
of alcohol, and yet driven back to it again and again,
as the only means of escaping from the spectral illusions
of a demon-haunted imagination.
These diseased conditions demand the anxious and care¬
ful moral and physical treatment of the physician, and they
illustrate in the most forcible manner the danger of con¬
tracting a habit which may become incurable; and yet
they need not deter the unhappy slave of alcohol fiv®
making an effort to escape from bondage, for he may rest
satisfied that he will almost succeed if he sets about it in
the right way .
Hitherto I have spoken to you as a physician and physi¬
ologist, but I am sure you will not think I transgress the
legitimate province of a lay lecturer if in conclusion I
point out what is “ the right way.”
The Word of God says, “There hath no temptation
taken you but such as is common to man, and God is
faithful, who will not suffer you to be tempted above what
ye are able to bear, but will, with the temptation, make*
w*y for you to escape.”
It is on his bended knees that the slave of alcohol can
alone find the “ way to esaepe,”—distrusting himself and his
own resolutions—let him come to Him who says, “My
grace is suffiicient for thee,” and who “ giveth us the vicfcoij
through our Lord Jesus Christ.”
Antidote foe Strtchnu.— Dr. J.
strongly recommends common salt as a curative of stiychm*
poisoning. He reports as many as twenty experiments on dog*»
in which violent symptoms following large doses of stn ehn»
ceased after emesis, induced after drenching the a o i i itfj^^jj .
water holding in solution so vflfaT bendfuls^df^^alt’ ]
Mod* times, I
The Medical Press and Circular.
HOSPITAL REPORTS.
Augiut 12,1808. 139
JfjcrjfiM geprk
CITY OF DUBLIN HOSPITAL.
Cases of Luxation under the care of Mr. CROLY.
Case 1 . — luxation of lower jaw (double).
R Pil. Hydrarg.
Ext. conii. aa gr. ti.
Ft. pil. Take one three times daily.
6th.—The eye is much more on a level with the oppo¬
site. To continue the pills.
9th.—She now suffers no inconvenience. The eye 13
entirely restored to its natural level.
J. M., aged 20 years, a housemaid, living in the vicinity
of the hospital, worked very hard, and went to bed late
and tired. She yawned frequently, and then experienced
a painful sensation in front of each ear, and could neither
speak nor close her mouth. She came to the hospital, and
presented the following appearance:—Her mouth was
widely open, and her chin projected. She could not speak
distinctly. There was a well-marked depression in front
of each ear, and a prominent tumour under the zygoma of
either side.
Case 2. — luxation of lower jaw (single).-
Mrs. L., aged 70 years, presented herself amongst the ex¬
tern patients with well-marked luxation of the hft side of
the lower jaw, produced some hours previously yawn¬
ing.
Her chin was twisted to the right side, and the condyle
of the jaw could be easily felt beneath the zygoma. There
was a depression in front of the ear. The patient could
not articulate, and appeared to suffer a good deal of
distress.
Mr. Croly performed reduction in these cases in the fol¬
lowing manner:—The patient was seated in a chair, and
the head held steadily against the breast of an assistant.
The thumbs (only one being used in case 2) guarded by a
few folds of a handkerchief, were placed in the mouth on
the base of the coronoid process, and the jaw depressed.
Tl^e condyles were immediately restored to their normal
position by the action of the muscles. A piece of cork,
Of wedge-shape, and grooved for the teeth, was placed at
each side between the jaws, and a four-tailed bandage
applied to the head.
Remarks .—Luxation of the lower jaw usually occurs
from yawning, and is easily recognised. Reduction was
effected in these two cases by Nelaton's method—viz., by
merely dislodging the condyles of the lower maxilla from
their abnormal position, muscular action completing the
reduction.
Case 2 is remarkable, having occurred in a woman ad¬
vanced in years, which is an unusual occurrence.
In neither case was there a flow of saliva, nor a sudden
snap on the reduction being effected, as mentioned by sur¬
gical writers.
DR. STEEYENS' HOSPITAL.
Under the care of Mr. COLLES.
(Reported by R. L. Swan, Resident-Surgeon.)
EXOPHTHALMIA : RECOVERY.
Sarah Byrne, set. 22, of (lelicate appearance, was taken
into hospital, February 1st. A week before, she had been
suddenly seized with a violent headache, which continued,
without intermission, for four days. On the morning of
the 5th, she noticed the lids and soft parts round the right
orbit much swollen. The following day, she was attacked
' by a darting pain in the eyeball and deep-seated circum-
' o&ital headache, accompanied with dimness of vision and
baftsea. On examination, there was considerable oedema
of 4h &Rda, the globe of the eye itself was prominent; the
pupils of both eyes were sluggish and dilated ; the conjunc-
tw protruded eye was slightly vascular.
^jpo fcred four leeches to the temple, a calomel and jalap
-Peels better; the protrusion of the eyeball stil
the medicine has caused free action of the bowek
* ^h&s resumed a healthy appearance,
FRACTURE OF SUPRA-ORBITAL FLATK BY CONTRECOUP :
DEATH.
J. R., iet. 65, a labourer, was taken into hospital, May
6th. lie had fallen from a scaffolding in the neighbour¬
hood about 15 feet in height. The fall had been inter¬
rupted by a cross beam, against which he struck when
half way down. Ho subsequently fell on his head on a
heap of stones, inflicting a severe lacerated wound on the
brow of the right side.
On admission the breathing was stertorous; the pupils
irregular, that on the injured side being more dilated than
the other ; pulse laboured, and 60; the man is quite insen¬
sible, though giving evidences of pain when stirred ; there
has been some bleeding from the nostrils.
Ordered an oil and turpentine enema; bleeding to 10
ounces.
May 7th.—The pulse has become more full and fre¬
quent; the urine and faeces are passed involuntarily ; beef-
tea is swallowed in small quantities, when given with the
spoon.
10th.—Death occurred this morning after a slight con¬
vulsive attack. No change had taken place in the condi¬
tion of the patient since last report.
Autopsy .—No injury to the bone at the situation of the
wound. On exposing the supra-orbital plate, a transverse
fracture about its centre, extending across the cribriform
plate was discovered. A considerable amount of semi?
fluid blood was effused within the dura mater, extending
principally up the injured side.
KING'S COLLEGE HOSPITAL.
Cases under the care of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Renal Epilepsey. —Rachel M., act. 12. Admitted
February 9. Died on February 10. Subject to headache,
but never before had fits ; semi-conscious on admission.
Recovered in about two hours, but died in a second fit
same evening.
Post-mortem. —Brain congested ; arteries at base athero¬
matous ; lungs gorged ; some patches of pulmonaiy
apoplexy; left ventricle of heart hypertrophied; aortio
valves thickened ; atheromatous plate in mitral valve;
kidneys uneven on surface, cortex thin ; deposits of urate
of soda in straight tubes ; urine in bladder contained one-
half of albumen.
Calomel and scammony.
Hysterical Aphonia. —Louisa B., set. 21, servant.
Admitted March 16 ; discharged May 4 ; in hospital 49
days. Relieved. Lost her voice suddenly months ago.
On admission can only speak in a whisper; has slightly
lost power over left leg; pain under left breast. Sour
eructations, and occasional vomiting. Catamenia irregular ;
pulse 100; bowels constipated ; partially regained voice.
Quinine, sulphate ;.of iron, sulphuric acid, sulphate of
magnesia and chloric ether; asafeetida; valerian and
bark. Shower baths.
Pericarditis and Endocarditis. —CL C.,set. 27, smith.
Admitted September 17; discharged September 28. In
hospital 11 days. Recovery. Exposed to great variations
of temperature. Previously ill 4 days. Pain in chest and
throat. Pulse 52; respiration 20. Area of prsecordial
dulness increased. Systolic murmur over apex, and occa¬
sional diastolic sound at base. No sweating or joint affec¬
tion. Tongue furred. Free from pain 4 days later. Bruit
I audible till discharge.
Digitized by
Google
2
140 The Medical Press and Circular.
REPORT ON WINE.
August 18,1868.
Bicarbonate and nitrate of potass, and aromatic spts. of
ammonia.
Cardiac Disease. —J. L., jet. 30, farrier. Admitted
June 10; discharged July 9. In hospital 29 days. Much
relieved. Never had rheumatism. Heart’s impulse strong.
Apex directly below nipple in 5th intercostal space. Area
of cardiac dullness much enlarged. Double bruit. Systolic
sound loudest over 2nd right costo-sternal articulation.
Pulse 56, very collapsing. Thrill at root of neck, over
carotids. Startings at night.
Dilute hydrochloric acid, henbane, and quassia (18 days).
Then same, with quinine.
Cardiac Disease. —A. M., jet. 18, tailoress. Admitted
October 25; discharged December 14. In hospital 50 days.
Believed. Fourth attack of acute rheumatism began 6
weeks ago. Much pain in chest lately. Free from joint
pain three days ago. Subject to palpitation and shortness
of breath on exertion since first attack. On admission
much cardiac pain. Area of heart’s dulness enlarged. Loud
systolic bruit at apex; faint diastolic bruit at base. Pulse
120; moderately full. Twenty-eight days later slight basic
rub (2 days).
Bicarbonate of potass, sp. ammon. arom., and chloric
ether. Brandy 4 oz. Dover’s powder.
Cardiac Dropsy. —T. H., jet. 40, commissionaire. Ad¬
mitted May 10; discharged June 18. In hospital 39 days.
Very much relieved. Was in King’s College Hospital with
dropsy in February last, under Dr. Garrod. Dropsy and
dyspnoea returned soon after discharge. Orthopncea 6
weeks. On admission—pallid, legs very cedematous, chest
barrel-shaped and resonant; rhonchusand sibilus over lower
2-3rds of lungs; loud double bruit at heart’s base. Pulse
90, collapsing; respiration 30. Urine ith albumen.
Sesquichloride of iron and chloric ether. Grey powder
pad coiocynth, Turpentine stupes.
-♦-
REPORT ON WINE
AND ITS ADULTERATION.
[specially prepared for the medical press and circular.]
No. VII.
In resuming our Reports on Wine, which excited such wide¬
spread interest last year, and have only been interrupted
by the press of practicjil matter on our columns, we pro¬
pose, in compliance with the requests of several of our
supporters, before taking up the subject of sherry, to devote
a preliminary essay to the methods employed in jiscertain-
ing the facts we have to report.
The reader will not have, forgotten^ how large an amount
of space we allotted to the question of the amount of alco¬
hol contained in the port-wine of commerce, nor the con¬
troversy occasioned by the apologists of the system of
fortifying , taking up the gauntlet, in its defence, so far as
port-wine is concerned.
Our investigations have lead to the discovery that sherry
wine—the one we shall next take up—is even more
constantly adulterated than port, and that the addition of
alcohol to even good sherry is carried to a still greater ex¬
tent. It is therefore natural to consider, first, the mode of
ascertaining the amount of spirit in wines. This, accord¬
ingly, is the subject of the present number.
The amount of spirit has to be determined by the cus¬
tom-house authorities, in order to determine the duty
payable by any sample of wine; since beyond a certain
strength a liquid becomes liable to the duty charged on
mixed spirits. This limit used to be 33 per cent. It was
advanced, however, to 40 and 45; and now, though said to
be unlimited, may be considered practically as 50 per cent.
—considerably more than double the natural strength of
wines.
In estimating directly the strength of wines, the hydro¬
meter is not satisfactory, since various substances present
in the wine necessarily interfere with the results. Various
other means have been employed, but the most satisfactory
of all is the process of distillation. This has been found the
most advantageous by the Government officials, and has
been uniformly employed in our own experiments. The
principle and practice will be readily understood from the
following remarks:—
Water, at the ordinary pressure of the air, and on the
level of the sea, boils at 212° Fahr., at which temperature
it rises as an invisible vapour, and would continue in this
state were its temperature maintained unchanged. Pass¬
ing into the colder air, however, it is manifested as a
cloudy vapour, in which state it is commonly called steam,
though it consists in reality of very minute globules of
finely divided water : steam, properly so called, being in¬
visible, and having all the mechanical properties of air or
gas. The visible state is caused by the partial condensa¬
tion of steam into its original state of water; and a further
degree of cold would cause the drops to unite in the liquid
form.
On holding a cold plate against the spout of a kettle
while the steam is issuing, the surface is first dulled as
with a mist; gradually drops of water form, and these
again unite and fall, unless the heat of the steam raises the
temperature of the plate sufficiently high to evaporate the
deposit, when no further condensation takes place. If by
any means the coldness of the surface be maintained, the
deposit will continue, and in time a quantity of water will
accumulate. But this process is both tedious and waste¬
ful ; a large portion of steam escapes uncondensed, and a
mere fraction of the whole is procured as water. What is
obtained, however, is distilled water, and is freed in course
of the process from any non-volatile impurities that may
have been held in solution.
Instead of the mode just described, let the steam he
prevented from escaping, and conveyed through a long
tube immersed in cold water (such tube may for conveni¬
ence be bent spirally, when it is called a worm); the
whole of the steam will now be condensed, and we shall
obtain all the water, purified, as the product of the opera¬
tion. To ensure complete and continued condensation,
the cold water surrounding the tube must be changed
frequently, as the amount of specific heat necessary to
keep water in the state of steam is sufficient to raise to
boiling point a much larger bulk of water than it would
itself form when condensed.
Should the water contain in combination anything that
will evaporate by heat, both will pass over together, unless
the temperatures at which they arise in vapour differ; in
which case we have a means of effecting a separation of
greater or less completeness, subject to the control of other
influences.
This much premised, we pass to the separation of alcohol
from water and other matters by the same process, for
wines and spirits are all compounds of alcohol and
water, the former having in addition mucilaginous, sac¬
charine, and other matters derived from the grape; the
latter merely containing small quantities of essential oils
and sweetening and colouring matters.
Alcohol pure and entirely freed from water, or anhy¬
drous, is a highly inflammable, colourless liquid, having a
specific gravity of 793811 at 60° Fahr. ; it boils at 173®,
and rises in vapour. When mixed with water, the com¬
pound boils at a temperature intermediate between 173°
and 212°, which varies according to the proportion of each
ingredient. As the alcohol is more readily volatilized, it
rises first; but always mixed with more or less water.
Hence, by exposing the mixture to heat, and condensing
some of the vapour, we can obtain a more concentrated
spirit.
Repeated distillation, or better still, a process by which
the effect of repeated distillation is produced in one
operation, as in Coffey’s still, procures a high degree of
strength, limited, however, by the extraordinary affinity
which alcohol possesses for water, and which prevents our
obtaining by this mode a higher degree of strength than
about 70 O.P.; beyond this, chemical means must be
resorted to. The entire separation can only be effected by
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TtaHedictl Preat and Circular.
REPORT ON WINE.
Augmt 12,1868. 141
the aid of something having a stronger affinity for water
than alcohol has. Fresh burnt quick lime is ordinarily
used for this purpose, as also many other substances with
a like attraction for water ; the description of the process,
however, is unnecessary here.
In estimating the proportion of alcohol in wines, &c.,by
distillation, it is not requisite that it should be obtained
pure, nor even in a highly rectified state ; it will be suffi¬
cient for our purpose if we get the whole that is contained
in the quantity experimented on, and free from every other
admixture than, pure water. The percentage of proof
spirit can then be readily estimated by Sikes's hydro¬
meter. •
It is desirable that the process of distillation should be
rapidly effected, while it is absolutely essential that the
apparatus employed be such as to give exact results.
The simplest and best apparatus we have ever used is
that now generally employed in the custom-house, and
which we shall therefore proceed to describe. It consists
of five principal parts—1, the condenser ; 2, the still flask;
3, the receiver; 4, the lamp; 5, the stand.
The following figures and description fully explain its
use:—
1. TnE Condenser. —In this the principal value of the
instrument consists. It is a copper box made water-tight,
about 7J inches long, 3 inches broad, and inches deep.
Into the upper part of this box two tubes are inserted for
the entrance and exit of water, with which it is kept con¬
tinually full, the supply changing with sufficient rapidity to
keep the temperature low enough for the complete conden¬
sation of the vapour. Were it not thus changed, it would
become so heated with the surplus caloric given up by the
steam on being reconverted into water, that the steam
would soon escape uncondensed. The tube which conveys
the water into the condenser enters at the top and reaches
nearly to the bottom ; tho other tube only just enters the
vessel. By this arrangement the greatest amount of cold¬
ness is secured ; as the water, acquiring heat from the con¬
densed steam, becomes specifically lighter than the rest, and
rises to the upper part of the vessel, keeping its position
above the colder water which enters from below, and passing
off first at the exit pipe.
At the end of the condenser, near the exit pipe, a piece of
strong metal tube is joined on, inclining upwards for about
6 inches, and then curving downwards in a perpendicular
direction, terminating in an arrangement for attaching the
Btill flask, and forming a kind of still-head. This tube, on
entering the condenser, is spread out into a broad, flat
tube, which continues to descend till it nears the other side
of the condenser, when it is folded backwards and then for¬
wards, still slanting downwards, till at the bottom on the
farther side it connects with a small spout or delivery tube,
curving downwards for insertion into the receiver.
The flatness of the tube within exposes a greatly increased
surface to the action of the water, and the heat is rapidly
absorbed from the enclosed vapour, which is not only reduced
almost instantly to the liquid state, but is still further cooled
on its passage downwards, so that it runs out at last at a
temperature only a few degrees above that of the surround¬
ing atmosphere. The tube by which the cold water enters
and leaves the condenser are joined to the main supply and
Waste pipes by means of india-rubber tubing. It will be
sufficient if the cistern from which the water supply is
obtained be a yard or two above the condenser.
An improved form of condenser suitable for wine distil¬
ling has been brought out by Messrs. Dring and Fage. The
principal fx>ints of difference are as follow:—The condenser
« Cylindrical and is so constructed that the bottom is
readi ly removable so as to render repairs of the worm
WyrMe worm is flat and its width equal to the radius of
^ “Winder in which it is placed. It is wound spindly
jrfte Central axis, and thus forms a screw between the
tdf which the condensing water has to wind its way
t ia tjba^exit pipe, while the distillate takes the op-
f Alow downwards inside the worm. The conden-
ifcjwpfcct, and the distillate in its descent comes
continually into contact with a cooler surface, and the
whole cooling effect of the water is completely utilised.
2. The Still Flask, or retort, is a conical glass ves?
having a thin flat bottom, and a neck at the upper part to
which a brass screw is cemented for the purpose of con¬
necting it to the tube leading to the condenser. The bot¬
tom of the flask is made extremely thin to allow of the
rapid passage of heat to the contained liquid, and render
it less liable to break from sudden changes of temperature,
while its breadth and flatness expose a greater surface to
the action of the flame than in the case of ordinary bulb¬
ous retorts.
3. The Receiver is a vessel graduated for the purpose
—viz., at a point in the neck to mark the bulk used in the
operation, and again at one-half and two-thirds of this
quantity. The bulk experimented on is no fixed measure,
it must Suffice to float the hydrometer at zero in the trial
tube, and the distillate must be received over and filled up
in the same vessel. Receivers are made of several shapes,
some tall and conical, others short and bulbous ; but it is
necessary to have the upper marks in a narrow part, so as
to make it more easy of exact adjustment.
4. The Lamp. —This may be either a gas or spirit lamp.
The former is preferable, but where it cannot be conve¬
niently obtained, a spirit lamp is an excellent substitute ;
it is, however, more expensive and troublesome, and more
liable to accident. In the Custom’s Laboratories gas is
employed in the following manner :—An argand burner,
fixed on a stand, and supplied with gas by a flexible tube
for the purpose of mobility, has a brass cylinder placed
Digitized by
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142 The Medic* Press and Circular. FOREIGN MEDICAL LITERATURE.
August 12,1808.
round it in the manner in which the glass chimneys are
usually attached. This cylinder is open at the bottom,
but at the top Is covered with a fine wire gauze. On turn¬
ing on the gas it rises in the cylinder, mixing at the same
time in explosive proportions with the atmospheric air
which enters at the lower part. This mixture, escaping
with reduced velocity through the wire gauze, is ignited
on the outside, forming a pale, smokeless flame, producing
intense heat. At the same time the flame is prevented
passing to the gas in the cylinder below, by that peculiar pro¬
perty of wire gauze which hinders the transmission of flame,
and which led to its application by Sir Humphrey Davy to
the Miners’ Safety Lamp. There are other modes of apply¬
ing the gas flame equally effective and more economical.
5. The Stand. —This consists of a stout tubular brass
pillar fixed on a heavy base, having a collar at the top,
with a screw, by which the height of the condenser can be
regulated, that part of the apparatus being screwed to a
rod, which works up and down inside the pillar. On the
outside, attached by a movable collar and adjusting screw,
is a bracket, on which the receiver stands during the opera¬
tion ; and when a spirit lamp is used it can be connected
in like manner.
In addition to the apparatus we have described, the
following will be required:—A thermometer, which it will
be convenient to have narrow enough to enter the flask in
which the wine is measured, to take its temperature before
the operation, where great nicety is required, otherwise the
temperature can be taken in a separate vessel. A Sykes’s
hydrometer with the movable weights, or which is better
in practice, have two separate hydrometers, weighted in the
bulbs of the instruments themselves, as 80 and 90 respectively
HL
til
A far more convenient form,
and one that we strongly recom¬
mend, has been invented by Mr.
Keene.
It simplifies the process very
greatly, as will presently be seen,
and should be obtained by every
one who wishes to follow out such
experiments.
Here is a figure of it.
In this very convenient instru¬
ment it will be noticed that the
scale of divisions is laid down for
steps of one per cent, each of proof
spirit, rising ordinarily to 50 per
cent., that strength being high
enough to include the strongest
wines imported. In using this
with the distillate at 60° Fahr.,
the exact strength is at once
shown by the indications. To
meet, however, cases in which
that temperature cannot be con¬
veniently obtained, a table is given
with each instrument for a range
of 11 degrees either side of 60.
They are made by Dring and
Face, and sold with their new
stills. A trial glass, in which the
diluted distillate is poured for
testing; and lastly, a pipette or
dropping tube to adjust tne mea¬
surement of the wine and the dis¬
tillates.
Having now fully described the
apparatus employed, we shall, in
our next, proceed with a sketch
of the process itself.
Keeno’s Wine Hydrometer,
Jm'dp JjJfehital ^iterate.
RECENT CONTRIBUTIONS TO THE
THEORY OF THE INNERVATION OF THE HEART
AND BLOOD-VESSELS.
(Reported bt Dr. Christian Loven.)
Translated from the Ilygita for March, 1888, page 112, by
W. D. MOORE, M.D.Dub.etCantab., M.R.I.A., L.K.Q.C.P.I.
HONORARY FKLLOW OF THE 8WF.DISH SOCIETY OF PHYSICIANS J OF
THE NORWEGIAN MEDICAL SOCIETY; AND OF TftE ROYAL MEDICAL
SOCIETY OF COPENHAGEN J SECRETARY FOR SWEDEN, XOBWAY AND
DENMARK, TO THE EPIDEMIOLOGICAL 80CIBTY OF LONDON.
The ancient controversy, how far the movements of the heart
are dependent on nervous influences from without—that is,
from other organs or not—may now be considered as so far
decided that the heart must be looked upon as possessing in
itself the fundamental condition of its activity. This has been
shown from the fact that this organ, even after it has been
separated from all connection with the rest of the body, con¬
tinues to act for a time, which is longer or shorter in animals
of different kinds and ages, and in those with cold blood, as, for
example, the frog, may, under favourable circumstances,
amount to several days. An anatomical complement to this
physiological fact, and at the same time an indication for the
correct appreciation of this autonomy of the heart, was first ob¬
tained through the discovery by Remak, in 1844, of the gan¬
glionic cells scattered in the substance of the organ—an indi¬
cation which, moreover, was immediately followed up by
Volkmann in his well-known theory of the heart’s action, as
deriving its origin from a number of distinct centres connected
with each other, which are to be sought in the heart itself, and
especially in its ganglia. This view must now, notwithstand¬
ing the opposition of which it has been, and still is, the object,
be considered as that most generally received, as it is also in
the most complete harmony with the prevalent opinions re¬
specting the physiology of the nerves in general.
But that the heart is, in addition, dependent on the nervous
system in general, and on the brain and spinal cord in particu¬
lar, so that the rhythm and also the intensity of its movements
can be directly or indirectly modified through the influence of
the central organs just mentioned, is a matter of old standing
experience, though it has been reserved for modern times to
indicate more accurately the nature of this influence, and the
routes by which it is exercised.
The first step in this direction was taken by the well-known
discovery of the brothers Ernst Heinrich and Edward Weber
in 1845, so important for the theory of the innervation of the
heart, that electrical irritation of the part of the brain from
which the nervi vagi take their origin, as well as directly of the
nerves themselves, relaxes the heart, makes its rhythmical
movements slower, and even brings the organ to a
standstill. Edward Weber now sought an explanation of this
remarkable phenomenon—an explanation so successfully found,
that no better can be substituted for it, all others soon failing
before closer investigation.
He characterises the influence of the vagus as a restraining
action, a nervous function completely without any analogy in
physiology, if we consider the nervi vagi as the proper cardiac
nerves going to the muscular fibres, and restraint as a result
of their direct action on these fibres. We have, however,
instances of such restraint of the involuntary action of animal
muscles ; for example, in the relaxation of the sphincter ani,
as well as in the restraining action of the brain on the
reflex movements, &c. “ But,” says Weber, “ as in these
animal muscles the restraining influence is exercised, not
directly through their motor nerves, but in the first instance
on the spinal cord, whence their activity is maintained, the
restraining influence which the nervi vagi exercise on the move¬
ments of the heart, seems not to act directly on the muscular
fibres, but in the first place on the nervous apparatus, whence
the cardiac movements proceed, and which are here found in
the very substance of the heart; therefore, the action of the
heart interrupted through irritation of the nervi vagi returns
spontaneously, and this notwithstanding that the irritation of
the nerve is continued ; if, that is to say, in consequence of its
exhaustion the motor nerves of the heart, thus freed from the
restraining influence of the former, again resume their activity.”
This doctrine of the restraining power of
daily of the pneumogastric nerves, was
by some investigators, especially Budge. Sc"
but was defended and supported with
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Hie Medical Pfcss and Circular.
FOREIGN MEDICAL LITERATURE.
August 12, 1868. 143
(foremost among whom were Volkmann, Ludwig, PflUger, and
▼on Bezold), and may now be looked upon as fully established.
Ludwig enriched the facts ascertained by the brothers
Weber with various new ones, which shed a further light upon
the nature of this obscure influence. Thus, he found among
other things, that the cardiac pulsations, which occur during
or immediately after the irritation of the nervi vagi are stronger
than those observed before the same, and from this circum¬
stance, taken along with that already known—that while the
heart, in consequence of irritation of the vagus, is quiescent,
every mechanical or electrical action on any limited part of its
surface, instantaneously produces an energetic contraction of
the whole heart—Ludwig drew the conclusion that the nor¬
ms vagus certainly prolongs the pauses, but does not weaken
the intensity of the motor powers peculiar to the heart, or
prevent the recovery of the irritablity ; on the contrary, the
action of the vagus seems principally to be through increase
of the resistance, which we must suppose hinders the inces¬
sant discharge of the impulses constantly developed in the
motor ganglionic cells of the heart, and through which the
movement, instead of being continuous, becomes periodical and
rhythmical, to accumulate, as it were, in these ganglionic cells
a larger store of tensive force, which, when it at last overcomes
the resistance, exhibits itself in the subsequent more powerful
contractions. In such a manner the action of the vagus be¬
comes not properly lowering of, but rather regulating the heart’s
action ; the work performed by the heart is nof diminished, it
is only differently divided, fewer but more powerful contractions
take the place of more numerous, but weaker ones. But this
resistance, which, like a flood-gate hinders the constant outflow
of the motor impulses, is produced not exclusively by the nervi
vagi, for after their division, and even in the heart taken out
of the body, the movements continue to be rhythmical and
periodical. Therefore, if the theory of the action of the pneu-
mogastric nerves now described be correct, and everything
favours this viow, we must assume the existence in the
heart itself of a restraining apparatus, whose activity is in¬
creased by the nervi vagi, and with which, consequently, these
nerves stand in direct connection, or in which their filaments
terminate.
A new feature in the question respecting the nature and
arrangement of the nervous central organs to be found in the
heart itself, is derived from the well-known experiments first
instituted by Stannius, and called after him. This investigator
in fact observed, that if we tie with a ligature, or cut through
with a scissors, the boundary between the sinus venosus and
the auricle in the heart of a frog, the sinus just mentioned con¬
tinues to pulsate, but the rest of the heart stops, after some
few strokes, immovable in a state of diastole. If a fresh liga¬
ture be now applied, or if a new cut be made in the depression
between the auricle and the ventricle, the contractions of the
ventricle recommence and continue for a long time, but the
auricle remains unalterably at rest. Stannius contented him-
Belf with describing the phenomena he had observed, without
mitering into any explanation thereof; but several other inves¬
tigators repeated and modified these experiments, and put for¬
ward various hypotheses to explain them. To give a fuller
account of the controversy elicited by these investigations
(between Heidenhain, von Bezold, Eckhard, Bidder, Goltz, &c.)
lies beyond the aim of this essay. I shall here briefly allude
’to only one of the hypotheses in question, which probably has
most advocates—that is, Heidenhain’s. This is based upon the
fact that after the first ligature or incision between the sinus
and the auricle, the heart’s quiescence, as Volkmann observed,
after a time (from five to thirty minutes) ceases, to give place
once more to regular contractions; it rests partly, also, on the
■ignificant circumstance, that the experiment succeeds most
•orcly if the cut be made with a blunt scissors; but, on the
other hand, often fails if it be accomplished in one stroke with
a very sharp instrument. From this Heidenhain concludes that
the ligature or incision has a stimulating effect on the restrain¬
ts apparatus, which is probably of a ganglionic nature, placed
hi the region affected by the operation.
In accordance with this interpretation of Stannius’ experi-
®*nt, the following hypothesis has been suggested to explain
the pe culiar phenomena characterising the movements of the
"hart:—In the heart there are two different kinds of automatic
<*wflex central organs (ganglia) connected with each other t—
exciting and restraining (regulating). In the former,
fCirdee are incessantly produced through the normal
which are prevented from being incessantly
through the motor nerves in this manner, that in
centre* forces are developed, which to such an
outflow oppose a certain elastic resistance, which is first, after
the exciting forces have attained a certain quantity or tension,
overcome by them, and then in consequence of irritation of the
motor nerves and the cardiac contraction is produced. At the
same time, now the whole accumulated store of exciting force
is exhausted, the elastic resistance regains its power, is anew
overcome, &c., and a periodical movement is necessarily pro¬
duced, whose rhythm and intensity must, of course, vary accord¬
ing to the different energy in each of the central organs
mentioned, whose irritability may be increased or depressed
through different influences affecting them. Further, to ex¬
plain the regular sequence of the heart’s movements, these
central organs must be assumed to be arranged and combined
with one another in a definite manner—an arrangement, of the
details of w r hich we have not, as yet, the slightest knowledge.
Friedlander 1 has recently instituted a series of experiments
in von Bezold’s laboratory, which, extended and modified,
may probably shed some light on this obscure question. The
author observed that small portions of the sinus venosus,
auricle, and upper third of the ventricle of the heart of a
frog, removed with a sharp scissors, continued, in an artificial
serum (one part of albumen -f- nine parts of solution of
common salt of 0 8 or 0*9°/ o ), to pulsate for more than 48
hours, and he even succeeded, by careful preparation, in
obtaining small, actively pulsating muscular portions, measur¬
ing not more than 0‘2 mm. in length, and containing only two
or three muscular fibres. Their movements could thus be
quite conveniently observed under the microscope. The author
now first availed himself of this favourable circumstauce to
test the view maintained by Schiff and others, that the gan¬
glionic cells were not of any essential importance in the pro¬
duction of the rhythmical movements. It is clear that if any
independently pulsating muscular preparation were found, in
which no ganglionic elements could be demonstrated, the
opinion just alluded to would find therein great support, and
the whole of the above described theory of the nature of the
cardiac movements would be dangerously compromised. But
this was not the case. In order to be able with certainty to
discover the ganglionic cells often perceptible, only with diffi¬
culty, in fresh preparations, the author employed a peculiar
method of colouring with aniline red, and the result of his
investigations in this direction was, that in no case could he
convince himself of the absence of ganglionic cells in those
preparations which had previously pulsated ; usually he could
demonstrate two or three, even where in the recent state he
should not have suspected their presence.
The pulsations of Bin all muscular portions varied both in
frequency (between 2 and 40 in half a minute), and in in¬
tensity ; indeed different portions of the same preparation—
in size not amounting to half a mm.—often exhibited the
greatest varieties in the rhythm and strength of the contractions.
Gentle mechanical influences increased the movements and pro¬
duced them when they had ceased. Changes of temperature
were found to have a particularly powerful influence, gradual
or sudden warming up to from 86* to 95° Fahr., often excit¬
ing the most active movements in such preparations as had
not before pulsated, and in those which had previously pul¬
sated, both the number and the intensity of the contractions
were greatly increased.
Lastly, the author employed also irritation of the small
preparations of the heart with an ordinary electro-magnetio
induction-apparatus, and observed the different effect in dif¬
ferent cases. Thus, at one time the frequency of the move¬
ments was increased, and this was usually the case; at another,
on the contrary, the induction-stroke had no effect upon it,
although the intensity of the contractions was augmented ; in
other instances again, the author saw distinct diminution of
the number of the pulsations (even to diastolic quiescence),
and he considers that he may explain these latter as restrain¬
ing phenomena on this account, that together with diminution
of frequency an increase of intensity of the contractions could
be distinctly observed. Not unfrequently even, in different
parts of the same preparation, under the influence of the
electrical current, all these various changes were witnessed.
The results of the author’s investigations, it will be seen,
agree well with the hypothesis above put forward. With
respect to the question of the anatomical arrangement of the
special exciting and regulating gaoglia, they seem moreover to
indicate, that these central organs, though so differently con¬
structed, often lie so near one another, that the actions charao
1 Ucber die Nervoeen Ctntraloryane des Frosckkcrscns in Unttrsuc-
Imogen aua dem Physiol. L&borat. zu Wttrtzburg herausgegeben VO*
A. v. Bezold. Bd. II., p. W.
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144 The Medical Press and Circular. FOREIGN MEDICAL LITERATURE. August 12,18&.
tensing them may at once exhibit themselves in preparations
of the smallest dimensions.
E. Cyoni has instituted in Ludwig’s laboratory, and with par¬
ticularly ingenious apparatus and methods invented by him, a
series of investigations upon the changes exhibited by the
movements of the heart of the frog under the influence of dif¬
ferent temperatures, which incontestibly belong to the best
and most reliable researches upon this subject. Without being
able to enter in this place into any more accurate description
of the very complicated apparatus employed in these experi¬
ments, I shall give a brief account of its plan and object. A
circulating system of glass tubes was passed on one side into
the left aorta, on the other into the vena cava infe¬
rior. This system of tubes, which, as well as the heart itself,
was filled with fresh serum of rabbits’ blood (dogs’ serum was
found to act as a poison upon the heart of a frog), communi¬
cated with a small mercurial manometer, which, by means of a
so-called “ float,” marked the heart’s pulsations, as on an or¬
dinary Ludwig’s kymographion, on a cylinder rotating with
uniform rapidity, in the form of curves, distinguishing both the
frequency, course, and intensity of the pulsations. The heart,
with its artificial vascular system, was included in an atmo¬
sphere, which could easily be brought to the desired tempera¬
ture. In this apparatus, as the reporter, who was at the time
working in the same laboratory, had the opportunity of satis¬
fying himself, the heart continues to pulsate for more than 24
hours, provided that the serum is now and then drawn off and
replaced with fresh.
The author’s investigations comprise two different series
namely, A, the effects of a gradual change of temperature; and,
£, those of sudden alterations of temperature.
A.—1. Change of frequency of the pulse with the temperature.
—The author commences by confirming Schelske’s observation,
that the heart of the frog maintains its power of automatic
action only within certain limits of temperature, of which the
lower lies between 24'S 3 and 32° F., the higher varies from 86°
to 104°. A diagrammatic curve, exhibiting the comparative
frequency between these extremes, ascends from the lower
limit, at first very slowly, and afterwards more rapidly, to a
temperature where the maximum of frequency is attained, and
subsequently falls some degrees at first slowly, but afterwards
so rapidly, that if the heart is merely warmed some few de¬
grees more, it remains perfectly at rest. Under the two or
three degrees which precede the quiescence of the heart, the
latter beats not merely slowly, but also irregularly, and imme¬
diately before the quiescence the motion is peristaltic, the ven¬
tricular fibres contracting at different times. The maximum
above mentioned falls in different hearts at somewhat different
degrees of temperature ; as also a number of individual circum¬
stances act on the appearance of the curve in particular cases.
As a definite result it may, however, bo stated that elevation
of temperature within certain limits considerably increases the
frequency of the pulse—a welcome fact for those physicians
who believe the acceleration of the pulse in fever to be caused
by increase of temperature.
2. Alteration of the volume of the contraction .—In this respect
a very definite law seems to prevail, which is best exhibited in
the same manner as the frequency of the pulse—namely, by a
curve, whose absciss represents the temperatures, and whose
ordinates correspond to the intensity of the contractions. Such
a curve exhibits here, also, a maximum and two minima, which
latter lie at the superior and inferior limits of temperature,
where the heart, as above mentioned, ceases to beat. But, in
opposition to the cause of the frequency of the pulse, this
ascends so rapidly from the lower limit of temperature, that
even only some few degrees above zero it attains the maximum,
keeps usually at this height to about from 59°. to 66’2°, and
sinks afterwards uninterruptedly to the superior limit of tem¬
perature. At the degrees of temperature immediately preced¬
ing this, we observe the peculiar circumstance that the heart
is still engaged in active contractions without exercising the
slightest effect on the manometer. This depends upon the
fact that the contractions are peristaltic, and therefore cannot
overcome the external resistance, as the parts of the heart
which do not contract are dilated, just as much as those which
contract are compressed.
3. On the relation between the volume and the frequency of the
pulsations of the heart .—From what precedes it appears that,
with increase of temperature from zero to a certain limit, the
frequency of the contractions uniformly increases, while their
1 Ucber dm EinfliiM dtr I'tmpcratxtrHnderun'ifn auf Zahl, Dantr uud
Stdrke der HerzscMdge, von Dr. E. Cyon. Arbeitch aus der physiol.
Anstalt su Leipzig vom Jafire, 1866 mltgethoilt durch C. Ludwig.
intensity remains unaltered. In the interval of temperature
immediately next following, the frequency continuously in¬
creases, but the intensity sinks until the temperature is passed,
at which the heart’s pulsations have attained their maximum
of frequency, after which both frequency and intensity diminish
until they become nil. These facts show incontestibly that the
relation between the intensity and the frequency of the cardiac
pulsations bannot be explained from a dimple principle; in a
word, that no necessary connection exists between these two
elements.
4. On the course of the contractions of the heart .—In this
respect different hearts do not all behave in the same manner.
At one time we see the curve which represents the pulsation of
the heart rapidly ascending and almost immediately sinking,
at another rapidly ascending and sinking with tetanic points,
at another again rapidly ascending with a sudden transition to
a state of diastole, which is gradually terminated; at another,
finally, slowly ascending with a gradual transition to diastole,
and then slowly sinking. Even in one and the same heart the
course of the contractions varies at different temperatures, and
this in general, so that with a diminution of temperature the
ascending and descending parts of the curve are drawn out in
length. According to the author’s view, all these varieties are
easily explained as depending on different conditions in the
nerves and muscular fibres, and not on peculiarities in the sti¬
mulating apparatus. Supposing, in fact, that, as Marey does,
we may look upon the pulsation of the heart as a single muscu¬
lar contraction—an opinion in favour of which many cogent
reasons may be adduced, though there are also various difficul¬
ties, which may, perhaps, be regarded as depending on the
peculiar structure of the cardiac muscles.
6. On the loorh which the heart can perform in each unit of
time at different temperatures .—If authors would always employ
the same manometers of known dimensions, and the same
serum for each separate heart, the work accomplished by each
cardiac pulsation might, if the question were only as to the
relative value, be easily calculated from the weight of the pillar
of fluid driven into the manometer, and thus the work accom¬
plished by the heart in a certain unit of time might be calcu¬
lated by multiplying the said value by the number of pulsa¬
tions. In this manner the author found that the maximum of
work was accomplished by the frog's heart, generally between
64’4* and 78’8° F.
6. On the quantity of the motor impulses t which at different
temperatures proceed from the automatic centres .—As a relative
measure of this quantity, we may in general employ the mag¬
nitude and duration of the muscular contraction, provided
always that the impulses to be compared with one another
have acted on equally irritable and similarly loaded muscles.
In view of the difficulties which in the present case attend
such a determination, we must be satisfied with only imperfect
indications. Thus, it is impossible positively to decide whether
the sum of the impulses is increased or diminished, when the
temperature sinks below 64° F., because therewith the work
performed by the heart is certainly diminished, but at the same
time, also, the muscular and nervous irritability is considerably
lowered. On the other hand, we can with full certainty xon*
elude that it is diminished for every degree above the mean
temperature (64 4? F. to 78’8°), for there, as is well known,
the irritability of the nerves and muscles increases, but never¬
theless both the duration and the volume of the several con¬
tractions are lessened.
7. Of the adaptation of the number of the motor impulses to
the state of the muscular mobility .—Every transversely-striated
muscle, the heart not excepted, requires, when its temperature
is greatly lowered, a long time to perform its contractions.
Now, if at the lower degrees of temperature the heart were
stimulated as often as at the higher, it would unconditionally
lapse into tetanus, because the one contraction would not have
passed off before a fresh one had begun. To explain the adap¬
tation which here undeniably takes place, we might be inclined
to assume such a connection between muscle and nerve on the
onfe hand, and the stimulating apparatus on the other, that a
fresh stimulus could not act until the previous contraction had ter¬
minate cj. Various facts observed by the author would, however,
bear most decidedly against such a view, and therefore no other
mode remains of explaining the phenomenon than to assume
that both the exciting centres, the nerves and muscles, are
uniformly affected by the temperature; that therefore the cir¬
cumstances which increase or diminish the mobility of the
nervous and muscular molecules, have one and the same action
on the exciting apparatus.
8. Of the change of the elasticity off.cardiac m*mk at an
The Medical Press and Circular.
LITERATURE.
August 12,1868. 145
increased temperature,—In this respect the author found that
the extensibility of the heart is considerably increased at an
augmented temperature, which is manifested by the fact that
the quicksilver in the manometer sank at the higher tempera¬
tures during the diastole, several mm. deeper than at the lower,
and this was especially apparent if the dilatation of the heart
were compared when it stood still at the upper and lower
limits of temperature.
B. Effect of sudden changes of temperature on the impulse of
Vie heart .—This appeared to be totally different from the effect
of gradual change of temperature. The results of the author’s
experiments were briefly as follow :—1. If the heart, previ¬
ously pulsating at a temperature of from 68° to 7l'Q & F., is
suddenly brought into contact with serum or air at 32°, the
deviations of me manometer are diminished, the movements of
the heart become peristaltic, and the heart is dilated in a higher
degree than is usually the case in gradual transition to this
low degree of temperature. After some minutes, the move¬
ments again become greater, and the heart subsequently be¬
haves as when it is slowly cooled. 2. If a heart, which has
for a long time been kept at or below the freezing point, be sud¬
denly brought in contact with serum or air at 104° F., it per¬
forms a series of strokes following so rapidly on one another,
that it finally passes into a state of complete tetanus, which is
evidently produced by the impulses following so closely on one
another, that one contraction does not terminate before the
next commences. This tetanus may continue for from fifteen
to thirty seconds, and subsequently the heart runs through all
the forms of pulse, which it usually exhibits when slowly
heated. 3. The state of the heart is again quite different,
if frt>m the normal temperature it be suddenly exposed to 104°
F. In contrast to the foregoing, and to its condition in slow
heating, the beats now become strong with long intervals, and
precisely resemble the form of pulse obtained by irritating the
nervi vagi at the normal temperature. After the lapse of one
or two minutes, the heart once more passes through the above
mentioned intermediate stages, characteristic of slow heating.
4. A heart which has been poisoned with curare differs from
one not poisoned, insomuch as the former, when suddenly
heated from 68° to 104° F., does not exhibit the strong pulsa¬
tions separated by long pauses, but behaves precisely as in
slow heating.
This dissimilarity is explained by the fact that curare, accord¬
ing to Heidenhain’s experiments, confirmed by Czermak and
by the author, annihilates the irritability of the nervi vagi, and
this observation therefore supplies a powerful reason for the
assumption that the phenomenon mentioned in 3, depends on
an irritation of the termination of the vagus in the heart.
The author concludes his essay with an attempt to explain the
phenomena observed, by the above mentioned usually received
hypothesis respecting the nervous apparatus of the heart.
When the heart is gradually cooled from the mean tempera¬
ture to the freezing point or below it, the power of the restrain¬
ing apparatus must, within the interval, in which the frequency
of the heart’s pulsation, but not its intensity, is diminished,
have increased, and likewise the motor impulse causing each
stroke of the heart must have grown stronger, while at the
same time the irritability of the nerves and muscles is dimin¬
ished by the lowering of the temperature.
The phenomena which occur on slow warming from the
mean temperature to the degree of temperature at which the
heart exhibits the maximum frequency of pulse, indicate that the
forces in the exciting and restraining centres at the same time
diminish, because the work therewith performed by the heart
is lessened. The arrest at the superior limit of temperature
must be caused by this, that the stimuli developed are not
sufficient to excite the muscles to contraction, for in
this case, as is well-known, the nervous and muscular irrita¬
bility is in general increased, which, in this instance also, is
proved thereby, that the weakest mechanical or electrical
stimulant produces a pulsation of the heart.
But that during arrest in warmth the irritability of the
regulating apparatus also is almost removed is shown by this,
that local irritation of the sinus venosus then produces com¬
plete tetanus in the ventricle, which continues as long as the
irritation lasts.
By this, the condition in which the heart is found during this
iiteet is distinguished from all others, for at the mean tempera-
irritation of the same place through excitation of the vagus
““My produces an arrest of the heart in diastole, and in the
»of movements which characterises the. lower limit of
. atone, such an irritation produces merely a single con-
bat 90 tetanus. Hence too the opinion already put
forward by Schelske acquires great probability—namely, that
at the high temperature spoken of, all the apparatuses, which
otherwise can modify the results of an external irritation
have ceased to act, or in other words, that both the organs
which generate , and those which co-ordinate the motor impulses,
have fallen into a kind of trance. As to the sudden change of
temperature it seems to act principally as an irritant, and in
the first place upon the vagus.
The author remarks, in conclusion, that though his investiga¬
tions, which were rather calculated for a general review, may
not be considered as an experimentum crucis for or against the
current hypothesis, they may however lead us to hope that by ac¬
curate special studies in this direction, we may arrive at results
important in their bearing on the theory of the heart’s action.
(To be continued.)
-♦-
Siltruhm.
LECTURES ON CLINICAL MEDICINE. 1
In our number for the 6th of November, 1867, we briefly
reviewed the third and concluding part of the first volume of
Dr. Bazire’s translation of Trousseau’s admirable lectures, so
that we need not again enter on a description of them, or of
Dr. Bazire’s well and faithfully executed edition of the Eng¬
lish version of them.
The eminent French teacher and his brilliant and industrious
pupil have been both called to their rest, leaving the English
work of the latter incomplete. Such being the case, the New
Sydenham Society—very properly, we think—took up tke con¬
tinuation of the translation, and, in order that whole might be
published uniformly and in their usual style, they decided on
reprinting vol. i., which had been just before Dr. Bazire’s death,
and of afterwards continuing the work which that lamented
physician left unfinished.
The volume before us is, then, a literal reprint, not a new
edition, of Dr. Bazire’s work, and as such we hail its appear¬
ance with pleasure.
It is scarcely necessary to add that the “ get-up” of the
volume is in the usual and favourably-known style of this most
useful Society.
THE LATE DR. ADDISON’S WORK.
In this case,2 as in that of Trousseau and Bazire, we need not
introduce to our readers the classical name of Thomas Addi¬
son, or give any description of or criticism on his writings,
which are known to most well-read, modern physicians, and
which enjoy so solid a repute as to have induced the New
Sydenham Society to publish them, as they have done, among
the medical classics of the nineteenth century.
This volume consists of 242 pp. 8vo, and is opened with an
editorial biography of Addison, which shows how hard work
and unceasing determination did not fail to place him in that
position which he was ambitious to fill, and which he did fill
with such distinction and usefulness.
Prefixed to the first five papers on diseases of the lungs is an
excellent editorial preface. No. 6 is entitled, “ Observations
on Fatty Degeneration of the Liver,” No. 7 “ On the Disorders
of Females connected with Uterine Irritation;” No. 8 records a
“ Case of Ovarian Dropsy removed by the Accidental Rupture
of the Cyst;” and No. 9 is a reprint of a celebrated paper, well-
known in connection with Addison’s name: “On a certain
affection of the skin, Vitiligoidea—Plana; (6) Tuberosa.”
No. 10 is also a well-known original contribution to medical
science—“ On the Keloid of Alibert, and on true Keloid.” No.
11 treats of “ Disorders of the Brain connected with Diseased
Kidneys;” and No. 12, “On the Influence of Electricity as a
remedy in certain Convulsive and Spasmodic Diseases.”
The last paper—No. 13—is perhaps that with which Addi¬
son’s name will be best known to medical posterity, and is
entitled, “ On the Constitutional and local effects of disease of
the Supra-renal Capsules.” Beside his own preface, the editors
have also prefixed one. Of course we need say nothing to our
readers about “ Morbus A dissonii.” This collectton of Addi¬
son’s papers is an admirable publication. Addison never wasted
words; and so he, being dead, yet Bpeaketh.
i By A. Trousseau. Translated and edited with notes and appendices
by P. Victor Bazire, M.D. (Published for the now Sydenham Society.)
London, 1808.
I 2 A Collection of the Published Writings of the late Thomas Addi¬
son, M.D., Physician to Cuy’s Hospital. Edited, with introductory
| prefaces to several of the papers, by Dr. Wilks and Dr. Daldy. (Pub¬
lished for the New BydenhamlBodety). London. 1608.
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Notes on current topics.
August 12 , 1868 .
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WEDNESDAY, AUGUST 12, 1868.
ARMY MEDICAL OFFICERS.
Army medical officers have some real grievances. They
complain of the restriction under which, as compared with
the combatant ranks, they obtain leave of absence, either
on private affairs or on the recommendation of a Medical
Board, when serving in foreign stations ; and of the ex¬
tremely short time they are, as a rule, permitted to re¬
main in the United Kingdom between the completion of
one term of foreign service and the commencement of the
next. That there exists a desire on the part of the present
Director-General to improve the position of his officers in
both respects, there connot be a doubt. We really do
know of a few very fortunate men who have of late re¬
turned to this country on what is called private leave , but
we are no less aware of the utter hoplcssness of a medical
officer, other than in very exceptional cases, obtaining this
boon, at the same time that the battalion officers of his
own regiment obtain the indulgence almost, as would ap¬
pear, without limit. With regard to sick leave , the
medical officer is still more disadvantageously placed. A
surgeon of a regiment, and a major in the same corps, for
example, arrive in England from abroad, both “ to appear
before a Medical Board.” Both have suffered from liver,
or dysentry, or cholera, and the severity of the illness is
as nearly as possible alike in both. The surgeon obtains
three months' leave, the period being toq short to permit
him to fairly settle down into that regimen which is neces¬
sary for the restoration of health. At the expiration of that
time he, perhaps, get ^extension of other three months, but
if, at the end of that period, his health should happen
not to be restored, he knows perfectly that he must submit
to being deprived of bis regiment, in order that he may,
in the words of a late Director-General, “ make way for a
more efficient medical officer.” But this is not all. In the
event of his health not being so completely broken as to
render him totally unfit forwork, he is placed upon duty
at a home station, and, at the same time, in the roster for
foreign service ; but if so completely used up as to be fit
for nothing, is shelved on half-pay. Not so with the
major however. W hat is in this supposed instance sauce
for the goose, is by no means sauce for the gander. lie
that Is the major, has, in all probability, obtained six months’
leave at at one fell swoop. He then obtains six months
more ; then an extension, and so on for eighteen months or
a couple of years ; and then, when convenience and season
suit him, rejoins what is still his corps, but in which the
name of the surgeon is all but forgotten, it is so long
since he left it.
Now, if our views are correct, there are abuses both ways
here. If the sauce be of Normandy pippins in the one,
let it not be of crab apples in the other. And so, as re¬
gards home service. Regiments, as a whole, are supposed
to spend five years at home for every ten they are abroad.
Officers of the Royal Engineers make arrangements, as a
matter of course, for five years at a home station ; and so
on with other “ departments,” save and except the medical
officers in all ranks of which can seldom reckon upon more
than a few months, or at most a year in England.
The reason assigned for all this, is that “ the estimates’’
limit the numbers of medical officers to their present stan¬
dard ; and that really the roster comes round so rapidly
that the existing evils are unavoidable under the system.
Precisely so ! But ought not a system which works so
unequally, and often so injuriously, be modified? Un¬
doubtedly it ought. Let the officers most concerned,
therefore, use their best endeavours to return to a Parlia¬
ment a member pledged to support and advocate their in¬
terests as a department. If the present numbers of tiiedi-
cal officers are insufficient for all the duties required of
them, the interests of the service demand that they be
increased. •
--+-
IToics nil fexeut
Medical Honours at Oxford.
Our great educational nursing-mother at Oxford has fol¬
lowed the example of her humbler sister in Dublin’in its
honorary rewards to the eminent members of the profes¬
sion who] have visited her walls this year, and has laid
the hand of approval on the heads of six men worthy of
every honour in her power to bestow.
Not only medical eminence, but great talents and inde¬
fatigable perseverance in the pursuit of science, have been
rewarded in the persons of the gentlemen selected for the
Honorary D.C.L. No one can say that Sir Charles Locock,
the Rev. Dr. Haughton, Dr. Gull, Mr. Paget, Mr. Simon,
and Mr. Syme are mere physicians or surgical handicrafts¬
men. They are men within whose minds there is room for
greater considerations than money-getting practice, and it
[ is a noble assurance to those competitors who labour for
celebrity in the widest fields of medical science, that such
men are not only successful practitioners, but are thought
worthy of the highest praise our greatest University can
give.
Nomenclature of Diseases.
We are glad to report that the new nomenclature of
the London College of Physicians, of which we have
already given some particulars, is now ready. It will be
adopted by all the public departments, and no doubt will
shortly be recognised as the standard Nomenclature of
Diseases. I he College will, we suppose, present a copy to
every fellow and every member on application, as was the
case with the report on leprosy. We hope other medical
men may be able to purchase the book at a low price. The
College has no longer its pharmacopoeia to produce, but a
work of this kind may very well absorb its energy. There
can be no reason either why some day a small profit should
Digitized by VjiUUV LC
the Medical Press and Gheolafc
Notes on ctJRRENT topics.
August 12,1868. 147
not accrue. If we think how many thousands of copies
might be sold at a very low price, there is ample room for
this. No publisher need be employed to take his large
profits, but the College could sell at one uniform rate direct
to the purchaser. The post would distribute it in a rapid
and economical manner through the country. In London
the purchaser could send to Pall Mall for it. We really
see no reason at all why the College should not thus take
advantage of its production in this way. At any rate, it
might recoup the heavy expenses of getting up such a
work. The book, too, like a pharmacopoeia, will need re¬
vision, and the College already contemplates that contin¬
gency, and will be prepared after ten years with a revised
issue.
This first attempt at a universal nomenclature in Latin,
English, French, Italian, and German, is a work worthy
of the learning and traditions of the Royal College of
Physicians of London.
Sir James Simpson.
The profession will shortly receive, in the person of one of
its greatest obstetric representatives, a very unusual
honour. It is seldom that eminence in our body receives
a direct publicand extra professional recognition, for very few
medical men can afford to take such a part in the adminis¬
tration of the commonwealth as to render them suitable
claimants for public honours. Sir James Simpson is to
receive the freedom of the city of Edinburgh, and the
honour is enhanced ten-fold by the fact that, in its confer¬
ring, he is to stand side by side with Lord Napier, of
Magdala. Such a compliment at the hands of the Repre¬
sentative Council of the chief city of Scotland is an une¬
quivocal proof of the estimation which Sir James has
obtained in his private and local capacity, and amounts to
a declaration that a medical man, who may prove himself
deserving of public reward, is in no respect incapacitated
from receiving as full a measure of honours as the most
esteemed and worthy of the servants of the Empire.
The late Mr. Travers.
We regret to have to notice the decease of Mr. Benjamin
Travers, F.R.C.S., who bore through a long life most
worthily the illustrious name he had inherited. If he ever
had an enemy it must have been in his youth, and the
feeling could scarcely survive. The almost sneering man¬
ner in which one periodical has spoken of the deceased is
therefore particularly obnoxious to censure. The person
who penned that paragraph has evidently no notion of
greatness except such as consists in making great incomes.
What an ignoble test of a professional life. The writer
who applies it does not deserve to have any connection
with the medical profession.
The Cattle Plague.
Our congratulations on the entire annihilation of the
battle plague throughout the empire must bo tempered with
the recollection that its ravages extend much closer to our
coasts and the sources of our import trade than we could
wish. It has broken out with great violence in the districts
of Heyde Kong and Goldup, in Prussia, and in the Tyrol,
and the most active precautions are being enforced to pre¬
vent its spread. It is to be hoped that our official guar¬
ding will hold themselves on the alert against the impor¬
tation of any cattle from these districts within our coasts.
4 _ -r !. -
Sunstroke.
The exceptional heat of the weather this summer has ex¬
cited unusual interest in the phenomena of sunstroke, and
the prevention of this formidable malady, and its treat¬
ment when it appears alike deserves renewed attention.
It should never be forgotten that rational precautions
seem almost always to be successful. In this country
sunstroke ought to be not only rare but unknown. Pro¬
tect the head and nape of the neck, wear loose clothing of
proper material, and avoid stimulants—those are the car¬
dinal rules for prevention.
How is it that the British gentleman cannot be per¬
suaded to discard his absurd chimney-pot, and take as a
head-dress any light-coloured and broad-brimmed cap?
The ignorance and folly prevailing on these points astounds
many. As medical men we ought to set a good example,
and teach our patients to emancipate themselves from the
thraldom of fashion. Some are ready to do so, but hesitate
to go against established usage. The boldest reformers
stop half way.
We lately met in Piccadilly a physician, whose name is
well-known, walking in a white silk alpaca loose coat. He
had been to visit his patients in that attire, and confided
to us that they all complimented him on his courage ; but
even he had on his chimney-pot hat, although wise enough
to use his umbrella as a parasol. The same day we met
another physician walking about London in a Panama hat.
He said, “ What is the use of brains if we dare not use
them?” We repeat his query, but we may add that to
arrive at a proper dress for such weather as we have had
it would be necessary to combine the courage of these two
bold reformers.
So much for prevention. As to cure, Indian officers
place most confidence in the douche to both head and
shoulders. The best account of sunstroke we have met
with is by Dr. Maclean’s essay in Reynolds’s “ System of
Medicine,” the most remarkable collection of original
medical memoirs produced in this generation. To that
learned work we accordingly refer our reader for informa¬
tion of the most trustworthy kind.
Junior University Club, Dublin.
The provisional committee of this Club have issued a cir¬
cular, in which they announce that their exertions for its
establishment have been attended with very fair success—
such as to lead them to the conclusion that they may anti¬
cipate largo support from the University Graduates
throughout Ireland. The Club will be available for alumni
of any University of the United Kingdom. Premises have
been secured in the neighbourhood of Dawson-street, and
it is hoped that accommodation will be available for the
members by the 1st of October next.
The Plague of FHes.
The activity of insect life, consequent on the recent tropical
heat, has as yet only made itself manifest to the body
corporate of the individual Englishman, but it appears
from the correspondence of our contemporaries that more
serious results are to be feared in the destruction of crops
by the enormous multiplication of such depredators.
Against such a result we must look for help to our native
small birds, and we may yet feel the punishment of the
unreasoning slaughter of our natural protectors.
The sparrow club*, which have hitherto been simple and
comparatively inocuous aggregations of rural blockheads,
Digitized by VjiOO^IC
148 The Medical Press and Circular. THE BRITISH MEDICAL ASSOCIATION. August 12,1868.
become now absolutely hostile to the public gain, and it is
to be hoped that the emergency may induce them to sus¬
pend operations until the plague of flies, which threatens
our island, is neutralised.
Bathing.
The Royal Humane Society have followed up their valu¬
able circular of directions for the resuscitation of persons
apparently drowned, by a further paper drawn up by Dr.
Sieveking and Professor Christison, on the subject of
bathing. Though less within their function, the public
are none the less under obligation to the Society for inform
mation which no one has thought of giving them else¬
where. The following, in substance, are the suggestions
of the Society :—
Not to bathe until the stomach is empty ; at least two
hours after a meal.
Not to bathe when the system is debilitated by unusual
fatigue.
Not to bathe when the skin is in a condition of perspira¬
tion, or immediately afterwards, but w hen the surface of
the body is warm.
Not to bathe when chilliness is felt, nor to cool down
the body by standing naked either before or after bathing.
Not to bathe at all if a short stay in the water, under the
above conditions, be habitually attended with chilliness or
numbness of the hands and feet.
Not to bathe, if the system be weakly, early in the
morning, when the system ha3 been many hours without
support, but, if possible, about three hours after breakfast.
Pepsine Biscuits.
Messes. BeWley and Hamilton, of Dublin, have recently
introduced to the notice of the profession biscuits prepared
by them with the view of providing an agreeable and
eligible form for the administration of pepsine. Each
biscuit contains 5 grains of pepsine, so that two or three
may be eaten before a meal. They are put up in i ltu
canisters, containing twenty biscuits. In this preparation
the pepsine is administered in a perfectly unobjectionable
form, for they differ in no respect from ordinary wine
biscuits, and are devoid of any objectionable flavour what¬
ever.
-♦-
THE BRITISH MEDICAL ASSOCIATION.
The meeting of the profession at Oxford which has been
looked forward to with much interest, took place since the
ublic&tion of our last issue, and may be pronpunced*to have
een an entire success. The arrangements usual at all the
meetings of the British Medical Association for the provision
of information and accommodation were efficiently carried out,
and several of the colleges opened a portion of the apartments
at their disposal for the reception of the visitors. The very
great length to which the addresses and communications run,
prevent us from doing more than abstract their most important
parts.
The inaugural meeting took place on Tuesday evening at
eight o’clock, in the hall of Christ Church, and was so largely
attended that it would be impossible for us to attempt an
enumeration of the members present. The chair was taken
by Dr. Stokes, Physician to her Majesty the Queen in Ireland,
and the outgoing President of the Association, who proceeded
to deliver his valedictory address.
t The President, after some preliminary observations, said, let
me, before bidding you farewell, say a few words as to the
future of this great Society—now the most numerous body
working for the benefit of science in the world, and which will
doubtless attain to large dimensions. So far, we have been
an united body, which is to be attributed to our federal consti¬
tution, with independent local action, and a representative and
imperial executive. How long this strength giving union may
last no man can predict; nor, on the other hand, can any man
say to what an amount of influence for good this Association
may attain. But it is plain that its durability and useful¬
ness will depend on its being made the instrument for the
public good, rather than the machinery to advance the imme¬
diate worldly interests of the profession. And everyone of us
must lay it to heart that a great issue rests within his hands.
The man among us who by his unselfish labour adds one useful
fact to the storehouse of medical knowledge, does more to ad¬
vance its material interests than if he had spent a life in the
pursuit of medical politics. Far be it from me to say that there
are not great wrongs to be redressed. It is impossible, in any
country, that evils of custom and of administration, private
wrong, corporate shortcomings, hard dealings, unfair competi¬
tion, and scanty remuneration for public and private services
should not occur. But these evils being admitted, how are
they to be lessened, if not removed ? Is it by public agitation
and remonstrance, addressed to deafened or unwilling ears ? Is
it by the demand for class legislation ? or is it, by the efforts of
one and all, to place medicine in the hierarchy of the sciences
in the vanguard of human progress; eliminating every influ¬
ence that can lower it, every day more and more developing
the unprofessional principle, while we foster all things that
relate to its moral, literary, and scientific character. When
this becomes our rule of action, then begins the real reform of
all those things at which we fret and chafe. Then will medi¬
cine have its due weight in the councils of the country. There
is no royal road to this consummation. On the one hand, the
liberal education of the public must advance, and the intro¬
duction of the physical sciences in the arts courses of the Uni¬
versities, has given the death blow to empiricism; and, on the
other, that of ourselves must extend its foundations, and
trust far less to the special than to the general training of the
mind. When medicine is in a position to command respect,
be sure that its rewards will be proportionally increased, and
its status elevated. In the history of the human race, three
objects of man’s solicitude may be indicated: first, his future
state; next, his worldly interests; and lastly, his health. And
so the professions which deal with these considerations have
been relatively placed; first, that of divinity; next, that of law
or government; and, as man loves, gold more than life, the last
is medicine. But with the progress of society, a juster balance
will obtain, conditionally that we work in the right direction,
and make ourselves worthy to take a share in its government,
not by coercive curricula of education, not by overloaded exa¬
minations in special knowledge, which are, in comparison to a
large mental training, almost valueless; but by seeing to the
moral and religious cultivation, and the general intellectual
advancement of the student. Doubtless, such a revolution,
which, could men only read the signs of the times, is slowly,
though surely, coming, will lessen the number of a certain
order of candidates for license to practice. Doubtless, also,
while the funds of special corporations will be diminished, uni¬
versity education will be extended; and the whole character of
medicine will be changed, greatly to the advantage of its social
position in the country, and the interests of scienoe and the
public at large.
Putting aside the success of your labours at Dublin, in a
scientific point of view, your meeting of last year deserves a
long remembrance. It was the first occasion on which the
members of all ranks of British and Irish professional men
met to know one another, to unite in the common cause of the
advancement of knowledge, and to learn, on a great scale, how
the mutual cultivation of science will efface national preju¬
dices ; for it is only in this way that those national dislikes and
distrustings which become hereditary feelings, transmitted
from one generation to another, which separate peoples and
delay the peaceful federation of the world, can ever be removed.
The star of knowledge, while it illuminates the path to wider
and still wider discovery, yet is like unto that which guided
the sages of the east to the cradle at Bethlehem ; for its be¬
nignant light is the herald of peace and good-will among men.
Dr. Stokes’h observations were received with vehement
applause, which was renewed on the assumption of the chair
by Dr. Acland, the President, who proceeded to deliver the
inaugural address.
Having spoken warmly of the success of the visit of the
Association to Dublin—The President said,—We are living
in a critical period of our country’s history; in a new era
in the history of man. Every part of our social fabric
is now undergoing scrutiny, revision, and reform. Go¬
vernment, trade, institutions, laws, the artificial usage* of
Digitized by
The Medical he, and Circular. THE RRITISH MEDICAL ASSOCIATION.
August 19,1668. 149
society, the character to be given to our children by the
method of their early training, are not only being criticised,
but are most of them being changed—changed with unex¬
ampled rapidity* mid the change is, some think, a tendency to
absolute perfection, or, according to one philosopher, a last
plunge down the Falls of Niagara. The facility with which
ideas are communicated through the whole human family, dis¬
tinguishes our age from all that precede it. Our own profes¬
sion is not exempt from these influences ; even if it were, we
are part of the body politic, and, as wise men, we might do
well to look forth from the fretted shelter of this ancient hall,
itself a memorial of the ferment of the fc Reformation, and,
watching the storm as it drifts along, take the bearing of our
own course in the stream of time. I propose to take a general
survey of the position occupied by our professional knowledge
in relation to other branches of knowledge, and to consider the
objects which ought to be held in view when we discuss the
temper required of us by our times, and the training proper for
the formation of that character and temper.
Now, in judging of the medical character, we set aside, of
course, all reference to individuals. We form an ideal char¬
acter. And yet the ideal cannot be considered wholly in an
abstract way. We have to judge of it in its relations—first to
the condition of Science, and secondly^ to the constant pro¬
perties and the variable accidents of Humanity. In the pre¬
sent age, science is advancing, and the means of its progress
are increasing with altogether unexampled rapidity. No
bounds can be set to its possible conquests. A profession de¬
pendent on science must vary with* that on which it de¬
pends; and if it does not advance with the advance of science,
that fact proves it to be in error. Humanity has its constant
properties and its variable accidents; its constants of need of
food, of warmth, and of clothing; its constants of sickness and
disease; its constants of relative poverty and relative wealth ;
its constants of yearning after good, and exposure to misery
and guilt. But humanity has also its variable accidents of
climate, of fashion, of ease, of luxury, of degradation; not, like
death, unavoidable and irremediable, but accidents, terrible
acidents—such as, however formidable and perilous, to a cer¬
tain extent may be avoided or can be remedied. Reflection
will show to what a vast range of subjects medicine is linked
by these two circumstances, the progress of Bcience and the
fluctuations of humanity. How numerous are the points of
science which touch us more or less closely.
Let us then consider, first, the relation of modern medicine
to modern science. It was just now said that medicine is
necessarily linked to the existing condition of science. This
statement must be examined more closely. Medicine is at
once in advance of the exact sciences, so-called, and behind
them. It is in advance of them, inasmuch as it clinically ob¬
serves as facts some things which science has not yet fully
explained; and it believes with strong conviction what can at
present be neither demonstrated nor ignored. It is behind
them, inasmuch as they claim for every fact of science an ex¬
actness to which medicine cannot always pretend. But medi¬
cine too long consented to regard itself as an art as dis¬
tinguished from science. Now, the existing relations of pure
science and medicine are both direct and indirect. In the
direct relations it follows the lead of science without hesita¬
tion ; in the indirect relations it cannot afford always to wait
for positive instructions. Let us look for a moment at each
of these relations. The relations are direct in the case of all
those means of modem invention and research which are
applied duly, in ways of which half a century ago there was no
conception, to the discovery and the explanation of physio¬
logical and pathological phenomena. To the interpretation of
sounds heard within the body, Laennec and a host of subse¬
quent observers brought precise acoustical observation and ex¬
periment, and showed us how to map out the condition of ex¬
ternal parts, the action of which we hear but cannot see ; so
that though we are not always able to say absolutely what is
tile nature of an abnormity, producing an abnormal phenomena,
we can at least say what it is not. By applications of optical
instruments Czermak and Cruise have laid open to us many
Organs of the body before inscrutable—the pharynx, the vocal
'chords* the trachea, the vagina, the uterus, the bladder ; so
that the actual but hidden causes of many phenomena are no
longer matter of argument, but of sight and demonstration,
the secrets of the eye, I need not say, arc uow disclosed by
Tlmnn of the physical contrivances of Helmholtz and others,
by the many elucidations contributed by our own
'QQM|£jpBe&« Albutt and Ogle in this country, and others on
WltiitiUttflitii fire working out the further proposition that
some states of the eye are not only important in themselves as
local abnormities, but as being pathognomonic of other suspected
conditions in other and distant organs. The sense of touch is
so supplemented by the skilful apparatus of Marey that the
wave phenomena of the pulse and heart are registered ; and
thereby, through indirect but clear induction, we can fathom
the secrets not only of the circulatory apparatus, but of nerve-
action and nerve-lesion behind and beyond. And am I to add
in this company that the very romance of zoological evolution
is brought to enlarge our knowledge of the parasites that in¬
fest our bodies, modifying sanitary regulations in a remarkable
manner, or that in every practitioners hand, the microscope
and the test tube answer in a moment questions once un¬
answerable. though on them hang issues of life and death ?
The exploration of the nervous system by electrical agen.
cies, by manometers and the like, through the .recent labours
of the many, but especially of M. Duchenne de Boulogne, and
the registration of changes of temperature in evidence of
chemical alterations and in proof of corresponding alterations
in the organism, Bhould be cited as among the less developed
but equally certain advances of physical inquiry as applied to
disease. The framework of medicine simply considered as an
art now eepends on accurate data, on experiment, on observa¬
tion, and direct induction therefrom. But though this be
true, yet medicine as an art cannot always go hand in hand
with medicine as a science. The physician, with emergencies
constantly before him, cannot wait to act till science has estab¬
lished her conclusions with absolute certainty. In bo far as
medicine is purely scientific it is not in hazinony with the
average mind of mankind ; in so far as it is empirical it is at
variance with pure science. Science being organised know¬
ledge, and admitting no uncertain element, objects to the pro¬
babilities which guide the master of the art to his conclusions,
and lead him to act with a promptitude incomprehensible and
appalling to the uninitiated. Just as the scientific navigator,
who is furnished (as every navigator ought to be) with the in-
Btincts of the empirical seaman, trusts those instincts in a gale
as readily as his accurate observations in clear weather; so
the true clinical physician decides first, and afterwards puts
together in logical arrangement the reasons for his decision.
In so far as he does this he abandons the order observed in
pure science. Still he must do so in many cases if he is to act
at all. If he cannot do so, he is apt to become first sceptical,
then indifferent. That such scepticism and such indifference
may be a real danger in the practice of medicine, and is some
counterpoise to the many advantages which modem medicine
may derive from her scientific character, is hardly to be
doubted. This subject of medical scepticism is too grave to
be here passed over without some consideration. Healthy
criticism of existing belief is one thing ; mere destructive
criticism, with no honest purpose of getting at the truth, is
another. The former is a necessary quality in a man of full
power ; the latter is the frequent sign of idleness in youth,
and of carelessness in advanced years.. There was a time
when the priest and the physician were one, and when the art
of healing was looked on as a supernatural gift. It is so es¬
teemed even now among savages. Cures wrought by a higher
intelligence, being above the conception of the “rude untu¬
tored mind,” seem emanations from the attributes “ of the un¬
known god.” The impostor priest could be also impostor
physician. Trading on the weaknesses of his fellow-men, he
would dogmatise on the ailments of the body and their cure,
as well as on the diseases of the mind and their remedies
The destruction of such dogmas, groundless though they may
be, is a glow and dangerous process, as all students of history
can tell. But the time is come when every opinion and con¬
clusion has to be sifted ; and another danger has come rapidly
upon us—that of reckless negation of the accumulated experi¬
ence of our race. What are our fathers to us ? Are we not
better than they ? This is with some the modem version of
the well-known lamentation :—
“ AStas parentum pejor avis tulit
Nos nequiores, mox daturos
Progeniem vitiosiorem.”
But still in the traditions of the past there is a mass of
practical wisdom. Nothing is more admirable than the cau¬
tion and care—tho generally scientific spirit, and often the
truly scientific method, with which the best men, such as Mor¬
gagni, Sydenham, and Hunter, observed and reasoned. It is
conceivable that this caution was duo in great measure to the
uncertainty of the ground they trod, and the want of preci¬
sion in tho means they possessed. We are superior to our
fathers in the means at our disposal, and in the pmUvmwB
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i3o The Medical Press and Circular. THE BRITISH MEDICAL ASSOCIATION.
August 12, 1868.
with which we can up to certain points enunciate our results.
But we ought not to overlook the fact, that with these posi¬
tive gains we aie subject to contingent losses, and that in an
epoch of details and comparatively facile methods of inquiry
the great qualities of patience and reserve may be lost to those
who are not themselves original investigators. From the
causes of twining in the delicate tendril to the causes of
variation in the human species, from the causes and
local conditions of atmospheric changes to the causes and
physical consequences of the combustion of a fixed star,
the biologists and physicists of the day are seeking a
true cause ; and, each* in his way appreciated by hundreds
of fellow-workers and ten thousands of more or les3 intelli¬
gent followers, is making a step towards the first cause which,
Newton says, “ Is certainly not mechanical.” And what have
they reached l First, the conviction, clearly expressed many
years ago, of the exquisite interdependence between our entire
fauna and flora in the chemical circulation of matter on our
globe ; and next, the generalisation at once so simple, so over¬
whelming, that all action of which we are immediately cogni¬
sant is but the result of the operation of solar heat upon and
through interdependent and correlative existences ; that all
things in this system are capable only of interchange ; that
there is no destruction of what exists ; no creation of new
energy. The theorem of the conservation of energy has not,
as may be supposed, brought direct fruit to medicine, but indi¬
rectly it has already told in more ways than one. But it explains
nothing whatever of the origin of things ; nothing of the nature
of will. However true it may be that the solar energy was
stored up myriads of ages ago in the coalfields, however true
it may be that, in the processes of vegetable life and decay*
the sun’s energy is constantly being first captured and then
liberated for further use in other organisms, yet nothing of
this emits the smallest spark of information on the true cause
of orginisation, or of the working of a single organic cell.
These fundamental ideas seem at first sight to belong so little
to the work of everyday life or to the practice of an art, a3
hardly to have any relation to them. Yet very little reflec¬
tion shows how the profession, which has always assiduously
pursued, indeed has been the chief promoter of, natural know¬
ledge, cannot separate itself from the indirect, any more, than
from the direct influence of science, and so has to follow these
apparently remote speculations. Who would suppose that
the question of spontaneous generation so keenly debated from
a very early period to our own year and day, need have any
immediate bearing on practice ? Yet see how the observations
of Pasteur are connected with the questions of infection—nay,
more, of suppuration, and (as shown to be proable by Pro¬
fessor Lister) of surgical treatment. It would indeed be a great
point if we could prove that no germs, Carriers of disease, spon¬
taneously originate, but must always immediately come from
rf progenitor cell. If so, there would just be a hope that some
diseases might be effectually and finally stamped out. What
we do know of zymotic diseases does not favour this expecta¬
tion. At the same time it has to be borne in mind that both
the success and the failure of vaccination disclose the existence
of properties which it would have been fantastic to expect, but
which experiments proved to exist. What the powers of
“ nature” are in producing and regulating morbid products,
and what the powers of man may be, is becoming every day
more apparent in such inquiries as those on the relations of
vaccination to syphilis, which are now being discussed by Bal¬
lard and Seaton. If we take them into consideration, together
with the researches into the origin of tubercle by Villemin,
Sanderson, and Wilson Fox, the inquiries into the origin of the
cattle plague, and the whole state of our knowleoge of the
nature of what is called, infection, we have presented to us
certainly one of the most remarkable series of biological and
paththological .investigations that has been ever recorded, and
to an intelligent and cultivated person unacquainted with the
state of human knowledge in respect of bialogy, one which
must, at first, seem almost incredible. “ There are two
methods by which the art must work : first, the method of pure
science, with no other object but the attainment of knowledge
and truth, the method which works by observation and experi¬
ment, in physics, chemistry, anatomy, and physiology, by the
study of agents, and, where necessary, by vivisections ; and
secondly, the empirical method, or the method which attempts
to cure by rules derived from tradition, probability and tenta¬
tive experiment.”
Now, by the first of these methods we are able to ascertain
the law or course of action of the most complicated vital pro¬
cesses, as appears from the researches into tubercle and
syphilis to which I but now allude. But this method is un¬
able to explain the relations of phenomena in any, even the
simplest organism, for it cannot be said that we at present un¬
derstand the simplest vital process. Still it te a great thing to
see the laws or course of action of living bodies being gradually
developed and laid down. We know, for instance, that a
certain disease w'ill run a certain course in a certain family.
What is this but the law that living matter acts in a definite
manner under definite conditions, and that when we can pre¬
dicate the conditions we can predict some at least of the re¬
sults ? This law is of course the scientific basis of all curative
medicine in individual instances, and of all preventative or
state medicine in communities. The application of this law
to vital as well as to inorganic phenomena strikes a blow at
many ancient prejudices which assumed and sometimes fos¬
tered the notion of exceptional and erratic procedures, that is
to say, of procedures for which no reason could be given.
Viewed calfnly, it is the ground for all hope of future progress
in Therapeutics ; and for this reason among others. In the
present state of knowledge we are always on the verge of the
most amazing results, and we do not know when or where the
outcome will be. And slowly, but surely, the siege of the for¬
tress of knowledge advances. Latterly it has shown sign of
progress in a new and unexpected direction. Chemistry which
used to be chiefly analytical has now become enthusiastically
synthetical. There are virtually no limits to the substances
which can be made. Berthelot makes a calculation of the
number of combinations with acids of certain alcohols. He
says if you gave each a name, allowing a line for the name,
then printed 100 lines in a page, and made volumes of 1000
pages,' and placed a million volumes in a library, you would
need 14,000 libraries for your catalogue. He therefore pro¬
perly calls such bodies infinite, instancing the synthetical con¬
struction of the alcohol and aldehyde series, of the organic
acids, of the amides, of urea, and the millions of possible
bodies which loom in the future—certain 1 to be made, waiting
to be made, the possessors of qualities suspected but unknown.
I almost hesitate to observe that bodies of this kind have im¬
portant relations to the properties of the nervous system in
man. Chloroform and the various amides employed by
Richardson have made this familiar to all. The beautiful ex¬
periments by Bernard upon amygdalin show the question to
be still more intricate and vast than Berthelot puts it in the
passage already cited. It is manifest, therefore, that the pos¬
sible agents for affecting the human body are infinite, and the
instances which I have partially touched on of the relations of
glanders, tubercle, and irritation ; of syphilis and vaccination,
show what might antecedently have been expected—the
equally infinite problems which may be experimentally dis¬
cussed and solved in the higher animal organism, problems
equally affecting the classifications of Pathology and Thera¬
peutics. Of the second, or the Empirical method, to which I
but now allude, it is not to the present purpose to speak.
Having said thus much on the relations of Modern Medicine
and Modern Science, in the hope of vindicating our profession
from one-sided attacks, founded on the notion that it is wanting
in scientific precision, I leave this light sketch of a vast sub¬
ject, in order to consider the present relations of Modem
Medicine to Humanity ; in other words, its relations to the
wants of man in the complex state of modern society. There
were great armies before the Christian era ; there must have
been great crowding in ancient Rome ; a careful and detailed
sanitary code was imposed on the Jewish people at the time of
the Exodus ; ‘Rome paid no small attention to sanitary works.
But neither permanent populous cities nor sanitary' codes were
the rule. In our day on the contrary', one of the peculiarities
of modem life is shown from statistics to be the tendency to
increase of population in great towns : so that in England be¬
tween 1341 and 1851 there was an increase in the population
of towns, of over 100,000 inhabitants, of 23 per cent. ; and in
the following decennial period, 1851 to 1861, there was, in
France, in towns of similar magnitude, taken collectively, an
increase of 50 per cent. In our day Preventive and Public
Medicine has become a great branch of Medical Science. Im¬
perfectly as yet carried out in this country, it is more fully de¬
veloped in several Continental countries, and, of late in a noble
manner, in the United States. It is here and there carried to
great perfection, a3 in various departments of armies ; it has
made great progress also in navies and in almost every part of
civil life. It will suffice to say that we have some reason to hope
that we may see the relations w’hich t ought to subsist between
this department of the Science of Medicine, and the community
at large, investigated systematically by a Royal Commission.
Digitized DyvJiv/v^V LV~
nubdkdfMi-«deiMta THE BRITISH MEDICAL ASSOCIATION.
August 12, 1866. 151
To anticipate the conclusions of such a commission would be
no becoming occupation. But this may be confidently ex¬
pected, that one result would be the elevation of the duties of
an officer in State Medicine to that of a recognised profession,
as in several special instances it has already become. At pre¬
sent it is not uncommon for a young man to be charged with
wasting his powers if he devotes himself to improve the public
health. Hereafter, charge of the puclic health must be made
as much a matter cf honourable ambition in the body politic,
and must become as much an object of special education and
training, as the business of any other recognised branch of the
civil service. The Government will have to define the duties
to be discharged by Public Health Officers or other Officers of
Public Medicine, and the General Council of Medical Educa¬
tion will be able to direct the education of those who aspire to
the performance of duties so defined. I have not here touched
on the problems arising from the condition of great towns.
They are become part of the literature—I had almost
said the sensational literature—of the day. Long familiar
with poverty, and the sorrows and penalties anti crimes which
hang about it, as well as the brightness and patience which
called forth the words ‘ Blessed be ye poor,’ I had not learnt
the intricacy of these problems till in the work of the Cubic
Space Committee (wherein I joined the most able President of
your Council) I found myself set face to face with them, and
had to consider what was the significance to the State of a
child born in the workhouse of a prostitute, brought up during
childhood in the workhouse, cast forth into the purlieus of the
city becoming pregnant and returning poisoned with syphilitic
sores, at an immature age to bear a syphilitic infant; nor did
I see the magnitude of the problems till I found that, not in
one instance but in thousands, not in one district but in many,
is this process being carried on. Where and how these fright¬
ful evils can be stopped is known only to Him who can tell the
causes which laid desolate whole kingdoms of Asia, and left us
to wonder at the ruins of cities whose very names are unknown.
But it rests upon us, more perhaps than on any other class in
the community, to see to it that no remedy which can be ap¬
plied, however partially, is neglected, and that no means by
which the comfortable and indifferent public can be roused to
appreciate the task before them shall be left unused. Still
less do I presume to handle now the relation of physiological
and medical knowledge to the habits of some among the
higher classes—to the conditions of modern society which over¬
stimulate nervous action, the late haurs, the exhausting effort,
the wholly unhealthy existence. This is a subject which needs
much tenderness and skill, and longer time than you can
Bpare. But it is a subject on which the advancing knowledge
and culture of modern medicine will have not a little to say ;
and which, it may be hoped, will be so said as to be heard.
There is one other relation of modem medicine which it
would be improper to pass by, although it is one which an
over-prudent man would instinctively avoid—its relation to
spiritual beliefs. The reason why an over-prudent man would
avoid all allusion to such beliefs is, that he dreads to entangle
himself in the maze of angry controversy which not only sur¬
rounds, but almost fills, the ecclesiastical world—controversy,
not between creeds permanently opposed, as the creeds of
Buddhism, of Islam, and of Christendom, but feuds in the
bosom of each separate religious system. The reason why we
cannot, if we would, avoid considering our own relation to
spiritual beliefs, lies in the two fundamental facts, that we are
ourselves men like other men, and that we stand in a closer
and more real relation to man, as man, than does any other
class of the commonwealth. It has indeed been said, “ TJbi tres
medici, ibi duo Athei.” The recent attacks by the' Cardinals
in the French Senate on the Faculty of Medicine show that
the charge • conveyed in this aphorism is not forgotten in
France. Signs of the same notion are not wanting in this
country. What is the fact ? The fact seems to be, that the
members of the medical profession are in their lives not less
religious than the average of the society in which they live.
Aa a body, they are calm, earnest men, who mingle little, per¬
haps too little, in the questions of the day, and seldom with
violence. Religious enthusiasm is rare with them ; fanaticism
»generally absent; and, on the whole, it may be said that,
u a profession, they stand aloof from religious discussion.
Self-interest operates in some degree ; usage operates to some
extent; but there is a deeper reason for their standing aloof,
whleli religious fpachers would do well to lay to heart. There
vAo know so much of the reality of man's nature,
f&jfttooflMtu, its conditions, its pains, its privileges. To the
frfrgfeWh/the bodily nature is bared in its beauty and iu its
hideousness, jn its formation and growth, and in its decay and
dissolution, The physician sees in the body of man the
material structure by which alone the known operations of the
mind of man are possible in this world, the organs by which
alone he can work liis earthly work, whether it be the work
which he shares in common with the beasts of the field, or the
work through which he can enter into conscious relation to his
unapproachable Creator : the frame by which, while bound
down in an earthly charnel-house, he lifts his eyes and
strains his heart with yearning ineffable towards a higher
nature, and obeys the upward tending impulses of affections
strong unto death, affections so pure and so divine as to
lose in the love of others even the consciousness of self.
All this, and much more, our profession sees as phenomena.
If these, then, be the relations of medicine to science and to
the bodily wants and the mental condition of man, and such
the character of the physician, what is to be the preparation
for his duties ? There is no better answer than this of Strabo:—
“ The value of a poet is bound up with that of the man. He
cannot be a good poet who is not a good man.” On which
Joseph Henry Green, who quotes the passage, says :—“ I anti¬
cipate no objection when I state that the process for attaining
or approximating to this great moral result constitutes, in its
scope or end, a liberal education.'' What that is, and how to
be attained, is held by all thinking men to be one of the pro¬
blems which our age has to solve, in and for the interests of
our country. May not grave mistakes arise herein ? At all
events, in the present transitional condition of this and other
questions of social economy, it were a waste of time for an
Association such as ours to undertake the investigation of this
difficult subject. But so far may be said, that the object of
academical education for our profession in from early life to dis -
cipline all the faculties. It is obvious that the physician should
be many-sided : he should be capable of sympathy with every
form of good ; he should have all his senses, eye, touch, hear¬
ing, disciplined to nice precision and exactness both in percep¬
tion and thought. We may take one instance—the bearing of
the so-called Fine Arts on the development of certain qualities
of mind. TJiere is a refinement of observation and a tact
acquired by the study of masters of music, architecture, paint¬
ing and sculpture, which add a charm to the life and character
of a man, whatever be his profession, such as is hardly attain¬
able in any other way. Not, of course, that I would wish all
men to be so educated as if they were to be artists or musicians.
Mathematics are valuable to train the mind to habits of accu¬
rate thought. The mathematics may be forgotten, may vanish
in all their details ; but the accuracy and precision Igiven by
their study may remain. So the practical dexterity of the eye,
and haud, and ear, in drawing and in music may be lost ; but
the delicate perception of form and colour and the relations
of colour, of sound and the relations of sound, and the effect
produced upon the mind by the study and cultivation of the
arts therewith connected, may remain, and tinge with a higher
character the whole nature of the man.
It would be trespassing too much on your good nature to
ask you to listen to the proofs that an acquaintance with the
mental constitution of man, of those ways of ennobling its
impulses, and of that mixed knowledge and discipline, which
are called religion, is more especially necessary for our pro¬
fession. I therefore assume that you generally consider
every scheme of preliminary education faulty which does
not admit this, and will only state briefly what present cir¬
cumstances seem to require of caution under that admission.
Granted that, for the intellectual training of a medical man,
religious discipline and psycologicai knowledge are required,
how are they to be imparted? and of what kind should they
be ? If those who have investigated the subject were
agreed as to the nature and origin of human families ; if
the unity of our race were conceded ; if there were no
variations in character dependent on family and inheri¬
tance ; if there were no questions as to the future state, nor
disputes concerning our relation to the Infinite ; if no ques¬
tions had arisen within the pale of Christendom as to the
scheme of redemption, nor outside that pale as to the evi¬
dence of that Christian faith,—then, indeed, the student
preparing for medicine would find some definite course of
mental philosophy and religious instruction in all colleges
from San Francisco to Calcutta. Till that day of united
conviction arrive, we must be content to take some general
position that all can accept. Nor is this difficult. All will
agree that we must, first, study the phenomena of human
nature as now known to us, without regard to the origin of
man; aud, secondly, study the principles of laws which
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152 Th» Medial Pnm and Circular. THE BRITISH MEDICAL ASSOCIATION.
Aag'uttt.UB.
ought to regulate the will and affections of man for the good
of nimself and society—in other words, the principles of
universal morality. Nothing less than this is necessary for
the youth who are to follow our profession ; nothing more
can we now enforce.
It will be useless to denounce the inquiries which tend to
explain the relations between thought and material organi¬
sation. That bundle (as it were) of qualities, good and
evil, which we call mind, does, 6s far as we know, require
for its manifestation the continuity and integrity of a com-
■plex organisation. That organisation varies with the quali¬
ties which are exhibited. The mental organisation of
animals inferior to man is as various as their bodily struc¬
ture. In truth, we have as good right to call the bodily
organisation the material part made for the action of mind,
as the mind the consequence of the bodily organisation.
The President then dwelt on the functions of a University
and the connection of the profession with them, and con¬
cluded thus:—As your representative I have asked freely
for what you seemed to desire, and in your name I thank
those who have granted it. In the name of your Oxford
friends, and as official head of the ancient and honourable
Faculty of Medicine in her University, I heartily welcome
vou to whatever in the lotus-growing, stagnant depth of the
long vacation you may find still living here. You bring your
own life, from England, Scotland, and Ireland, from the
United States, France, and Germany. Live it among us.
And in exchange for our welcome to the banks of the Isis
give us your thoughts and your counsels, to the end that we
may all return refreshed and strengthened to our common
and happy toil.
A vote of thanks to Dr. Stokes, the Ex-President, having
been then moved by Dr. Sibson, seconded by Dr. Paget, and
replied to, the Secretary proceeded to read the Annual Re¬
port, from which the following extracts are made:—
“It is with great pleasure that the Council have again to
report a continued and considerable increase in the number
of the members of the Association. At the end of the year
1867 the number of members was 8130. During the year 56
have died, 68 have resigned, and 111 have been erased for
rion-paymeat of subscriptions. Since the 1st of January of
the present year 621 members have been admitted. At this
time the total number of members is 3627.
“ The Treasurer’s Statement shows a considerable increase
in the receipts, and a sasisfactory state of the finances of
the Association.
“The Sub-Committee, appointed by the Council in 1866
‘to consider the mode by which the profession at large
may be directly represented in the Medical Council,' was
re-appointed during the past year, and a deputation of the
Sub-Committee, consisting of Dr. Sibson, Dr. Waters (Ches¬
ter), Mr. Southara, Dr. Simpson, Mr. Nunneley, and the
General Secretary (Mr. Husband being unable to be present),
had an interview,'on the 30th of June, with the General
Medical Council. At that interview the deputation pre¬
sented a memorial in favour of the direct representation of
the profession at large in the Medical Council, and they urged
its object by arguments, the force of which appear to your
Council to be unimpaired by any of the objections raised in
the debate which followed in the Medical Council, as
reported in the journals, where a resolution was carried to
the effect ‘ that, under present circumstances, it would not
be expedient for the Council to consider the propriety of
attempting to obtain a change of constitution.’ It would
have been gratifying to your Council if the Medical Council
instead of passing this resolution, had availed themselves of
the opportunity thus presented to them, and had commenced
the amendment of the constitution of their own body by a
movement from within.
“ The Council are deeply impressed with the conviction
that the direct representation of the large body;of registered
practitioners in the General Medical Council is an object of
high professional importance, that should be steadily pressed
by representations to the Government and to both branches
of the legislature. They feel satisfied that they have faith¬
fully interpreted, in this matter, the wishes of the profession,
and they are convinced that the efforts of the Association will
not be relaxed until this object is attained. They recom¬
mend that this object should receive the best attention of the
Oxford Meeting, and of the various Branch Meetings
throughout the kingdom.
“The Committee on State Medicine, appointed last year in
Dublin, commenced its duties before the dose of the meeting
and has since then, in conjunction with a Committee ap¬
pointed by the Social Science Association, held several meet¬
ings. On the 22nd of May, a large deputation from the
British Medical and Social Science Associations was received,
by the Duke of Marlborough, the Right Honourable Gatborne
Hardy, and the Bari of Devon, at the Privy Council Office,
and a Memorial drawn up by the joint Committees, showing
the necessity of a better administration of the laws relating
to registration, medico-legal inquiries, and the improvement
of the public health, was presented. The deputation was
assured that the Government would give the subjects brought
under their notice the best consideration.
“The Sectional Meetings, held for the first time at Dublin
last year, were eminently successful. The want, however,
of a section at which papers on State Medicine and Medical
Policy could be read and discussed, was much felt. This
want has this year been supplied by the formation of a Sec¬
tion on Public Medicine, and the Council anticipate that the
meetings of that Section will be of deep interest.
“The Sectional Meetings have assumed so sudden and im¬
portant a development, that the Committee of Council have
appointed a Committee to consider and advise as to their
future organisation.
“ Two essays were received for the Hastings Medal, but
your Council regret to announce that the adjudicators—
Professor Stokes, of Dublin, Dr. Paget, of Cambridge, and
Professor Gairdner, of Glasgow—have reported that they do
not consider either of them to possess sufficient merit; and
they therefore advise the Medal to be withheld for this
year.
“ The subject for competition for 1869 is ‘ Resection of
Joints.”'
The motion for the adoption of the Report gave rise to a
great deal of discussion, and speeches were made by Mr.
Gamgee and others condemnatory of the action of the Coun¬
cil of the Association in regard to their deputation to the
Medical Council.
This discussion was revived with considerable energy in
a motion of thanks to the Committee.
Eventually an amendment was carried, and after some
routine business the meeting adjourned.
Wednesday, August 5th.
The Association met this morning at breakfast, at the
Corn Exchange, and the assembly numbered nearly 400. A
large number of those present adjourned to the Convocation
House at half-past ten, to be present at the granting of
honorary degrees to Sir Charles Locock, the Rev. Dr. Haugh-
ton, Dr. Gull, Mr. Paget, Mr. Syrue, and Mr. Simon.
The place of meeting for next year was, on the invitation
of Mr. Nunneley and Dr. Husband, of York, fixed at Leeds,
where the new Infirmary is expected to be an object of much
interest.
Dr. Chadwick was accordingly chosen as President elect.
The following gentlemen were elected Honorary Fellows,
in accordance with the new law, on the motion of Dr. Sib¬
son Dr. Cookson (Vice-Chancellor), Professor Airey, and
Professor Stokes, of Cambridge; Provost and Vice-Provost
of Dublin University; Rev. Dr. Carson, of Dublin; Vice-
Chancellor of Oxford, Dean of Christ Church, Warden of
New College, Principal of St. Mary’s Hall, Sir B. Brodie,
Professor Phillips, Professor Clifton, Mr. Chapman, M
Duchenne, M. Marey, Professor Victor Cams, Professor
Gross, representing the United States Medical Association,
and Mr. Edwin Chadwick.
The Joint Report on State Medicine of the Committees of
the British Medical and Social Science Association having
been then presented by Dr. Stewart, Professor Holies ton
proceeded to deliver his address on Physiolgy—a disquisition
which displayed very great erudition and ability, and was
loudly applauded during its delivery.
WEDNESDAY AFTERNOON ME^T^VG.
The members again assembled at two o’clock, when the
Rev. Professor Haughten proceeded to read his communica¬
tion on the “ Relation of Food to Work/' The delivery ef
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Htt Vedkal Trm and Circular.
CORRESPONDENCE.
Aogwt IS, 1868. 163
this lengthened essay was received by the audience with the
utmost enthusiasm, and listened to with marked interest.
On the termination of Professor Haughton’s address, the
Sectional Meetings were opened. In the Medical Section the
ohair was taken by Dr. Stokes, in the absence of Sir W.
Jenner, and a communication was read by Dr. B. W. Foster
of Birmingham, “ On the Use of Ether and Etherised Cod
Liver Oil in the treatment of Phthisis.”
Professor Rolleston presided in the Section on Physiology,
and papers were read by Mr. Paget “On Stammering with
other Organs than those of Speech,” and by Dr. Robert
McDonnell, of Dublin, “ On the relative claims of Bell and
Majendie to the discovery of the function of the roots of the
Spinal Nerves.”
In the Surgical Department Mr. Paget assumed the chair,
and heard essays, from Mr. Birkett “On the mortality from
Abdominal Hernia,” and from Mr. Southam “ On the results
of Operations for Lithotomy at the Manchester Royal Infir¬
mary.”
THE PRESIDENT’S SOIREE.
At half-past eight, the New University Museum was
thrown open to a very large assemblage of the members.
The tables were covered with a variety of interesting speci¬
mens. Dr. Beale exhibited a very complete series of micro¬
scopic preparations in Anatomy and Physiology. The
Sphygmograph and Cardiograph were demonstrated in an
adjoining room, and a variety of novel scientific instruments
were exhibited and explained by Professor Clinton.
Thursday the 6th.
The Fourth General Meeting was held at ten o’clock, and
the report of the Committee on the nction of Mercury on
the Biliary Secretion, was presented by Dr. Hughes Bennett.
The experiments had been principally conducted on dogs,
and their result is very startling as tending to overthrow all
hitherto received ideas in the matter. The ultimate conclu¬
sion arrived at is that, inasmuch as mercury is found to act
in most respects on dogs exactly as it does on the human
subject, its effect on the secretion of bile may be assumed
to be similar. That, nevertheless, it is found in moderate
doses not to stimulate that secretion, and in large doses to
act in the direction of retarding it.
The Report of the Parliamentary Committee was then
lead, and a Committee was appointed to confer with the
Council of the Poor-law Medical Association.
The Sectional proceedings this day were signalised by a
very able paper on “Preventive Medicine,” read by Mr.
Simon, in the Public Health Section.
The Public Dinner of the Association took plaee in the
evening in the Hall of Christ Church.
- 4 -
LETTERS ON MEDICAL REFORM.—No. II.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir,— The great importance of some of the “ higher questions”
which must necessarily occupy the attention of our represen¬
tatives on the Medical Council, when the profession shall have
acquired the right of self-government, renders it desirable that
professional men should think over and make up their minds
upon them before they are called on to name the conditions on
which they will support Buch and such candidates for the
honour of representing them and upholding their interests on
the Council.
One of the fiijit and most important of these questions is
that of preliminary education. What are its objects ? what
ought to be its nature and scope ? and whether a high standard
•r a‘lew standard ought to be maintained ? To which latter
ytlon, if put in a general way, I presume no person could
replying that the standard ought to be low, though
the vital importance to us, both as a body and as indivi¬
duals, of maintaining a high standard, may, perhaps, be worth
demonstrating. The object of the preliminary examination
is of course to test intellectual ability in general, and in parti¬
cular the possession of Buch special qualities and faculties of
mind as shall guarantee that a young man shall be able to
study and practise medicine with satisfaction to himself and
benefit to the public ; such powers of mind as shall ensure that
after four years of average work, he shall be able without fail
to pass his professional examination, and shall not find
himself compelled, after so many of the best years of
his life shall have been spent in the study of medicine,
either to turn to some wholly different pursuit, or to settle
down, as is so often done in England, as an unqualified
assistant or practitioner, with just enough knowledge to be
able to pass himself off as being very learned among the lower
middle classes, underselling the respectable practitioner, and
lowering the general estimate of medicine as a science, and
medical practice as a pursuit. It is, indeed, of the utmost im¬
portance to us that a somewhat higher standard even than
this shall be reached, since every additional member added to
the profession increases the number of candidates for practice,
and so far lowers the standard of professional remuneration ;
and this more especially when the new member is a man of
low attainments, and hence under the influence of very strong
pressure to undersell his brethren for the sake of his own
livelihood. I know what the answer to this line of argument
will be in the minds of a very large number of medical men.
They will say—“ It is very true that a high standard of pre¬
liminary and professional requirements mil benefit us inaivi-
dually, but we have sons to put into the profession, and whom
we hope to succeed us in our practices, and if we raise the
standard of either examination too high they will not be able
to enter the profession.”
I presume that the difficulty is not one of cost, for which of
us would not be willing to spend a little more on his son’s
education, and it would be but very little more, in order to get
him into a profession so much better paid under those condi¬
tions than it is at present; but the question is one of intellec¬
tual ability to pass the higher examinations. Undoubtedly
there would be some lads found, sons of medical men, who
could not pass the barriers when raised, but these would
obviously fail in the practice of their profession if they should
now succeed in passing, and would do much better by select¬
ing some pursuit in life requiring less study, thought, aod
grasp of mind. But I wish to urge it strongly on my medical
brethren, that except in such rare cases the raising of the bar¬
riers is a movement altogether in favour of their sons as
against others. Those who would be kept out by such a
change would be the sons of the petty farmer and shopkeeper,
who now look upon the profession as affording them an en¬
trance into the rank of gentlemen. This will be obvious, on a
little consideration, by a comparison of the relative advan¬
tages possessed by the son of the medical man over the son of
a farmer or shopkeeper, as regards the passing of the prelimi¬
nary and professional examinations.
The son of the medical man is brought up from his infancy
in what we may call a scientific atmosphere. The knowledge
which his father possesses of chemistry, natural philosophy,
botany, and, we may almost certainly add, of mathematics
and classics, is unquestionably very great when compared with
that of the farmer or shopkeeper. In the company and
through the conversation of his father, these things ingrain
themselves into the lad’s mind; they are the foundation upon
which his education is built, the frame-work around which
his ideas twine themselves. His rival meanwhile thinking on
crops, the flocks and herds, or the markets, stores, and Btock
in trade, if indeed he ever think at all, in the Bense in which
a medical man understands the term. Which of these two
lads will best and most thoroughly take up the instruction
necessary for a high preliminary examination ; on the side of
which will the advantage lie in passing the examination, if
the barriers be only raised high enough ?
But this is an absolutely necessary step if the advantage is
to be thrown where it really lies, on the side of the medical
man’s son ; for, to illustrate the point by a reference to athle¬
tic sports, what advantage would the active and well-trained
hurdle-leaper have over the clod-hopper in a race where the
hnrdles should be only one foot high ?
I must defer to a future occasion the further consideration
of this subject.—I am, dear sir, yours faithfully,
Isaac Ashe, M.B. T.C.D.
[fgitized by ^ Google
Ifi4 The Medical Press and Circular.
MEDICAL NEWS. -
August 12, 18(t
jpiral' gCtfos.
The Public Health.— We extract the following
from the weekly return of the Registrar-General :—In the
week that ended on Saturday, August 1, 4416 births and 3770
deaths were registered in London and in 13 other large towns of
the United Kingdom. The annual rate of mortality was 31 per
1000 persons living. The annual rate of mortality last week was
28 per 1000 in London, 25 in Edinburgh, and 23 in Dublin ;
25 in Bristol, 39 in Birmingham, 36 in Liverpool, 36 in Man¬
chester, 39 in Salford, 38 in Sheffield, 39 in Bradford, 39 in
Leeds, 36 in Hull, 26 in Newcastle-upon-Tyne, and 30 in
Glasgow. The rate in Vienna was 35 per 1000 during the
week ending the 25th ult., when the mean temperature was
6T deg*. Fahrenheit higher than in the same week in London
where the rate was 31. The mortality from diarrhoea showed
a decline last week in London, but had further increased in
several of the other large towns, especially in Birmingham and
Liverpool. The annual death-rate from this disease during
last week was 4 per 1000 in Newcastle-upon-Tyne, 5 in Bristol,
6 in London, 9 in Bradford, 10 in Manchester and Hull, 11 in
Liverpool, 12 in Salford, 13 in Sheffield, 14 in Leeds, and so
Ligh as 20 per 1000 in Birmingham. There is little doubt
that under a well-organised system for treating the disease in
its earlier stages this mortality would rapidly decrease, and
the risk of the more dangerous choleraic forms would be re¬
duced to a minimum. The deaths of 859 males and S06
females, in all 1665 persons, were registered in London during
the week. It was the 31st week of the year; and the average
number of deaths for that week is, with a correction for in¬
crease of population, 1583. The deaths in the present return
exceed by 82 the estimated amount, but are less by 220 than
the number recorded in the preceding week. The deaths from
zymotic diseases were 691, the corrected average number
being 638. Five deaths from small-pox, 46 from measles, 47
' from scarlatina, 9 from diphtheria, 32 from whooping-cough,
and 52 from fever were registered. Thirty-eight deaths from
choleraic diarrhoea or cholera were recorded ; 27 fatal cases
were those of children under two years of age ; five children
who died were aged 'from 2 to 10 years, and 6 fatal cases
occurred in adults. 384 persons died from diarrhoea ; of that
number 42 were adults. The mortality from diarrhoea and
> choleraic diarrhoea or cholera in the London waterfields to
100,000 living was 12 in the New River, 11 in the Grand |
Junction, 17 in the Southwark and Lambeth, 14 in the East
London, and 18 in the Kent fields of supply. The deaths of 6
persons from sunstroke were recorded ; and in many cases the
fatal termination of diseases was stated to have been accele-
. rated by the great heat. At the Royal Observatory, Green¬
wich, the mean height of the barometer in the week was
29*801 in. The barometrical reading increased from 29*51 in.
on Tuesday, July 28, to 30*16 in. on Saturday, August 1. The
mean temperature of the air in the week was 67*6 deg., w’hich
is 5*3 deg. above the average of the same week in 50 years (as
determined by Mr. Glaisher). The highest day temperature
was 90*1 deg., on Tuesday, July 28. The lowest night tem¬
perature was 49*4 deg., on Saturday, August 1. The entire
range of temperature in the week was, therefore, 40*7 deg.
The highest reading of the thermometer in the sun was 167 0
deg. on July 28. The mean of the highest temperatures of the
water of the Thames was 68*7 deg.; that of the lowest was
68*4 deg. The difference between the mean dew point tem¬
perature and air temperature was 12*9 deg. The mean degree
of humidity of the air was 64, complete saturation being re¬
presented by 100. Rain fell to the amount of 0*23 in. The
general direction of the wind was W.S.W. and S.S;W. Ozone
Was observed on five days diming the week. According to a
• return furnished by the engineer of the Metropolitan Board of
Works, the daily average quantity of sewage pumped into the
River Thames at the Southern Outfall Works, Crossness, Was
46,190,315 gallons, or 209,864 cubic. metres, equivalent to
about as many tons by weight.
^Ialvern College.— The annual speech-day was
held on the 28th ultimo., and the Scholarship Examinations
closed on the 30th. After a few introductory remarks by
the head-master. TheTlev. ArthiiF Faber, M.A., announc¬
ing the increase of the school, &c. The usual speeches
were delivered by the pupils with much spirit, receiving
at the conclusion loud and well merited applause. The
prizes were then distributed, the chief award being the
Beauchamp prizes (classical), J. Haworth, E. N. Jones,
H. Barnes ; the Gully prizes (modern langaugea), J. Smith,
S. Curtis, A. Robinson, H. Walker; the Council prizes
to R. M. Drew, D. Faber, J. Perks, A. Hill, F. Pottes, J,
Scholfield ; Modem department prizes to J. Rogers, J, Staight,
&c. The Scholarship Examinations were concluded on the
30th. The Bishop Philpott Scholarship was awarded to H,
Barnes ; the Council Exhibition to R. M. Drew and C.
LuBhington ; and the Modern Exhibition to H. Boweu.
Belfast Branch of the Royal Medical Bene-
volent Fund Society of Ireland. —The stated quarterly
meeting of the committee of this local branch of the above in¬
valuable society was held on Wednesday, 5th August, at No. 33,
High-street. James Moore, Esq., M.D., M.R.I. A., was called
to the chair. Amongst the other members present were:—Dr.
Patterson, Dr. Whittaker, Dr. Wilberforce Arnold, and the
honorary secretary, Dr. Stewart. The minutes of last meeting
were read and confirmed. It was now reported that the several
parties, six in number, who had been recommended for grants
at the annual meeting of the Parent Society held in Dublin in
June last, had since received the several sums, as had been
suggested, and for which each was deeply grateful for the
timely assistance so rendered. The only regret felt by the
Parent Society was that more liberal grants could not be
awarded, the total sum in hands being so very limited. It was
pointedly observed at the meeting to-day how comparatively
few of the profession in Belfast gave any pecuniary aid or
countenance whatever to a society which, for its means, was
doing so much good, and whose objects were so purely disin¬
terested and humane. Much conversation took place as to the
best means to be adopted to increase the number of the
actual subscribers to this branch, especially in respect of Bel¬
fast, in which the names of little more than a third of the
practising members of the profession were in the list of subscri¬
bers. Amongst other resources approved of to increase the
list of subscribers, it was unanimously decided upon that it be
an instruction to each member of the committee, in town and
country, to use bis influence as far as possible in furtherance of
So good a cause as the society was engaged in, by making more
widely known its really humane objects, and soliciting on its
behalf the aid of every member of the profession, as weH as df
the affluent not belonging to its ranks, but upon whom die
medical profession had the strongest claims. A letter was read
from the Secretaries of the Parent Society requesting that the
subscriptions of the respective branches would be transmitted
to the Treasurer, in Dublin, as early in the month of May,
yearly, as possible, a request which it was resolved should be
acted upon for the future by this branch. After transacting
the usual routine business the chair was vacated, and the meet¬
ing separated.
Statistics of Insanity in Ireland.—B y the
aid of the Royal Irish Constabulariy and the police, a-very
careful inquiry has been recently made throughout Ireland
into the number of insane persons not placed in any asylum
or other institution (including wandering lunatics), with a
view to ascertain by the returns, conpled with those from
asylums and other establishments, the gross amount of in¬
sanity in the country. The result is as follows :—On die
31st of December, 1867, there were 5212 insane persons in
. public asylums in Ireland, and 626 in private asylums ; 2705
in poor-houses; 334 in goals; 158 in the Dundrum central
asylum for criminal lunatics, and 51 in Lucan private aSy*
lum, supported by the Government ; making 9086 registered
lunatics. To these are to be added 6564 lunatics at large,
making the total number of the insane in Ireland, 15,650.
In Connaught they constitute 2*0 per 1000 of the popula¬
tion enumerated at the Census of 1861 ; in Ulster. 2*4
per thousand; in Munster, 2*7 per thousand; in Lein¬
ster, 3*0 per thousand. Taking Ireland as a whole, the
number is 2*7 per thousand of the population at the Census
of 1861, or 2*8 per thousand of the estimated population at the
end of 1867. All classes of persons of unsound mind are included
—lunatics, idiots, epileptic imbeciles. Omitting the 51 in Lucan
not classified, 8822 are males, and 7277 females. The returns
relating to the 5212 patients in district asylums show that in
952 cases the insanit)' was due to moral causes; in 1074 toph^si*
cal causes; in 542 it was hereditary; in 2644 the cause was un¬
known. An examination of the 952 cases of insanity traced
to moral causes shows that in 280 cases it arose frop grief,
fear, or anxiety ; in 190 from poverty and. re verse of fortune;
in 154 (57 men and 97 women) from love, jealouely^orae^^
tion; ia-93 from domestic quarrels and afflictions; in 12?
Digitized by * oOoq le
The Medical Pren and circular.
OBITUARY NOTICES.
Angost It, 1888. 155
males, 76 females) from religions excitement; in 59 from study
and mental excitement; in 30 from ill-treatment; in 9 from
pride ; in 8 from anger. Among the 1074 cases of insanity
from physical causes are 289 from intemperance and irregu¬
larity of life, 76 from effect of climate or sunstroke, 14 from
abuse of medicine, 30 from sedentary habits. There were
5070 patients in district asylums at the beginning of 1867, and
1527 were admitted in the year, making 6597 under treatment;
638 were discharged recovered in the year, and 465 dead.
More than one-fourth of the lunatics in these asylums (exclu¬
ding idiots and epileptics) were pronounced probably curable.
The Cockchafer.— M. Payen communicated to
the Academy of Scienoes the leading points of a paper pub¬
lished in the “ Mdmoires ” of the Society d*£mulation of
Abbeville, by its vice-president, M. E. Hecquet d’Orval, on
the enormous havoc caused in 1866 by the white grub, or larva
of the cockchafer. In Lower Picardy the damage done to
breadstnffs amounted to from 35 to 50 per cent, to fodder and
meadows to between 25 to 50 per cent; to beetroot, potato,
and poppy to 50 percent., while the Jerusalem ortichoke only
•offered at the rate of 27 per cent The average amount ofr
the loss in the aggregate is therefore 40 per cent, chiefly
owing to the larva of the cockchafer, but also partly to the
Agrotia acgetum caterpillar. The author of the paper shows
that a severe winter fails to destroy any great quantity of
these enemiew, and that, if moles do some little damage to
fields, it is far outweighed by the great services they render
agriculture by devouring grubs. He also rejoices to see that
birds are more protected now than formerly. Ground lying
fallow is generally a hotbed for the propagation of the white
grub, and such fields ought, therefore to be ploughed and har¬
rowed at least five times during the year, when these worms
are near the surface ; in that way they are either picked up
bj the birds or kUled by the heat of Hie sun. M. Payen re¬
marked that last year M. Reiset proved that the collecting of
those noxious insects may be effected on a large scale at a very
moderate cost; they might then be easily lolled by the vap¬
ours of napthaline, and used for manure. In the department
of the Oise, M. Lallouette, proprietor of the sugar manufac¬
tory of Barberie, last spring paid 20f. for every 100 kilog. of
cockchafers, and for 6000f. obtained 30,000 kilog. of them, re¬
presenting 84 millions and a-half of individual insects, which
would have produced 690 millions of white grubs. The de¬
partment of the Seine Infdrieure, last year, at a cost of
80,000f.. got 1,149,000.000 cockchafers, which might have pro¬
duced 22,980,000.000 of white grubs, capable of devouring the
produce of 800,000 hectares (750,000 acres).— Oalignani,
OBITUARY NOTICES.
Thb late Dr. Elliotson, F.R.C.P. and F.R.S.—
This distinguished member of the medical profession, who
died, at the advanced age of 82, on the 29th ult., whilst stay¬
ing at the house of an old and attached friend, our contem¬
porary, the Standard , says, was the son of a chemist in the
borough, in which the subject of the present short notice after¬
wards practised. As soon as his preliminary studies were
completed he went to Edinburgh, then the chief medical school
in the kingdom, At Edinburgh he remained three years, and
proceeded to Cambridge, where he graduated, and took his
degree of M.D. In 1817 he became assistant-physician to St.
Thomas's Hospital, and a few years later one of the principal
physicians. On the establishment of University College, in
Gower-street, he was appointed Professor of Medicine in that
institution and physician to the hospital. These offices he re¬
signed in 1833 in consequence of the opposition raised to his
system of mesmeric treatment of cases in that hospital. Be¬
fore Dr. Elliotson yielded his faith to the marvels of mes¬
merism he made some useful contributions to medical litera¬
ture ; among which he published a translation of “ Bluxnem-
bach's Physiology," and a work on “ Diseases of the Heart."
H«lud a very extensive practice, and was the first man to in¬
troduce the use of the stethescope into this country. He was
elected a Fellow of the Royal College of Physicians in 1822 ;
U the Royal Society, in 1824 ; and has been president of the
Royal Medical and Chirurgical Society.
Tbs Late Dr. Stevens.— It becomes our duty to
bH this week's Herald the death of a gentleman who
mMM himself a name not only in this locality, where he
wwatoo** but in the wide wbrid of tfrience also; we
allude to William Stevens, M.D., D.C.L., formerly of the
Island of St. Croix and of this city. Dr. Stevens was a very
eminent physiologist, and recognised as a man of exceptional
acquirements by the ablest men of his day. In 1834 he was
chosen by the University of Oxford, on the inauguration as
Chancellor of the Duke of Wellington, as one of the three
members of the medical profession to whom the honorary de¬
gree of D.C.L. was awarded in convocation, the other members
of the triumvirate being J. H. Hume, M.D., and Sir Astley
Cooper, M.D. The magistrates of the county of Middlesex
awarded Dr. Stevens a vote of thanks and presented him with
a piece of plate of the value of a hundred guineas as an ex¬
pression of gratitude for his valuable services in combating the
cholera in the county prison of Coldbath Fields, and Ring
Christian VIII. of Denmark, in admiration of his genius, and
in requital of his valuable services rendered in the Danish
West Indies bestowed upon him a princely gift. The mode of
treatment adopted by Dr. Stevens in cases of cholera is now
acknowledged to have been founded upon a most enlightened
view of the diagnosis of that terrible disease. His writings
upon diseases of the blood will always be recognised by the
profession, and he leaves a monument of his research in the
well-known remedy for all affections of the kind, sold every¬
where as “ Lam plough’s Pyretic Saline." Dr. Stevens had
reached the patriarchal age of 82. A genius, a philosopher,
and a man of strong and original thought, he lived down pre¬
judices, and had the pleasure of seeing his theories carried into
practice by men who were at one time a little too willing to cry
him down.— Worcester Herald,
19th July, on board the African Mail-boat, Lagos,
on his passage home from Sierra Leone, John Bradshaw, Esq.,
L.K.Q.C.P.I., and L.R.C.S.I., Staff-Surgeon, aged 32 years,
fourth son of the late Dr. George Bradshaw, of Thurles, county
Tipperary.
Dr. Bradshaw fully maintained the prestige of the Dublin
Schools of Medicine, as by his superior attainments he was
promoted to the rank of surgeon after serving only four years
and three months as assistant-surgeon.
He was a young man of much promise as regards his pro¬
fession, and had endeared himself to all who had the pleasure
of his acquaintance by his many sterling good qualities. .
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in England on or before Friday morning are
expected to be returned to the Editor, at the office, 90, King
William-street, Strand, W.C., before five p.m., on Friday afternoon.
Proofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two p.k. on Saturday, which ia
an early closing day. Duplicate proofs are sent to authors, in
order that they may correct and return one oopy, and keep the
other for private use. Contributions should be lkoibly written, on
one side of the paper only.
All Communications and letters must be authenticated by the name of the
writer, though not necessarily for publication,
J. M. J.—Having perused the memorandum in question, we do not
think it would be suffidentJy interesting to our readers, to acoord it
space in our columns. We are disposed to question whether the flesh
of the Kangaroo, is the article, par excellence, tqp assisting the diges¬
tion of all other foods.
A Subscriber.— Your friend in Washington, should have no diffi¬
culty in procuring the regular supply of this journal, if his commands
were given to Messrs. Kelly and Piet, Baltimore, who are our sole
agents for the United States.
Dr. E. S.—Mr. Walton, of Gower-street, la the publishes of the
book in queetion, we believe the price ia 3s. 6d.
BOOKS, PAMPHLETS, Ac., RECEIVED.
The Practitioner for August.
A Treatise on Odontalgia, by 8. Parsons Shaw. Manchester : Palmer
and Howe.
Theory of the Treatment of Disease adopted at Ben Rhydding, bf
William Marleod, M.D. London : John Churchill and 8on«.
On Digitalis, by T. L. Brunton, B.8c. M.B. London i John
Churchill and Sons.
On the Immediate Treatment of Str ! ctnre of the Urethra, by
Bernard Holt, F.R.C.8. London: John Churchill and Sons.
The Edinburgh Medical Journal; the Dublin Medical Journal; the
Glasgow Medical Journal; Gazette Medicals De Pans; Le Mouvement
Medical; L* Union Medicele; and the Philadelphia Medical and Surgi¬
cal Reporter.
- * -
APPOINTMENT.
Hospital, vice Henry C. libbey, Req., re-
Digitized by Google
August 12,1868.
Sft* (ffiwutar iwfoKrtiiStf.
Established 1848.
PROFESSIONAL AGENCY AND MEDICAL TRANSFER OFFICE.
80, Lincoln’s-inn-fields, W.C.
¥E. J. BAXTER LANGLEY, M.R.C.S., F.L.S.,
&c. (King’s Coll.), has always upon his books a large
number of desirable investments and available openings for Medical
Men commencing their professional career. Gentlemen wishing to re¬
linquish practice can be introduced without delay to competent succes¬
sors with means at their disposal.
Mr. Langley devotes his prompt personal attention to the negotiations
entrusted to him, and treats confidentially and with care all matters re¬
lating to professional business. The strictest reserve will be practised in
all the preliminary arrangements and no expense incurred (except in
special cases) unless a negotiation be completed.
The business of the Professional Agency is based upon the general
principle that no charge is made nnlww work has been done and services
rendered.
A prompt and just system secured a large measure of success to the
General Partnership and Commercial Agency Business formerly con-
ducte d by him at his City offices: this has for some years been trans¬
ferred to Lincoln’s-inn-fields, and he has invariably adopted the same
equitable policy in the more professional matters placed in his hands.
Thus his experience in the management of large commercial under¬
takings, combined with his medical, scientific, and literary acquirf-
QTTEEN’S COLLEGE, CORK
SESSION—1868-89.
MATRICULATION AND SCHOLARSHIP EXAMINATIONS.
O N TUESDAY, the 20th of OCTOBER next, will be
held in the College, an Examination for Matriculation;
and for Scholarships on Thursday, the 22nd.
The Council have the power of conferring at these Examinations—
Eight Senior Scholarships, of the value of £40 each; and Forty-six
Junior Scholarships, varying in value from £20 to £25 each; to Fifteen
of which first year’s Students are eligible.
For Prospectuses and further information, apply to the Registrar of
the College.
Signed by Order of the President,
ROBERT J. KENNY, Registrar.
LONDON NURSES’ INSTITUTE,
118, New Bond-street, London, W.
(Removed from 42, South Audley-strekt.)
^TRAINED NURSES (Medical, Surgical, Mental, and
JL Monthly), can at all times be obtained from thia Institute.
Hospital Appointments by special arrangement.
Letters and Telegrams should convey the nature of the ease to be
arbitrator on matters of dispute between professional men, Mr. Langley
has had great experience, and he can refer to numerous cases in which
Letters and Telegrams should convey
attended.
Apply to the Manager or Matron.
T. HAMILTON, Manager.
and in which his awards have beep made rules of her Majesty’s Courts
at Westminster.
Mr. Langley can also refer to the Professors of his College, Members
of Parliament, Clergy, Merchants, Bankers and others, as a guarantee
of his integrity and honour in all negotiations entrusted to mm .
Full information as to terms, &c., sent free on application.
Office Hours from 11 till 4; Saturdays from 11 till 2.
T O PHYSICIANS.—There is a capital opening for a qua¬
lified M.D., in a borough town, in the Midland district. Popu¬
lation about 4500. The neighbourhood is extensive and respectable,
and there is no resident Physician within about 12 miles. Until within
the last three years a good fee-practice has been carried on above 40
n rs. A middle-aged gentlemen, with a small independency, would
thia a desirable opportunity. Address X 350, Mr. Langley, as
above.
J UNIOR PARTNERSHIP. —There is a vacancy in a large
town in the North of England fora Junior Partner, to conduct
a Branch Practice ? which has been carried on for 11 years. Receipts
£400 a-year; considerable scope for increase. The whole connection
can be transferred. Address X 349, Mr. Langley, as above.
P kENTAL.—In the West of England the incumbent of a
well-established Dental Practice is willing to retire, and transfer
connection to a well-qualified successor. Receipts £370 a-year.
House in excellent situation, at a moderate rent. Furniture, instru¬
ments, Ac., optional. Address X 348, Mr. Langley, as above.
S EA-SIDE, S.—-A gentleman in large practice in an improv¬
ing watering-place, is about to devote himself to a speciality, and
<■ mllllM* 4-1* infwulnMt > ~_CD.J_.1_.... -
M IDLAND. —In a large and wealthy town, a Practice for
transfer, with one year’s Partnership introduction. Receipts
£800 a-year, capable of large increase. The residence is situated in a
main thoroughfare, and is very commodious, with Garden and Stabling •
Emit £35. No Dispensing. Midwifery Fees from £1, is. upwards.
All appointments have been declined. This investment can be confi¬
dently recommended to an active-married gentleman with good Qualifi¬
cations and address. Address, X. 344, Mr. Langley as above
P ARTNERSHIP.—For Transfer, the Half-share of a large
Practice, the income from which is upwards of £800 a-year, derived
from public appointments. The opening affords an unusually good
onnortnnitv for A vnnnff nnmam/ul man »t,A _1 . • H .
THE LONDON SURGICAL HOME,
F OR Diseases and Accidents of Women; for the Re¬
ception of Gentlewomen and Females of respectability,
upon a weekly payment, under the sole management of Mr. Baxxb
Brown.
The Private Medical Attendants of the patients are invited to visit
them, and to meet in consultation before treatment.
Full particulars can be obtained on application to the Lady Sura-
intends xt, 18, Stanley-terrace, Notting-hilLLondon. W.; or to Mr.
Baker Bbown, 136, Harley-street, London, W.
30th November, 1867.
TO APOTHECARIES AND SURGEONS.
F r disposal, in one of the best business towns in
the South of Ireland, a Medical Hall, established over
50 years, with a splendid Retail Dispensing and Prescribing Pra ctice.
Receipts at present, £400 to £500 a-year, but capable of great extension
under an energetic man. Shop at present contains a large stock.
Rent only £30 a-year. Apply to M. K., Post-office, Thurlea.
TO BEGINNERS.
F OR Transfer, a practice in one of the pleasantest locali¬
ties in the north of Ireland ; appointments exceed £100
per annum; patients include the best residents in the locality Con¬
siderable scope for increase. Very comfortable residence, with erery
convenience, on lease at a low rent. Further particulars on application
by letter, to M.D. Practice, Poet-Office, Rathmines, Co. Dublin
TN consequence of the intended retirement of a medical
A gentleman from an old and valuable Practice, a peculiarly
ra^q^S^rioM 01 ^ 11111 ^ “ afforded for * successor posseming firat-
placefoubUn’D’, Mkdigal S ’* 888 AND Circular Office, 8, Timlin.
THE MEDICAL PROFESSION.
T he albert life assurance company.
Established 1838—Annual Income £350.000.-
accepting
and libers)
COMPETENT ASSISTANTS Provided
without delay, free of expense to the principal. No gentleman
recommended whose antecedents have not been inquired into. Apply
to Mr. Langley as above. 7
LOCUM TENENS can be despatched by
, . 811 tram after receipt of letter or telegram stating terms,
duties, and qualifications required. Fee 10 s. 6d. Address Mr.
Langley as above.
Now ready. Second Edition, with considerable additions.
A DVT0E on Buying or Selling Medical Practices,
■ CL Partnership., 4 C . By J. BAXTER LANGLEY,
po * t ,or * Ten rtamp9> bom **
ittte Chief Office”? waterlMi-i)l»ce, p2uj£5i^Lo n '5^^ I " K “ 8U *’
SIX POUNDS PER WEEK
while laid up by injury, and
&lOOO IN CASE OF DEATH
v . caused by accident of any kind.
May be secured by an annual payment of from £8 to £6,5s.
TO THE
RAILWAY PASSENGERS ASSURANCE COMPANY,
lSI toe C1 “ k * “ tteIUUw.yntatfaM.tott..
64, CORNHILL, and 10, REGENT-STREET,
. _ W . J. VIAN, Secretary.
ESTABLISHED 1812.
"Por the Sale of Leeches and all kinds of
MEDICAL HERBS. II. POTTERS, Depot, 56 ,
Famngdon-street, London, E.C. His new priced Catalogue sent to
**•»*»* * Turkey and
&Jie UjUdirat §?m n k Circular.
“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 1 9, 1 86 8.
CONTENTS.
ORIGINAL COMMUNICATIONS.
On the Nervous Connection of Certain
Skin Diseases. By Henry Samuel
Pardon, M.D., Physician, Belfast Dis¬
pensary for Diseases of the Skin, &c. page 157
On Some Points Connected with the
Operation for Hare-lip and Excision of
the Lip for Cancer. By Bd. J. Kinkead,
A.B., L.M.T.CJ)., L.R.C.8.I., &c.
( IUustraUd) . 160
Ovarian Neuralgia Treated by Hydro¬
chlorate of Ammonia and Tincture of
Aconite. By J. Warimr-Curran,
L.K.Q.C.P.I., Ac. . . ._! 162
HOSPITAL REPORTS.
City OP Dublin HOSPITAL—
Two Cases of Chorea Treated by the Ice-
bag. Under the care of Dr. J. Hawtrey
Benson. 163
Cases of Bent Knee, in which Division of
the Hamstring Tendons was performed
—Extension having been Subsequently
PAGE
Effected: Recovery in each Case, with
a Useful Limb. Under the care of Mr.
Croly. 164
Da. Steevbns’ Hospital—
Cases Occurring under the care of Mr.
E. Hamilton... 166
Kino’s College Hospital—
Cases underthe care of Dr. Beale, F.R.8. 165
LEADING ARTICLES.
The Royal College op Physicians of
London. 168
The Medical Council—Parliament or
Convocation. 169
The Reports op the Medical Officer
of the Privy Council. 169
The Army Medico-Chirurgical Society
of Portsmouth. 170
NOTES ON CURRENT TOPICS.
Representation of the Profession iu the
Council.—The Fellowship of the Royal
College of Physicians of London.—The
PAOE
T Chair of Botany in the University of
* Dublin.—Death of Dr. Mackenzie, of
Glasgow.—The Medicine of the Future.
—The Thames.—Yellow Fever.—Real
and Apparent Death.—Vaccination.—
The Onion as a Disinfectant.—Bathing.
—Conveyance of Food.—Water Com¬
panies.—Sickness in Dublin. 171-3
CORRESPONDENCE.
A Member of the Senate of the University
of Cambridge on the Representation in
the Medical Council. 175
A Medical Student (Dublin) on “ Fistula
in Ano”. 176
MISCELLANEA
Report on Wine and its Adulteration.
No. VIU. 167
Current Literature. 168
Army Medical Department.—Examina¬
tion Papers. 174
Medical News.175-6
Original Cjammirniaikiis.
ON THE NERVOUS CONNECTION OF CERTAIN
SKIN DISEASES.
By HENRY SAMUEL PURDON, M.D.,
PHYSICIAN, BELFAST DISPENSARY FOR DISEASES OF T1IE SKIN, ETC.
In a former paper* I endeavoured to point out one or two
symptoms held in common in three distinct diseases—viz.,
Herpes, Pemphigus, and Urticaria. Since the publication
of that paper an interesting article has appeared, by Dr.
Handheld Jones, on “Pleurodynia accompanied by a
Peculiar Eruption .”2 Drs. Woakes, Morris, Wilson, &c.,
have also contributed papers on the nervous origin of many
skin diseases.
The nervous system is divided into two orders—viz., the
cerebrospinal and sympathetic; the former comprising the
brain and spinal cord, together with the nerves proceeding
from those structures ; the latter presides over organic life.
Its nerves being chiefly sent to the blood-vessels, glands,
and internal viscera, intimate communication exists be¬
tween the two systems ; but, as our enquiry is more to¬
wards the nervous relations of various cutaneous diseases,
I shall only state that the skin which envelopes our bodies
is of varying thickness in different regions. No nerves or
blood-vessels have as yet been traced into the epidermis,
its nutrition being carried on by means of the selective
properties of the cells; and upon the deep or under surface
of the cuticle granular cells are abundantly found. The
tactille papillary layer of the cutis vera presents furrows
which pursue different directions, separated by elevations
which are occasioned by a double row of conical papilla?,
and into which a couple of capillary loops, together with a
nervous twig, enter. Th^ skin is united by “ connective
tissue,” which is loose and soft in texture, to the subjacent
parts, and which allows of motion taking place. Into this
connective tissue an exudation may take place, especially
if the part be very vascular. Nerve irritation may occasion
an exudation, which is due to direct transudation from the
c&pillaxT vessels themselves ; for, according to Bernard and
other physiologists, the cerebro-spinal nerves cause dilata-
Hfrnui the capillaries, the sympathetic, the opposite—viz.,
constriction ; and if these two functions be not equally
WHi A . L ‘I r ‘ - -
mrpM Pemphigus and Urticaria .”—Dublin Quarterly
•4 •KKpWiy Miff* wW*
* flWefog, July, 1668. No. VI.
balanced transudation may take place ; or, according to
Dr. Woakes, 1 “ the capillaries are in a state of equilibrium
between the forces exercised upon them by these two por¬
tions of the nervous system. A state of tone is in this
way maintained in them, the greater in accomplishing
which is referable to the regulating influence of the sym¬
pathetic fibres. By the term * tone* is meant that condi¬
tion of equilibrium between the capillaries and tissue cells
surrounding them which is necessary for the exercise of
those elective functions by the latter, upon the due per¬
formance of which the ultimate process of nutrition
mainly depends.”
When the skin is inflamed, say, for instance, in ery¬
thema, we have—when the disease is chronic—an exuda¬
tion poured forth into the subcutaneous tissue; or papules
may appear at certain anatomical points, as, for instance,
at the orifice of hairs, gland ducts, or other vascular spots,
as is well observed in eczema lichenoides.
Herpes and pemphigus form the connecting link between
erythema, on the one hand, and urticaria, on the other.
In erythema both the coritim and subcutaneous cellular
tissue are infiltrated with fluid which many pathologists
consider to be exuded through the walls of the capillary
vessels ; and, according to Virchow, 2 “the exudation that
we meet with is essentially composed of that material
which is generated by the altered condition of the inflamed
part, and of the transuded fluid which escapes from the
vessels.” In an article on “ The Passage of Blood Cor¬
puscles through the Walls of the Vessels,” Medical Times
and Gazette , May 2nd, 1861, the following occurs :—“ The
second experiment consists in producing congestion of the
capillary system in the web of a frog’s foot by the applica¬
tion of a ligature to the femoral vein. The resulting phe¬
nomena are :—1st, retardation of the stream; 2nd, the oc¬
currence of oscillation ; 3rd, stasis. This is -followed by
massing together of the corpuscles to the walls of the
vessels, which usually become pouched at these points. On
relieving the congestion, by removing the ligature, the con¬
glomerates of corpuscles break down and the stream re¬
commences. The corpuscles, however, which had become
adherent to the walls are now seen to pats through them
and to appear in the surrounding tissues. They are followed
by others, and soon the spaces between the capillary net¬
work will become loaded with blood globules. In attempt¬
ing to determine how this process takes place, we have to
l
*
Journal of (htanoot# Medicine, No. ILL page 279.
»c* u moiv w «* fzed by Goog le
j[ 58 The MedicjQ Press and Circular.
PURDON ON SKIN DISEASES.
August 19,1868.
consider, first, whether there are really apertures in the
vascular parietes ; and, secondly, whether the result is due
to any peculiar properties of the blood corpuscles them¬
selves. Dr. Cohnheim inclines to the belief that interspaces
exist between the cells of the lining membrane of the
smallest vessels ; and, in this view, he is supported by the
fact that openings have been proved to exist in the smaller
branches of the lymphatic system, apparently in connection
with the stomata-like orifices in the epithelium of the
serous membranes.” The so-called trophic nerves have al¬
lotted to them the office of regulating nutrition, but the
vaso-motor nerves fulfil the same function, control the flow
of blood and the- vital actions of the different parts.
Hyperemia and effusion are common to certain skin diseases,
and which are owing to nerve irritation—the transudation
to pressure. This latter may be limited or diffused ac¬
cording to the nature of the disease and the tract of nerves
injured. In large nerves the vasal filaments may be bound
up with the sensory when there will be more pain accom¬
panying the disease, as in herpes. Belladonna has the
power of acting on the vaso-motor nerves, causing them to
constrict the vessels, and is valuable medicine in herpes,
engorgement of the mammary gland, &c.
Owing to injury of nerve trunks, a change of structure
is observed in the skin, which covers the distribution of
the affected nerves, and from the observations of Dr.
Woakes 1 and American army , surgeons during the late
civil war in the United States, on cases of injury to nerves
by gunshot wounds, &c., it appears that the skin affected
usually takes on either an erythematous, papular (lichen),
or herpetic character. It also loses its hair (when on the
head alopecia), is smooth and glossy. I have met with a
disease of the hair which might be called “fragilatas
crinium,” or extreme brittleness of the hairs, an affection
in which no parasitic fungus could be detected, which i3
essentially a disease of defective or deficient nutrition and
of nervous origin. The following are the brief notes of the
case :—J. M., aged 45, consulted me on March 4th, 1868,
for a “ breaking-short” and brittleness in the hairs of his
left whisker, which has existed for about one year. He
cannot offer any explanation of how the affection com¬
menced, and never had syphilis. His health latterly has
not been good, is very nervous, easily agitated, sleeps badly
at night, and troubled with dyspepsia. No parasite could
be detected on the hairs, for at first sight it presented
some of the appearances of the declining stage of tinea
tonsurans, except the brany desquamation of the cuticle,
the skin of the affected part being healthy. The hairs were
uneven in length, fissured longitudinally, and extremely
dry, but of the natural colour, which was black, thus dif¬
fering from the hairs in tinea tonsurans, which are usually
bent, of a lighter colour than natural, nodulated, and easily
broken ; this latter state being due to the sporules of the
“ tricophyton tonsurans,” which are embedded in their
structure. The hair bulbs in “ ringworm” are also
diseased and considerably enlarged, but in this case were
quite healthy. I considered the affection to depend on
atrophy of the hair, arising from defective nutrition, which
was due to impaired nervous power, and consequently
prescribed tonics internally, and locally the application of
a stimulating lotion, the hair being kept cut short.
Should another case of the above affection present itself
I would be inclined to try phosphoric acid, considering, as
I do, that the disease was of nervous origin. The presence
of dyspepsia in this case is also of interest, and in Bostock’s
Physiology, page 92, I found the following passage *
“ Vanqueiin found that the colouring matter of the hair is
destroyed by acids, and suggested that when the hair has
suddenly changed its colour, and becomes white in conse¬
quence of any mental agitation, it is ow ing to the produc¬
tion of an acid in the system.” But this idea seems to be
very hypothetical. No doubt, in the case recorded, dys¬
pepsia, accompanied by acid eructations, was present, and
a form of dyspepsia has been called “ nervous,” usually
arising from mental anxiety, but to establish a case between
1 Journal of Cutmecue Medicine, No. QL
them would be difficult; nor is it at all easy to account for
how the physical properties of the hair was changed, except
on the ground of nervous origin. But, to return from this
digression, M. Dubois-Reymond has examined into the so-
called quiescent state of nerves, and found that cell
growth depended upon the nature and intensity of the ex¬
citing cause, and that nervous depression gives rise to
hyperemia, eventually leading to disease of nutrition; and
in the rare disease called morphcea, in which, according to
Mr. E. Wilson, 1 “ The nerves and the capillary vessels, the
papilke, in fact, the more highly organised of the tissues
of the skin have become atrophied. . . . While, there¬
fore, we regard this remarkable disease pathologically as a
retrograde metamorphosis of the tissues of the derina, origi¬
nating in neuro-paresis, as, in fact, a fibrous degeneration of
the skin, we must look upon it therapeutically as a debility
and aberration of nutritive power.” Morpboea, when
situated on the head, exhibits a bald patch, of a white
appearance, and corresponding to the distribution of parti¬
cular nerves.
In the disease known as prurigo, we have, on the autho¬
rity of Dr. Parkes, 2 a highly exalted, sensitive, and irritable
condition of the nervous system, a condition not unfre-
quently depending on a morbid state of the spinal cord;
and from the researches of M. Br&schet on the structure of
the skin, we are made aware of the fact, that the various
nerve filaments proceeding from different trunks are dis¬
persed in many directions, and ramify and subdivide minutely
on approaching the cutis, ultimately entering the papillae.
Again in gutta rosacea, a disease due to debility, a close
sympathy and nervous connection is evident between the
part affected—viz., the sebaceous follicles and the repro¬
ductive organs and uterine functions. We have in this
disease a determination of blood to the capillary vessels of
the diseased part, in fact, a hyperemia, and which finally
ends in suppuration.
Like erythema, herpes and pemphigus are diffuse erup¬
tions, appearing over a considerable extent of surface at
once. Pemphigus resembles urticaria, and which, according
to Hebra, 3 “ not only in its acute, but even in its chronic
form, sometimes presents the peculiarity, that instead of
wheals, bullae are found at certain spots. But no one need
be astonished at this exceptional occurrence, who bears in
mind that wheals themselves result from the pouring out
of serum, ahd that an increase in the quantity of fluid is all
that is necessary to raise the cuticle over a wheal, and to
form a bleb. That this was known to the older authors is
proved by the expressions urticaria vesiculosa , urticaria
bullosa .” In urticaria, it is the deeper filaments of the
cutaneous nerves which are affected, and that occasions,
according to some dermatologists, spasm of the muscular
tissue of the cuticle, whilst in erythema it is principally the
papillary layer that is affected. In urticaria, the redness
of the cuticle surrounding the wheals is due to hyperemia,
the elevation of the epidermis, which is called a wheal, to
fluid; and this latter state was considered by the late Dr.
Buchanan to arise from a circumscribed oedema of a cluster
of capillary loops, springing from a common stem, and
under the influence of a common nervous twig. From this
cause the epidermis may be raised, either in the form of
vesicles or bullte, the former in connection with the distri¬
bution of particular nerves, being called herpes, and the
latter, from its size, pemphigus. Mr. E. Wilson 4 has re¬
marked that “ pempnigus may be complicated with herpes;
indeed the smaller bullae of this disease bear a considerable
resemblance to the vesicles of herpes phlyctenodes, and the
likeness to herpes is still further increased by the occa¬
sional appearance of the small bullae of pemphigus, in the
form ot rings;” and in the late epidemic in Dublin of
cerebro-spinal jneningitis, herpes and pemphigus were
observed together, complicating the disease. 6 In consump¬
tion, the excessive sweating is evidently due to nerve-
1 Journal of Cutaneous Medicine, No> VI., page 1£3.
2 Thompson on Diseases ot the Skin, edited by IS, A. Parke*. IC.D.
8 “ Disease of the Skin." By P. Hebra. New Sydenham fiaCWty.
4 “ Disease* of the 8kin. M 2nd edition.
6 Journal of Cutaneous Medicine, No. Y., page
The Medical Press sad Circular.
PURDON ON SKIN DISEASES.
August 10,1868. 159
paresis, and I may mention that I have found no medicines
more useful to check it than large doses of tannin, com¬
bined with quinine. The following remarks of Dr. Hand-
field Jones r are extremely interesting:—“The fact is of
much significance, that in tolerably vigorous persons, the
application of a linseed poultice produces only a macerated
state of the epidermis, whilst in the weakly it gives rise to
well-marked eczematoid eruption. The influence of the
vaso-motor paresis in promoting perspiration is shown by
many facts, as the occurrence of profuse sweating during
deep in phthisical, rachitic, and other persons. The same
results from strong exercise, where the nerve-force is used
up by the muscles, and to a much greater degree in those
who are in training. By a statement made in a report from
the Vienna Hospital, that when the sympathetic nerve is
divided on one side of a horse’s neck, that side of the face
and head appear bathed in sweat. The occurrence of
sweating and vesicular eruption as co-results of nerve-
jjaresis is illustrated by a report given by Schrann respect¬
ing genuine intermittent fever, in the Upper Palatine, in
1856. The cold stage was short, while an abundant sweat
came on early, attended with an eruption of herpes of vary¬
ing intensity, which occupied the abdomen and forearm,
and appeared to be rather the cause than the consequence
of the sweat. In the above-mentioned instance, the vaso¬
motor nerves alone, or with the sensory, seem to have been
directly affected; but the same phenomena, or very similar,
may be produced by inhibitory (reflex) irritation/’
A short time since, I admitted a boy, aged 12, at the dis¬
pensary for skin diseases, who first suffered from urticaria,
whicheradually disappeared. Labial herpes and pemphigus
of the lower extremities then ensued; for, according to Dr.
Burgess, the same exciting cause will produce different
kinds of cutaneous diseases in different individuals. Thus,
certain substances which suddenly derange the organs of
digestion, sometimes produce urticaria, sometimes erythema
or roseola. The form presented by an eruption is no crite¬
rion as to its cause. In many instances urticaria is noso
logically identical with erythema, as is proved by their
occasional occurrence in the same person, from the same
cause. In other instances, urticaria is a reflex irritation
proceeding from, some important organ, usually the stomach
or uterus, and under the control of a plexus of the sympa¬
thetic system. Dr. Russell 2 has published a case of a female,
aged 23, affected with pemphigus. Every attack was
preceded from a few minutes to an hour by itching, accom¬
panied with pain ; the part about to be affected appeared
perfectly healthy until the eruption was becoming de¬
veloped, when a raised red spot became visible, at the
apex of which effusion quickly took place, a bulla forming,
the pain then began to moderate. The exciting cause of
herpes, or pemphigus, may be from exposure to cold and
wet, pemphigus being often observed in barge and lighter¬
men, who are, from their occupation, frequently wet for
hours, especially their lower extremities. In these indi¬
viduals the cutaneous eruption is often of a mixed char¬
acter, if I may so express myself—viz., bullae and vesicles,
when the latter, a considerable area of the b skin may be
covered by the eruption. The origin of pemphigus in
these men is considered to be due to cutaneous imbibition;
but I think that exposure to cold and wet, which paralyses
the nerves of the part, and the capillary vessels thus losing
their tone, allow of the escape of the more fluid parts of
the blood, is most probably the chief cause; in other
words, a paresis of the vaso-motor nerves takes place, for,
according to Dr. Brown-S6quard. 8 if the nervous sunply of
‘i part be injured, the blood-vessels become dilated, and
the temperature of the affected part is increased. That
herpes may arise from exposure to draughts of cold air,
&c.,^is well-known, the eruption being preceded by neu¬
ralgia. In common catarrh, herpes of the lips is a com¬
mon symptom, and this eruption has also been observed
alternating with asthma ; indeed Trousseau 4 states, on the
1 Journal of Cutaneous Medicine. No. VI.
2 Media# Timet and Gnsette, October 29th. 1864.
3 Lancet, November, 185S,
t Irousseau’ s Clinical Medica, translated by Dr. Victor Baziic.
authority of Dr. Duclos, that nearly all asthmatic subjects
present a herpethic diathesis. Dr. Woakes, in a paper on
the “Correlation of Cutaneous Exanthema with Neuralgia,”!
records cases of herpes arising from the exposure to a-cold
wind. One case is especially interesting—a little girl,
aged 3, took a long journey in a waggoner, during the pre¬
valence of a cola north-easterly wind. Though well
covered in front, it escaped observation that the seat
against which the child leaned was open at the back, and
the short skirts of the child, resting on the seat allowed an
almost uninterrupted admission of cold air to her waist.
The following day, although previously in good health, a
dense streak of herpes began to make its appearance round
the left half of the body, about the line of junction of the
child’s skirts, and the more closely fitting portion of its
attire.
Allusion has been made to the fact that herpes zoster is
frequently preceded by neuralgic pain in the part about to
become affected, and it is interesting to note that Heb-
erden was aware of this, as in the following case—“ In a
woman, more than 50 years old, the herpes appeared upon
the right clavicle, together with fever and pain throughout
the whole right arm; the eruption and fever continued
some weeks, but the skin remained scaly for several
months, and the whole arm gradually became weaker, till
it lost all power of motion, and in this state continued at
least three years, and probably her whole life. The fingers
were constantly in an involuntary tremor.” Brodie and
Watson have noticed more or less inflammation accom-
S inying neuralgia; and, according to Dr. Handfield Jones,*
r. Anstie has seen a well marked erysipelatoid condition
developed under the same circumstances.
Vesicles are defined by Hebra 3 to be elevations of the
horny layer of the epidermis -by transparent or milky
fluid. “ An essential character of the vesicle is its sue,
for only those elevations of the epidermis, which are in
size between a lentil or a millet seed, receive this appella¬
tion, all those larger are reckoned as bullae.” This latter
elementary lesion is considered by the same author to have
its seat in the epidermis between its mucous and homy
layers, and are found “ both at the aperture of hair sacs
and in the inter-follicular spaces, bullae, or blebs, are dis¬
tinct from vesicles simply by their magnitude In another
part of his work the same author states that the first formed
cluster of vesicles are always nearest the nervous centres,
and that those which subsequently develop themselves lie
more towards the peripheral distribution of the corres¬
ponding nerves.
The following are Dr. Handfield Jones’ 4 views of the
pathology of herpes zoster:—“ Some morbid matter or influ¬
ence strikes the cutaneous branch of an intercostal, or
other nerve, and affects both the sensory and vasal nerves,
paralysing them. The alteration produced in the former
conditionates pain, which is a mode of sensory paralysis.
The alteration of the vaso-motor nerves gives rise to
hyperaemia and vesicular eruption. Nothing is of course
more common than the neuralgic affection of the sensory
nerves, the vaso-motor remaining exempt, yet we have not
unfrequent examples of the latter becoming involved in
the paresis of the former.”
Herpes zoster resembles urticaria in its connection with
the nervous system, being now understood from the obser¬
vations of Dr. Von Barensprung to be occasioned by irrita¬
tion of the spinal ganglia, the posterior roots being impli¬
cated, 6 and, according to Trousseau, in neuralgia, a disease
1 Joumal of Cutaneous Medicine, No. III. 4
2 Journal of Cutaneous Medicine. No. VI.
8 Hebra on Diseases of the Skin. New Sydenham Society.
4 Journal of Cutaneous Medicine . No. VI.
5 Herpes zoster has, according to Dr. Eulenburgh, always a peripheric
origin, and consists of a characteristic change in the skin, with an accom¬
panying affection of the vaso-motor system ef nerves, and not a* Von
Barensprung insists, in a primary affection of the spinal ganglia. In
no case is it the rule that zoster follows the whole course of a certain
spinal nerve, frequently only a single twig, and oertain branches of
the plexus are affected, which sometimes is observed in the neighbour¬
hood of individual branches of a plexus (for instance, the braohial) with
interruption of motor power in the corresponding nervous branches,
complicated with paralysis of individual muscles. He records a case of
a shoemaker, in which the symptoms were as followsKeuraigia. then
160 The Medical Prw» and Circular.
KINKEAD ON HARE-LIP.
August Id, 186&
intimately connected with herpes, there is always tender¬
ness on pressure over the spinous processes of the vertebrae
accompanied by cutaneous hyperaesthesia at the point of
exit or the nerve trunks.
That the wheals in urticaria contain fluid has been proved
by the simple experiment of G. Simon, who passed a
needle into one, and subsequently observed fluid to ooze
from the puncture, and the vesicles of herpes zoster are
nothing more than small bullae, the only difference between
this disease, herpes, and urticaria is that in the former the
oedema ends in serous exudation, which elevates the cuticle
in the form of vesicles or small bullae, whilst in the latter,
the effused fluid is in less quantity, not so superficial, and
gives rise to the appearance known as wheals.
M. Dumontpalier 1 has reported a case of intermittent
urticaria, in which the attack appeared each night for six
weeks ; and it is interesting to note that different members
of the same family had each some nervous affection—the
parents were asthmatic, the grandfather rheumatic, the
grandmother had angina pectoris, the brothers were rheu¬
matic, and four children suffered from intermittent diar¬
rhoea.
The observations of Trousseau* on the connection of
asthma with cutaneous eruptions is of much interest—viz.,
that asthmatic subjects usually exhibit in their youth erup¬
tions of an eczematous or herpetic character, “indeed,
nothing is more common than to find herpetic, rheumatic,
gouty, and hsemorrhoidal affections transform themselves
into asthma. . . . Thus, eczematous eruptions, rheu¬
matism, and gout are complaints which may be replaced by
asthma, and may replace it in turn.” Asthma, as is well
known, is a neurosis.
Mr. E. Wilson 3 has recorded a case of traumatic eczema,
which occurred in the person of a volunteer at a review from
a M kick” of his rifle on the shoulder, and upon which he
rubbed tincture of arnica. In the course of a few days
the disease (eczema) appeared on his groin, as well as on
his shoulder. The tincture of arnica, probably, acted as
an irritant ; and the irritation, Mr. Wilson states, excited
in the injured part is propagated by the injured nerves to
the cutaneous branches at a distance, the mechanism of
nervous reflex function is set in motion, and papular and
vesicular eruption with pruritus are developed on parts of
the body at a considerable distance from the focus of irri¬
tation.
_ Mr. Hooker 4 has published a case of a neuralgic affec¬
tion of the leg, complicated by superficial ulcers, and which
was cured by division of the popliteal nerve, derangement
of the digestive organs, suppressed menstruation, &c.,
have caused the appearance of herpes and pemphigus—in
fact, the same set of causes as in urticaria, only that this
latter disease is more intimately connected with the func¬
tion of digestion and assimilation. Pemphigus usually
occurs in debilitated subjects, frequently from intemperance,
is secondary to some constitutional derangement, occasion¬
ally arises from local causes, and has been observed to
co-exist with urticaria; indeed, Hebra 5 has described a case
of urticaria, in which several of the wheals passed into
bullae.
From the preceding remarks, it will be evident that
there exists an intimate connection between certain cuta¬
neous diseases, especially as regards their origin. This
group might be arranged, as follows :—
1. Erythema. 2. Herpes.
3. Pemphigus. 4. Urticaria.
ansnthm and cramp in those parts to which the ulnar nerve is distri¬
bute^ diminution of sensibility; and, lastly, herpes zoster, with dis-
tinct local i z ati on to the course and distribution of a cutaneous branch,
lyimanly, here we have the affection of the ulnar nerve, apparently
rheumatic or perineuritic; from this arose diminution in the conducting
pow* of the edssory and motor portions, and loss of function of the
vaso-motor and sensory fibres which supply the skin, and hence the
aoster .—^Edinburgh Medical Journal , No. CLXL, June, 1868.
1 Butle* do PAoad. Jmper. <U Med.. November 80th, 1886.
i Lecture on Clinical Medicine. Translated by Dr. V. Bazire
4 Z^!a^!^9 UUSne0W XoMoine, »«• P-101.
§ AUf. Wien. JVM. Jetton?, 1888, No. U. j
For instance, we have in erythema, redness of the skin,
and fluid effused into the subcutaneous tissue, especially in
chronic cases ; this effusion may elevate the cuticle in the
form of wheals, and which, pressing on the cutaneous nerve
filaments, gives rise to tingling ; the disease may now be
called urticaria. The effused fluid may increase in quantity
and elevate the epidermis either in the form of vesicles
(herpes) or bullae (pemphigus). After the disappearance
of these symptoms, the infiltration may still remain
accompanied by itching, and leads to the establishment of
an eczema ; all these symptoms may be called the rebound
of nature against irritation either internally or locally,
which signifies in other words reaction, and which may
become permanent, as in chronic urticaria, for all chronic
diseases are liable to exacerbations.
Dr. Haughton! has well described this condition as a
series of continuous vibrations against a cause which was
formerly operative, but which has long ceased to have a
real and tangible existence. A familiar example of the
principle in question is the sensation as of sand in the
eye, after the offending particle has been removed, as is
also the common feeling as of pain in the foot, felt by men
whose legs have been amputated.
And now, in concluding my rambling paper, I hope that
the preceding remarks, in which the observations of others
are freely made use of, may direct our attention to the
morbid process going on in the lungs, and occasioning
many cutaneous affections, and also furnish us with a hint
to their successful treatment.
ON SOME POINTS CONNECTED WITH
THE OPERATION FOR
HARE-LIP AND EXCISION OF THE LIP
FOR CANCER.
Br Rd. J. KINKEAD, A.B., L.M.T.C.D., L.R.CB.I., Ac.
The operation for excision of the lip for epithelioma (being
almost identical with that for hare-lip, ana treated of under
the same head by most surgical writers) is, perhaps, one of
the simplest and commonest in surgery ; but it is also a
most important one, for on its being skilfully performed,
and the after-treatment carefully attended to, depends
much of the future comfort and, I may say, happiness of
the patient. Personal appearance being a subject so dear
to mankind, that very few are philosophical enough to re¬
gard with unconcern the disfigurement of the natural
beauty that each one of us believes that our own particular
self is gifted with.
But its importance has, like most surgical operations, a
two-fold bearing. The first, and most important, that relating
to the patient, and just now treated of; the second, that re¬
lating to the surgeon. I know of no operation that will
gain the surgeon, and the young surgeon especially, more
credit if skilfully, or more discredit if unskilfully, per¬
formed than that for hare-lip or for cancer of the lip. The
child is exhibited by its mother, the grown patient will point
out his own lip: and each will tell how beautifully the opera¬
tion was performed—how carefully the wound was dressed
afterwards. No unevenness, no gap, in the free edge of the
lip, little or no “ mark”, in the skin, no one, if not told,
would have known that a piece of the lip had been taken
away, or that there a hideous gap had before existed.
It is easy, on the other hand, to imagine how detrimental
must be the censures passed where the edges of the wound
are irregularly joined, where the lip is notched, and a broad
cicatrix disfigures the patient for life.
Many deem that the most important part of the treat¬
ment consists in the revivifying of the edges of the fissure-
in hare-lip, or the excision of tne diseased portion in epi
thelial cancer, and that the after-treatment of the case i s
trivial in comparison, but such is not the case. No doubt,
the cutting port, tlle actual operation, is most important,
but the after care of the case is no less so. The sucoess of
~I'xriicalMirror. October, 188V.
Th* Malic*! Press and Circular. KINKEAD ON HARE-LIP. August 19,1868. 161
the most skilfully performed operation may be defeated by
carelessness or ignorance with regard to the treatment
of the wound after the operation.
The two following cases show this so fully, and besides
contain many interesting points, such as the seat of
disease in one case, the extent of lip removed, &c., that I
need no apology in bringing them under the notice of the
profession.
S. M 4 G., aged about 80, a farmer, called on me towards
the end of August, 1867, to consult me about a sore lip.
He gave me the following history :—About three years
before a small sore came on his upjper lip , he thought
from sun-burn, but he did not mind it at first* thinking it
would get well in winter, and in the first winter after its
appearance it almost passed away, reappearing next sum¬
mer, in a more aggravated form, again getting better in
winter ; the next summer it was again worse, gradually
extending from near the centre of the lip towards both
angles of the mouth ; this winter it did not get better, but
continued gradually to get worse till the date at which I
saw it. For about six months the growth had been rapid,
and the discharge annoyed him greatly.
The lip presented the following appearance :—Its free
border was ulcerated for about three-fourths of its length,
the commencement of the ulceration being about equi¬
distant on both sides from the angles of the mouth.
The surface of the ulcer had a warty appearance ; its
edges were white and indurated. The induration and
thickening of the lip spread for something more than one-
fourth of an inch from the free edge of the lip towards
the nose.
I operated on the 1st of September, 1867, in the follow¬
ing way:—
An assistant compressing the arteries at the angle of the
mouth, I transfixed the lip from within outwards with
a straight bistoury, at a point opposite the centre of the
left nostril, about two or three lines below its orifice, and
carried an incision in a right line (so as to include the
cancer) towards the centre of the portion of healthy lip,
between the angle of the mouth and the diseased part.
When the knife had arrived within a line of the junction
of the mucous membrane and skin, I here turned the blade
inwards, and finished the incision as Druit recommends ;
the raw surfaces of the cut forming at the termination an
angle of about 100° with each other I made an exactly
similar incision on the right side.
The diseased part of the lip was now supported by a
portion equal in thickness to a half of each nostril and
the colnmna nasi. Taking the diseased part in my left
hand, I cut down on each side from the angles of the in¬
cisions at each nostril to the middle of the sustaining part,
the cuts terminating at a point opposite the centre of
eohunna nasi, and three lines from termination of the in¬
duration of the lip (about one-half inch from free edge).
The disease had now been removed by what I may call a
W*th&ped incision. I brought the edges into exact appo¬
sition by means of three needles with sealing-wax heads,
ttd a “ twisted suture,” laid a bit of wet lint over them,
ttd i*-thet» was considerable strain on the suture, owing
lost- of substance, I supported the parts by a
long strap of adhesive plaster, extending from ear to ear.
The third needle transfixed the v-shaped centre portion.
Very little blood was lost.
On the 2nd, twenty-four hours after the operation, the
wound seemed to have united throughout. No pain, no
pus. He complained of nothing but that he said his mouth
was too small, and asked me if I would not take out the
needles and make it larger, as he feared the neighbours
would laugh if his mouth was so small. The strain on the
suture appeared to have disappeared.
On the 3rd, forty-eight hours after the operation, I
withdrew two needles, but as the third was very firmly
adherent I did not remove it till the next day.
On the 5th, I found the whole anterior portion of the
lip in a sloughy condition. After being poulticed for a
couple of days the slough separated, and shewed that the
mucous surface and about the .posterior third of the lip
were firmly united, and the anterior two-thirds, or that
compressed between the ligature and needles, was that
which sloughed; the V-shaped portion escaped.
The wound healed r apidly, contracting as it healed, and
leaving very little more scar than would have been the
case if it had united by the first intention.
The situation of the disease in this case was very rare,
epithelioma as a rule attacking the lower lip.
Its situation, also, taken in connection with its size,
made the operation more difficult than it would otherwise
have been. If the same extent of the lower lip had been
implicated I would have removed it by a semi-circular in¬
cision extending from one angle of the mouth to the other,
tied the arteries, and brought the mucous membrane and
skin into apposition by a few points of suture; but this
method was inapplicable to the upper lip, as, owing to the
immovability of the parts, a gap, the shape of the incision,
would have left the teeth exposed and the patient unable
to close his mouth (this would not be the case in the
lower lip, the mobility of the skin over the chin being
such that in twenty-four hours it would be hard for a
casual observer to know, only for the suture, &c., that an
operation had been performed). Under these circumstances
I was compelled to leave as much as possible of the upper,
or, if I may so call it, the nasal portion of the lip, as it was
the most immovable, and hoping, also, that it would give
support and take off some of the strain from the freed edge
of tne lip. This I was able to effect by leaving the y-shaped
portion, and making the whole incision like an inverted W
(tnrfr woodcut). I finished the incision in the angular direc¬
tion, in order that a prominence might be left opposite the
line of union, to guard against a depression being left when
the wound was healed, for the wound not only contracts from
side to side in healing, but also iu its length, so that if this
precaution be not taken the line of the lip will not be per¬
fect, and the patient will be more or less disfigured.
The next case is only interesting as exemplifying the
lesson taught by the last, with regard to the length of time
the pins should be left in.
M. O’S., aged 69, farmer. Had an epithelial ulcer, on lower
lip, of moderate extent. On the 5th December, 1867, 1 re¬
moved the ulcer by the ordinary V incision, and brought
the edges together by three needles similar to those used
in last case.
On the 6th, exactly 23 hours after the operation, I with¬
drew the middle pin (which compressed the vessels) ; six
hours after I removed the pin nearest the angle of the
wound, and the following day the third pin, which was only
used to bring the edges into exact union. The wound
united throughout by the first intention, not a single drop
of pus appearing. A small ulcer formed at the orifice nearest
the point of the last pin withdrawn, a couple of days after
its withdrawal.
In this case I withdrew the needles so soon, one in 23
hours , one in 30 hours, and the last in 48 hours, because I
am convinced that the sloughing in the case of M 4 G. was
occasioned by leaving the needles in too long, and that
such was the case is shown by the posterior portion of the
lip not exposed to the pressure between the needles, and
Digitized by v J °°8 le
2
162 Tha Medical Press and Circular. WARING-CURR AN ON NEURALGIA.
August 19,1806.
the suture uniting at once, and not participating in the
sloughing condition of the anterior parts between the two
lower needles, and yet I left in the two lower needles only
48 hours, and the upper needle 72. Most surgical writers
recommend the needles to be left in as long, if not longer,
as, for instance, Liston says 48 hours, Erichsen 60 hours,
S. Cooper 4 days, and Druit says that in 5 to 7 days is
quite time enough to withdraw them.
In all cases where a large piece of the lip has to be re¬
moved, there must, of necessity, be a very considerable
pressure of the lip between the hemp or silk of the suture
and the needle, in order to get the edges to meet at all,, and
therefore there must be (and especially in old people) a
great danger of killing the part, and losing, as in S. M‘G.’s
case, the whole portion by .'loughing, or, as I once witnessed,
the needles ulcerating out, and leaving not only the scar of
the incision, but that, also* of each needle, which, to say
the least of it, is not an improvement to the human face
divine.
I would even recommend in many cases the needles to
be removed in even a shorter period than 24 hours, as the
hemp or silk of the suture is firmly cemented to the lip by
the coagulated blood, &c., and will keep with the aid of a
strip or two of adhesive plaster, the edges of the wound in
firm apposition.
OVARIAN NEURALGIA
TREATED BY HYDROCHLORATE OF AMMONIA
AND TINCTURE OF ACONITE.
By J. WARING-CURRAN, L.K.Q.C.P.I., Ac.
Whilst acute inflammation of the substance of the unim¬
pregnated ovary is of rare occurrence, having never
myself, in either hospital or private practice, met with
what one would be led to believe a genuine or an estab¬
lished case, thus believing that the ovarites of writers on
the subject is in character chronic , or perhaps in a few rare
cases sub-acute, yet neuralgia of the ovary is far from un¬
common. By neuralgia of this body, I meau that class of ova¬
rian disturbance which Dr. Churchill has described under
the nomenclature of “ ovarian irritation” and to that which
Dr. West applies the simpler designation of "ovarian
pain ” to me ovarian neuralgia appears a preferable and
m >re correct terra. Clinical observation has taught that
the disease is independent of any local lesion, and more
remediable by constitutional than any other method of
treatment. My object here is not to enter into those cases
of ovarian neuralgia dependent on defective moral train¬
ing, and where a strictly moral treatment is to be enforced,
and undue connubial excitement checked, but those cases
where the patients* sufferings are constant and severe, when
there is no hysterical temperament, and no obvious symp¬
tom of imprudence or immorality. My object, also, as
briefly as possible, is to enter upon the treatment of such
cases, and to illustrate, by the history of the six following,
the great benefit to be derived from the muriate of am¬
monia and tincture of aconite in the treatment of this
affection, when leeching, purgatioa, antispasmodics, vesi¬
cants, sedatives, internally administered and locally ap¬
plied, had signally failed.
Case 1.—R. A., twenty-seven years of age, of sedentary
habits and chlorotic appearance, unmarried, sought advice
for a severe and constant pain suffered in the left iliac
fossa ; had been under anotner medical gentleman for ten
days, from whose treatment she stated she had experienced
no benefit. The pain was dull and aching in character, oc¬
casionally passing along the anterior surface and inner side
of the thign ; has not slept for a week ,* the appetite is im¬
paired, but the secretions are all healthy ; the tongue has
a characteristic nervous coating, and tne pulse is quick ;
there is no hysteria. Upon examination, I find a fullness in
the left iliac region, with tenderness. I ordered the appli¬
cation of liniment, belladonna, with chloroform, over the
seat of pain; prescribed a saline aperient mixture, contain¬
ing tincture of belladonna and a sedative draught at bed¬
time. For three days this treatment was persevered in, but
there was no relief to the symptoms ; the only ease ex¬
perienced was when the patient lay flat on the face. I then
applied a blister over the seat of mischief, gave opium,
cannabis indicis, and camphor, in the form of pill, and
tincture of conium in mixture. The following day there
was an aggravation of the symptoms ; the patient had
spent a restless night, and the relatives became anxious.
Upon this I prescribed an eight-ounce mixture, containing
two drachms of the muriate of ammonia, with five-drop
doses of tincture of aconite. The combination seemed to
act magically ; before the bottle was finished the pain was
gone. Sulphate of iron and quinine was afterwards given,
and four months have now elapsed without any return of
the complaint.
Case 2.—A. L., aged 19 years, single, of a full habit,
and hitherto healthy, became affected with a violent pain
in the left groin, for which immediate advice was required,
as the woman in attendance dreaded the existence of a
hernia. On being visited I found the pulse high, and the
usual symptoms of inflammatory fever. She had suffered
severely four months previous to being visited, and had
passed no water from the commencement of the attack;
vomiting was a constant and distressing symptom. On
examination I found slight swelling on the left side, with
intense pain on manipulation ; the tenderness extended
below Poupart’s ligament. Having satisfied myself that
there was no rupture, I ordered turpentine stupes to be
applied, and directed her to have a warm hip-bath, and a
mercurial aperient. The following day, as there was no
progress towards amendment, I applied six leeches over
the site of pain. This gave temporary relief, but towards
evening the pain became if anything more severe. I
found her, on being visited, on her hands and feet out of
bed, apparently suffering most acutely. I prescribed her a
draught containing twenty drops of cannabis, and im¬
mediately placed her on the muriate of ammonia and
aconite mixture. The ensuing morning she expressed her¬
self considerably relieved, but the tenderness remained,
and at times the pain recurred, producing vomiting when
it did so. The patient got on remarkably well until the
menstrual period arrived, when the same state of things
occurred over again; but under the muriate of ammonia
and aconite much was done to arrest the disease. She has
had a menstrual period since without any recurrence of the
pain.
Case 3.—A. R. F., aged 22 years, married for the last
14 months, has long suffered from chronic ovarian pain,
increased during the menstrual period. Has taken, to use
her own words, “ no end of medicine,” and has been
under the treatment of various physicians, u who all told
her the same thing.” I prescribed at once the muriate of
ammonia and aconite; two bottles in the course of six
days entirely removed the pain. Six weeks have elapsed,
a menstniation passed with little pain, and at the present
time (July 14) I learn from the woman, who came with
another patient, that she has entirely recovered, and has had
no return of the pain since she finished the last mixture.
Case 4.—J. L., married, aged 40 years, has suffered from
ovarian neuralgia for a number of years. At times the pain
is unendurable; during its existence there is fulness and
tenderness over its site. Having been under treatment
for an hepatic lesion, and obtained the above information
in the history of her case, I told her, when the ovarian
neuralgia returned, to apply, and I should prescribe for its
relief. She accordingly aid so in the course of time, and
from the muriate of ammonia and aconite she obtains
almost immediate ease.
Case 5.—G., about 25 years of age, single, has suffered
from the time of her first menstruation with ovarian pain,
causing frequent and painful micturition, with vomiting.
Gave her the muriate, and had the satisfaction of hearing
her express that she obtained instantaneous relief after its
administration. Has suffered from subsequent attacks,
which invariably yield to the medicines advocated.
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Tke Medical Trm and Circular.
HOSPITAL REPORTS.
August 10,1868. 168
Case 6 is furnished to me by a professional relative.
It is that of a woman, aged 30 years, who has borne three
children, and has laboured under ovarian suffering for a
term of years. She had been a constant patient of my in¬
formant. He had “ exhausted the Pharmacopoeia,” as stated,
but with no benefit. Upon the exhibition of the muriate
and aconite, the symptoms directly yielded to treatment,
and the woman was relieved much periodic suffering, and
the physician re-established the confidence hitherto placed
in him.
Although I am at a loss to account for the inexplicable
property possessed by the muriate of ammonia in curing
ovarian neuralgia, I can unquestionably vouch for its
efficacy in the same way as the French and German
authors first bore out its high character and undeniable
specific action as a stimulant in mucous fevers, when the
inflammatory symptoms have subsided.
P.&—Since writing the foregoing, my attention has
been directed by an eminent London physician, to whom I
submitted the paper, to the exhaustive treatise of Dr.
Prosser James, “ On Sore Throat and the Laryngoscope,”
wherein I find that, in several recorded cases of tonsilitis
complicated with ovarian neuralgia, aconite had been pre¬
scribed, and with success, by the distinguished author.
I had not the benefit of being previously acquainted
with the book in question, and although I am ever ready
to give honour where honour is due, I believe that this
circumstance, together with the fact that the exact nature
of the cases are materially different, does not deprive the
above paper of its therapeutical importance, whilst an
honest acknowledgment screens me from what the gifted
candidate for the representation of Edinburgh and St
Andrews might feel inclined to look upon in the light of
plagiarism, my motto not being “ Pereani qui ante nos nos¬
tra dixerunt”
- 4 -
CITY OF DUBLIN HOSPITAL.
TWO OASES OP CHOREA TREATED BY THE ICE-BAG.
Under the care op Dr. J. HAWTREY BENSON.
In the month of March last I brought under the notice of
the Surgical Society of Ireland two cases treated success¬
fully by means of the ice-bag, the report of which appeared
afterwards in The Medical Press and Circular for April
8th. One of these was the case of M. P., who had been
suffering for about twelve months from incomplete hemi¬
plegia of the left side, accompanied with choraic tremors.
The disease had resisted all treatment both in the country,
whence he came, and in the City of Dublin Hospital under
my care, until its progress was arrested, and the disease
greatly benefitted, by the application of Chapman’s spine-
bag. When admitted on that occasion into hospital, and
for a month after while we used other remedies, the
patient was quite unable to walk across the room without
assistance, but after twenty-five days’ treatment with the
spine-bag, the use of the limbs was so much restored that
he was enabled to walk up and down stairs, and the choraic
tremors had so far subsided that he could raise a tumbler
filled with water to his mouth, several times successively,
without spilling the fluid—a feat which he could not have
performed for more than a year previously. He left the
nouse, however, before the treatment had been continued as
long as I was desirous, and subsequently many of his
former symptoms soon returned, but in a milder form than
at first. In the following May, 1868, he returned to town,
aftd I admitted him a second time into the City of Dublin
Hospital
I found on his re-admission that the paralysis had not
altered umoh in its condition for the worse, since he left the
ftflOae in July, 1867, but the choraic tremors had in great
jitfc returned, so that he was unable to undertake any em-
pymebfr necessitating the use of the left hand. These
muscular movements were now almost confined to the
neck, shoulder, and upper extremity of left side, and were
most conspicuous in the extensors of the forearm. The
fingers were jerked backwards continually, and with consi¬
derable force, either singly or in pairs, but rarely all toge¬
ther. The whole arm was occasionally drawn suddenly
backwards or forwards, and sometimes the shoulder was
involuntarily shrugged. He was enabled to flex the fore¬
arm at a right angle with the arm, but could scarcely sepa¬
rate the latter from the trunk. I immediately ordered the
spine-bag to be applied for an hour and a-half twice daily,
regulated the bowels, gave him cinnamon water as a placebo
and put him upon full diet. This treatment was continued
for about one month, during which he steadily improved,
and by the end of that time the choraic tremors had
almost completely vanished, and the use of the left arm
was so far restored that he was enabled to raise his hand
once more to his head.
Case 2.—E. M., a girl, set. 13, was admitted into the
City of Dublin Hospital on May 12th, 1868, suffering from
chorea. She was well nourished, fat, and florid in com¬
plexion. Up to the commencement of her present illness,
about three weeks previously, she had habitually enjoyed
excellent health, with the exception of being subject to
constipation. This, however, never produced any ill con¬
sequences, as far as she was aware. The origin of the chorea
from which she was now suffering was referred, by her
mother and herself, to her having used fatiguing physical
exertion in lifting large buckets of water.
When admitted into hospital the muscles of the face,
neck, extremities, and trunk were convulsed to a degree
painful to witness. A female attendant was obliged to
stay with her constantly to prevent her injuring herself
against the bed-posts, or throwing herself out of bed. The
tongue was furred ; the pulse at the wrist could not be
counted, owing to the subsultus of the neighbouring ten¬
dons ; but, by placing the hand over the apex of the heart,
the number of beats per minute were ascertained to be
about 80. The action of the heart was very irregular, but
no murmur was heard. The bowels had been confined for
several days previously.
The ice-bag was applied, immediately after admission,
along the whole length of the spine, and kept in its posi¬
tion by carefully-adjusted bandages. After one hour and
a-half the bag was removed, as the application did not
seem to be attended with the slightest benefit. She was
then ordered a dose of jalap and calomel.
13th.—The purgative powder had acted well on the bowels
during the night, but still the chorea, though somewhat
moderated, was distressingly severe. The ice-bag was
again applied, as at first, but before it was removed a most
marked abatement of the choraic convulsions had taken
place.
14th.—The muscular movements were about the same as
at the time of the removal of the bag on the previous day.
A dose of turpentine and castor oil was ordered.
15th.—The medicine had operated well, and brought
away a large quantity of dark foetid material from the
bowels. The bag was again applied, and with a benefit
almost equal to that experienced on the 13th. Menstrua¬
tion coming on then interrupted the treatment, it being
deemed not prudent to use the ice to the spine
during the continuance of that function, lest it might be
followed by some derangement, possibly by menorrhagia.
Before the natural flow had subsided, however, the patient
had so far convalesced that no further treatment was used
beyond a few shower baths as a tonic.
She left the house in a week after perfectly recovered.
Observation *.—The first case I have designated one of
chorea, following the example of Trousseau. He did not
confine that name to the disease called by Sydenham
chorea sancti viti, but used it as a generic term to desig¬
nate convulsive diseases, affecting any part or parts, no
matter how local or how general, characterised by muscular
agitation, or more or less strange movements and contor¬
tions, which were not distinctly admissible under any other
Digitized by VjiUUSc
164 Hie Medical Press and Circular.
HOSPITAL REPORTS.
August 10, IMS.
head. Duchenne would, probably, have designated the
affection of the forearm, where the mass of the disease
seemed, at this his second admission, to be concentrated, as
functional spasm, it being accompanied by paralysis, and
being, probably, a consequence of the monotonous over-use
of some of the muscles of the forearm in the practice of
his trade as shoemaker.
Whatever its name be, the success of the treatment, in
removing a second time the muscular agitations, and in
affording a more free use of the limb, speaks highly in
favour of the method employed, and, even if the benefit
afterwards prove not permanent, it has, at least, done more
than any otner of the numerous treatments used with the
patient.
Case 2 illustrates how the ice-bag may be useless as a
sedative to the nervous centres so long a3 any eccentric
cause of irritation exists, and how that sedative effect may
be exerted when such cause is removed. In this case,
doubtless, an accumulation in the bowels, or some irritating
substance there, was the eccentric, reflex cause of the
disease. But, even after the cause was removed, the
disease continued till the sedative action of the ice rapidly
restored equilibrium to the agitated muscular system, by
operating on the disturbed nervous centres. No doubt the
mere removal of the cause might have been followed by
recovery, but the application of the ice, as we have every
reason to believe, very materially hastened the event.
UNDER THE CARE OP Mr. CROLY.
CASES OP BENT KNEE, IN WHICH DIVISION OF THE HAM¬
STRING TENDONS WAS PERFORMED—EXTENSION HAVING
BEEN SUBSEQUENTLY EFFECTED : RECOVERY IN EACH
CASE, WITH A USEFUL LIMB.
Case 1.—J. F., a lad, aged 16 years, was admitted into
the surgical wards, under Mr. Croly’s care, suffering from
contracted knee-joint.
History, —Five years previously, an abscess formed in
the lower and outer third of the left thigh, and was opened
by a surgeon. No cause could be assigned for the abscess,
and the patient enjoyed good health up to that time ; a
year subsequently he fell upon his left knee, inflammation
of the joint ensued, and the knee became gradually bent;
he was obliged to use a crutch or stick in walking.
Condition of joint on patient’s admission into the
Hospital. —The internal condyle of the femur projects con¬
siderably inwards and forwards; the tibia is partially lux¬
ated backwards and outwards; the back of the condyles of
the femur rest on the anterior edge of the head of the
tibia; the patella is dislocated outwards ; the hamstring
tendons are tense ; the muscles of the thigh and leg ore
wasted. The ends of the toes touch the ground ; the heel
is raised ; the knee-joint can be flexed, but cannot be ex¬
tended ; the patient uses a stick, on which he leans when
walking ; his general health is good.
Treatment. —The limb was placed upon a well-padded
McIntyre’s splint, and fixed by a carefully applied roller.
The screw of the splint (corresponding to the popliteal
space) was turned gradually from day to day, so as to make
further extension. This treatment was steadily persevered
in for some days, and then Mr. Croly performed tenotomy
in the following manner:—The splint having been re¬
moved, and the patient placed on his face, the tendon of
the semi-tendinosu8 muscle, which was most prominent,
was first divided, by passing the tenotome flatwise be¬
neath the integument, and turning its edge against the
tendon, which on division yielded with a crackling sound.
The tendon of the semi-membranosus muscle then became
prominent, and was also divided through the same wound;
and lastly, the biceps tendon, on the outside, was cut in a
similar manner, due care having been taken to avoid in¬
juring the peroneal nerve ; each puncture was covered
with a small compress of lint, retained by adhesive plas¬
ter, and the splint was re-applied ; no attempt at exten¬
sion was made until the wounds had healed
The patient suffered but little pain, and when all irrita¬
tion had subsided, extension was made cautiously and
gradually, by an occasional turn of the screw on the back of
the splint, and in about twelve weeks the limb was
almost as straight as the sound one. The McIntyre’s splint
was removed, and a starched bandage applied with paste¬
board splint, to give additional support. The patient was
supported by nutritious diet and a liberal allowance of
porter, with cod-liver oil and syrup of iron. He was dis¬
charged from hospital, and is now able to walk without
any artificial support. He works at a trade, and has almost
as good use of the limb as of the sound one.
Case 2.—J. Q., a boy aged 16 years, was admitted into the
hospital for contraction of the right knee, and inability to
walk, except by the aid of a crutch.
History. —He fell when ten years old, and struok the
patella. He suffered much pain from the injury. Inflam¬
mation and abscesses around the joint resulted. The knee
became gradually bent, until at length he could barely
touch the ground with the ends of his toes. He was re¬
ceived into an hospital in the city, but did not remain,
in consequence, as he said, of amputation having been
proposed to him.
State of joint and limb on admission of patient into the
City of Dublin Hospital. —Right leg flexed, condylffl of
femur projecting forwards and inwards, the toes pointed and
raised two inches from the ground, the heel six inches, the
tibia thrown backwards into the popliteal space, the
hamstring tendons prominent but not tense, the joint
moveable. Flexion can be performed, but not extension.
Two cicatrices are visible above the external condyle of the
femur, the result of abscesses consequent on the injury.
The boy is pale and delicate-looking.
Similar treatment as in case 1 was adopted—m,
McIntyre’s splint, of suitable size, and well padded, and
the same constitutional treatment, with subsequent divi¬
sion of the hamstring tendons, and cautious, gradual ex¬
tension of the limb. In two months the knee became
sufficiently straight, and the patient was discharged.
This young man is now engaged as a teacher in a school,
and walks several miles daily, and uses neither crutch nor
stick. The joint is not stiff. A cast and drawing of the
limb were taken previously to commencement of treatment
The cast is preserved in the Museum of the Royal College
of Surgeons, and the drawing is preserved in Mr. Crolys
private collection. A photograph and cast were also lately
taken, which show that the limb is almost as sightly as the
unaffected one.
Case 3.—M. W., a girl, aged 5 years, came under Mr.
Croly’s observation as an extern patient, suffering from
strumous abscesses around the left Knee-joint.
History. —Her mother states that the child was in good
health until about a month previously, when she complained
of pain m the knee-joint. She limped, and kept her leg in
the flexed position. The symptoms increased in severity;
and she passed sleepless nights. Fomentations were applh-
without relief, and abscesses formed on inner side of the
joint.
Appearance of child and condition of joint on admis¬
sion into Hospital. —The patient presented the usual symp¬
toms of hectic fever. The left knee-joint was enlarged, ami
the leg was flexed upon the thigh. The hamstring tendons
were tense. The little sufferer screamed when any attempt
was made to move the limb, for the purpose of examining
the joint.
Treatment. —The child having been placed frilly under
the influence of chloroform, the limb was fixed upon a
gutta-percha splint, which was moulded so as to
support the joint. Liberal diet, with wine and quinine,
were prescribed. The ulcers on the inner side of the
joint were dressed with lint steeped in cod-liver
oil. Under this general treatment the joint improved
in condition, and all inflammatory action ceased. Mr.
Croly then performed tenotomy, as in cases 1 and 2, and
the limb was gradually extended. #
The patient was discharged in one month, the joint being
Digitized by VjiiJOv VC
fh* Medio*! Vrm and Circular.
HOSPITAL REPORTS.
August 10,1868. 165
supported with a starched bandage and paste-board splint.
The child is able to walk and place her foot flatly on the
ground, and she has recovered her usual strength.
Remarks .—The foregoing cases are examples of false
anchylosis of the knee-joint, resulting from injury, and sub¬
sequent inflammation, in strumous patients. In each case
the tibia was drawn backwards by the action of the ham¬
string tendons, and the posterior part of the condyles of
the femur rested upon the anterior surface of the head of
the tibia. The patella was luxated outwards. The leg was
flexed, and the foot everted. The limb in each case was not
only deformed, but weak and useless to the patient. The
cases prove the value of tenotomy and cautious extension of
the limb (nearly to a straight line) after all inflammatory
action has been subdued. The results were most satisfac¬
tory.
DR. STEEVENS’ HOSPITAL.
Cases occurring under the care of Mr. E. HAMILTON.
THE ANTISEPTIC TREATMENT.
It is the manifest duty of every Hospital Surgeon to sub¬
mit to the test of clinical practice, modes of treating
disease which have been proposed in the advance of
surgical science, in order to determine whether they are
mere speculative innovations, or bona fide improvements.
There seems to be little doubt that the antiseptic treat¬
ment, as suggested and carried out by Professor Lister,
will ultimately take its place under the latter head ; but,
as in the case of many similar discoveries, it will require
time to sweep away old prejudices, and assert its true
value, a few cases, selected at random from a great
number which prove its utility, may not be uninteresting
to those who still hesitate to adopt it.
A boy, aged 16, sustained a severe contusion in the left
leg by the passage over of a car wheel. The skin was un¬
broken, ana the bones escaped fracture, but there was ex¬
tensive effusion of blood mto the subcutaneous tissue.
Attempts were made to promote its absorption by the con¬
tinued application of cold lotions, and the use of saline
purgatives. Inflammation set in, followed by suppuration,
yielding a mixture of pus and blood most unfavourable for
the ordinary treatment of abscess. The part was covered
with lint, saturated with carbolic oil; beneath which it
was opened, the water pressed out, and the aperture care¬
fully closed with the carbolic acid putty and tinfoil, with
the most satisfactory result.
A painter, aged 65, fell from a scaffold and sustained a
compound fracture of the lower end of the humerus, ex¬
tending into the joint. A portion of the inner condyle
was detached, ana removed through the wound. There
was considerable oozing of blood, but no distinct vessel re¬
quired haemostatic treatment. The limb was placed in a
bent position, the fragments adjusted, and the wound
closed with the carbolic acid in linseed oil. As the parts
lay well, and there was no pain or constitutional disturb¬
ance, the dressing was not removed for four days. At this
time the wound had united without a trace of suppuration,
and the progress of the case has been most confirmatory of
the value of this treatment.
A female, aged 40, presented a tumour at the verge of
the left breast, which had the character of schirrus in a
marked degree. In consultation, its removal was decided
on, but the presence of herpes zoster obliged us to defer it
for a week. It was necessary to remove the skin over
the tumour very freely, as it was discoloured. One
or two small vessels were twisted. The wound was
not washed with any antiseptic, but carefully sponged
until all oozing of blood had ceased, and then accurately
closed and covered with the carbolic acid putty. On the
4th day the dressings were carefully removed under cover of
lint and carbolic on —the sutures cut, and the putty re-
ahpHed. * At the next dressing the cavity was filled, and
& wound united without suppuration. In this case the
Uf^mture was accurately noted, and no elevation was
observable at any time after the operation, nor was there
any other indication of traumatic fever.
A man, aged 25, presented symptoms closely resem¬
bling those of acute rheumatism: severe pain in the larger
joints, which ultimately became concentrated in the hip of 1
the right side. The thigh was much enlarged, and the
movements of the joint attended with severe pain. After
some weeks, fluid was perceptible on the outside of the
thigh : poultices were applied until the coverings became
thin. It was then opened on the antiseptic plan ; the
fluid was greenish and unhealthy in character; the
patient’s system lowered by long confinement, yet no un¬
pleasant results followed.
On the same day, in the same ward, for the purpose of
clinical comparison, a large psoas abscess was treated with
the drainage-tube, which was followed by very severe con¬
stitutional irritation. I candidly confess that the earlier
trials which I made of the antiseptic plan, did not impress
me favourably with it, but having had, through the kindness
of Dr. Fleming, an opportunity of seeiug Professor Lister
himself demonstrate the modus operandi , and having
since attended strictly to the minute details of it, and
from what I have seen of the practice of others, I am
satisfied that it will prove a valuable aid to the practice of
surgeons; but to be successful, it must be applied and
carried out with care and steady perseverance.
KING’S COLLEGE HOSPITAL.
Cases under the car* of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Cardiac Disease.—M. F., set. 21, nurse. Admitted Sep¬
tember 17 ; discharged September 28. In hospital 11 days.
Unrelieved . Cough, night sweats, dyspnoea, and slight
haemoptysis 1 month ; increase of cough and dyspnoea one
day. On third day after admission pulse 132, respiration
44, much dyspnoea and cough ; slight gurgling at left
apex ; heart’s action tumultuous ; double bruit at base ;
two days later expectoration tinged with blood.
Quinine, dilute sulphuric acid, and liq. morphia; seidlitz
powders.
Cardiac Disease — Typhus. —Rebecca N., cet. 16,works
sewing-machine. Admitted March 19 ; discharged May
6. In hospital 48 days. Much relieved. Three attacks
of acute rheumatism, 6, 4, and 2 years ago ; palpitation
and dyspnoea on exertion 6 years ; three attacks of angina,
the last one month ago ; lately cough, night sweats,
emaciation, and oedema of legs. On admission very pallid,
pain over heart and in left side ; cough, palpitation, and
dyspnoea ; pleuritic rub at lower part of left side ; loud
systolic blowing at heart’s apex, and loud diastolic bruit at
base ; urine one-third albumen. On third and fifth days
after admission had severe angina—almost moribund in
second attack ; also much diarrhoea and vomiting (three
days); frequent attacks of cardiac pain afterwards. On
ninth day after admission, cough, expectoration, and sibilus
over bases of lungs. Seven days later crepitation over
both lungs, and some bronchial breathing and bronchophony
over left side behind ; pleuritic rub still audible.
Digitalis, carbonate of soda and bark ; opium, sp.
of amnion,, aromatic and chloric ether; dilute muriatic
acid and bark ; iron and quinine.
lie-admitted August 11. Died September 9. In hos¬
pital 29 days. Has been at Walton since discharge ; worse
during last month ; breath shorter ; more pain and palpi¬
tation, and slight cedema of legs ; heart’s apex in sixth
intercostal space half an inch to right of left nipple ; pulse
126, full, slightly collapsing ; loud blowing sound all over
heart; trace of albumen in urine. Attacked with typhus
about September 2. Much angina on 2nd, 3rd, and 4th.
On September 5 pulse 136, respiration 44 ; intense head¬
ache, constant vomiting, marked rubeoloid and petechial
rash on trunk. Death four days later.
Post-mortem. —Heart but little enlarged ; mitral valve
much thickened and very incompetent; many fibrinous de¬
posits in spleen and kidneys.
Digitized by VjiOOQlC
166 The Medical Press ind Circular.
HOSPITAL REPORTS.
August Id, 1868.
Digitalis and bark; digitalis and iron ; brandy ; bella¬
donna plaster over heart. On September 6, quinine, dilute
muriatic acid and chloric ether ; brandy to 12 oz.
Cardiac Disease.—H arriet C., set. 42, married. Ad¬
mitted May 24. Died June 7. In hospital 14 days. Acute
rheumatism 28 years ago ; occasional oedema of legs 19
years; cough and expectoration, and dropsy of legs 2 months;
slight dulness and small crepitation at bases of lungs ;
faint systolic bruit at heart’s apex ; cardiac dulness in¬
creased ; pulse 120, small; sleeps badly ; orthopnoea ; ap¬
petite bad. Four days after admission crepitation all over
right lung, back and front, and dulness below scapula.
Three days later much haemoptysis ; pulse 132, respiration
44; U] rine one-half albumen. Four days later patch of
broncnial breathing below spine of right scapula ; albumen
two-thirds. Death next day.
Post-mortem. —Fluid in pleurae ; diffuse pulmonary apo¬
plexy of lower lobe of right lung, and a circumscribed
patch in left lower lobe ; some emphysema ; heart 13 oz. ;
right auricle greatly distended ; mitral valve atheromatous;
liver nutmeggy ; cortex of kidneys wasted.
Chloric ether and aromatic spts. of ammonia ; same,
with juniper and henbane ; conium and henbane ; turpen¬
tine stupes.
Cardiac Disease—Bronchitis.—A. B., aet. 39, needle¬
woman. Admitted April 13 ; discharged April 30. In
hospital 17 days. Much relieved. In King’s College Hos¬
pital six months ago for bronchitis, under Dr. Beale.
Acute rheumatism 19 years ago ; slighter attacks since.
Winter cough 6 years ; palpitation 2 years ; occasional
oedema of feet ; catamenia irregular ; lately much pnecor-
dial pain extending down arms ; occasional pain after food,
and vomiting. On admission dyspnoea, cough and expecto¬
ration ; rhonchus and sibilus at upper, and crepitation at
lower, part of lungs ; first sound of heart rough and pro¬
longed ; diastolic bruit at base ; pulse 90, collapsing.
Carbonate of ammonia and senega (3 days) ; then sp.
ammon. arom and mist, ammoniace ; turpentine stupes.
Cardiac Dropsy.—J. H., set. 64, laundress. Admitted
November 15. Died November 19. In hospital 4 days.
Never had rheumatism ; subject to winter cough—this
lately worse—and much dyspnoea ; dropsy of legs 1 year ;
ascites 3 months. On admission face congested ; legs ery¬
sipelatous ; sloughing in places; great dyspnoea ; heart
very irregular ; pulse 80, respiration 40 ; systolic bruit at
heart’s apex ; dulness and fine crepitation at bases of
lungs ; urine albuminous, loaded with lithates ; conjunc¬
tiva yellow.
Post-mortem .—Much fluid in peritoneum and left
pleura, and a little in right pleura ; pericardium adherent
about apex of heart ; heart 20 oz. ; ventricles hyper¬
trophied and dilated, especially left; mitral and aortic
valves atheromatous ; lungs gorged and emphysematous ;
liver and spleen large ; left kidney fatty.
Squills, digitalis, and broom tops ; gin 9 oz.
Cardiac Dropsy.—E mma P., set. 29, married. Ad¬
mitted September 27. Died November 11. In hospital
45 days. Scarlet fever 23 years ago ; typhus 15 years ago;
5 years ago severe prsecordial pain and palpitation, cough,
and haemoptysis (6 weeks). Now dyspnoea 9 weeks; dropsy
6 weeks; cough 1 month. On admission cheeks congested;
considerable ascites ; abdominal girth at umbilicus 36
inches ; feet and ankles uedematous ; prsecordial dulness
extending to third rib, and mid-sternum ; heart feeble and
intermittent; systolic bruit at apex ; pulse 90, small; re¬
spiration 15 ; crepitation at posterior base of right lung.
On October 26, abdomen 38 inches ; urine scanty; respira¬
tion 40. The dyspnoea increased, and on Nov. 2, 200 oz. of
fluid were drawn off from abdomen by tapping. Became
delirious next day, and remained so till death on Nov. 11.
Post-mortem. —Much fluid in pericardium and peri¬
toneum ; lungs congested ; heart 15 oz.; right auricle
dilated ; mitral valve very thick, and almost cartilaginous,
and auriculo-ventricular orifice much narrowed; liver and
kidneys congested.
Diuretics, stimulants, opiates, compound jalap powder.
Cardiac and Renal Dropsy.—C. R., aet. 45., married.
Admitted 'April 20. Died on May 23. In hospital 33
days. Right hemiplegia in spring of 1863. Was in King’s
College Hospital 3 months under Dr. Johnson ; regained
some power over leg ; memory worse since ; swelling of
legs 4 months ; increase of dyspnoea and cough lately.
On admission very corpulent, considerable anasarca ; legs
erysipelatous; mouth drawn to leftside; tongue protrudea
to the right; complete loss of motion and partial anaes¬
thesia of right half of face, and right arm and leg ; ortho-
pnoea ; troublesome cough; pulse 112; respiration 32;
rhonchus and sibilus, and coarse crepitation over lungs;
systolic bruit at heart’s apex; urine half albumen; the
legs were punctured three times ; albumen fell to one-
third ; gradually became exhausted, and died on May 23.
Post-mortem. —Left pleura full of fluid ; lower lobe of
lung carnefied ; right lung gorged, and everywhere ad¬
herent ; pericardium containing bloody serum, and covered
with recent lymph ; heart 18 oz. ; left ventricle much
hypertrophied ; mitral orifice narrowed ; one curtain of
valve thickened ; much fluid in peritoneum ; kidneys
greatly wasted ; combined weight 5 oz. ; granular on sur¬
face ; urate of soda in tubes ; old apoplectic cyst in left
optic thalamus ; inner and posterior part of thalamus
softened ; commencing atheroma of arteries at brain’s base.
Liquor ammon. acetatis, chloric ether and sp. juniperi co.;
dilute hydrocyanic acid and effervescing mixture; jalap
and scammony powder ; podophyllin ; turpentine stupes.
Cardiac Dropsy. —George B., set. 9. Admitted No¬
vember 27 ; discharged February 11. In hospital 76 days.
Worse. Never had rheumatism ; pain about heart a year
ago, after a fall down a well; dyspnoea and oedema of legs 7
weeks. On admission anasarca and considerable ascites;
sloughing of prepuce ; systolic bruit at heart’s apex, double
bruit at base ; pulse 150, small, and collapsing ; respira¬
tion 66 ; rhonchus and large crepitation all over lungs;
dulness at bases ; no albumen in urine ; 12 days later
bronchial breathing over right supra spinous fossa; 35
days later bronchial breathing at upper part of right lung,
coarse crepitation over left lung ; 19 days later right lung
clear, coarse crepitation all over left lung. On 10th day
after admission abdomen measured 324 inches at umbilicus;
18 days later 25 inches ; 3 days before discharge, 32
inches. Was removed by parents.
Aromatic spts. of ammonia; sp. junip. co., and decoction
of broom tops ; blue pill, squills, and digitalis. On Janu¬
ary 2, liq. ammon. acetatis ; chloric ether; sp. ammon.
arom. and tincture of squills.
Ulceration or Larynx. —E. H., aet 35, labourer.
Admitted March 12. Died on March 12. No histoiy.
Almost moribund,on admission ; lips blue; face livid; ex¬
tremities cold ; breathing sfridulous and difficult; pulse
feeble, 120; operation refused by patient; death 3 hours
after admission.
Post-mortem. —Bones and aim of nose destroyed by
syphilitic ulceration ; slight adhesions of lungs, a few
tubercles ; bronchi clogged with creamy matter; upper
half of epiglottis destroyed by ulceration ; its upper margin
level with arytenoids; its corners linked together by a
fibrous cord containing cartilaginous nodules ; false cords
thickened ; true cords gone ; inner surface of arytenoids
bare ; trachea opposite first ring narrowed to the size of
a goose quill, by a bridge of fibro-cartilaginous tissue on
its anterior wall ; tongue fissured and ulcerated.
Steam inhalation ; brandy ad. lib.
Acute Bronchitis. —M. C., act. 37, King’s College
Hospital nurse. Admitted March 3 ; discharged March
12. In hospital nine days. Recovery. Was admitted
into King’s College Hospital with cough six weeks ago,
under Dr. Garrod. Discharged. Much relieved three
weeks ago. Worse last two days ; face flushed ; cough,
and scanty viscid expectoration ; pulse 90, respiration 32;
sibilus and a little rhonchus everywhere over chest*longue
furred ; appetite bad.
Aromatic spts. of ammonia, chloric ether, and squill*;
urpea pee.
Googl
The Medical Press and Circular.
REPORT ON WINE.
August 19,1868. 167
Acute Bronchitis—Chronic Pneumonia.—J. C., net.
42. Admitted March 8. Died on March 8. Was in
King’s College Hospital for pneumonia, under Dr. Beale,
last April. No history of present illness. Was admitted
gasping for breath ; extreme dyspnoea ; profuse frothy
purulent expectoration; coarse crepitation and sibilus over
right lung, crepitation over left. Died 10i hours after ad¬
mission.
Post-mortem. —Finn, universal adhesion of left lung ;
pulmonary pleura very thick ; substance of lung greyish
and solid ; sinking in water ; right lung emphysematous,
non-crepitant; bronchial mucous membrane very red ;
tubes cooked with purulent matter ; liver fatty, slightly
cirrhosed ; small stone in pelvis of left kidney.
Liq. ammon. acetatis, sp. arnmon. arom., chloric ether
and decoction of bark ; mustard emetic ; brandy ad. lib. ;
dry cupping to back of chest.
Chronic Bronchitis.—L ouisa M*N., set. 31, married.
Admitted Jan. 15. Discharged March 2. In hospital 47
days. Relieved. Winter cough twelve years. Was in
King’s College Hospital last winter, under Dr. Beale.
Previously ill seven weeks. Cough and expectoration ;
chest resonant; large crepitation at bases ; elsewhere sibi¬
lus ; pulse 102.
Carbonate of ammonia, squills, and senega ; compound
jalap powders ; turpentine stupes ; whiskey.
Acute Bronchitis.—L ouisa M‘N., set. 51, married.
Admitted May 13 ; discharged June 11. In hospital 29
days. Very much relieved. Since discharge on March 2
has been nearly free from cough and dyspnoea ; previously
ill 7 days; began with catarrh. On admission muen
dyspnoea ; face dusky ; pulse 96, respiration 36 ; physical
signs of slight emphysema ; dulness at right base ; large
crepitation all over both lungs ; sputum viscid, moderately
abundant.
Liq. ammon. acetatis, aromatic spts. ammonia, squills,
and chloric ether.
Acute Bronchitis.—J. F., set. 47, fur-skin dresser.
Admitted September 30 ; discharged November 2. In
hospital 33 days. Recovery . Had typhus many years ago;
acute rheumatism 13 years ago ; previously ill 12 days ;
rigors at commencement. On admission headache, sore¬
ness of limbs, slight cough, expectoration viscid and frothy;
crepitation at posterior bases of lungs ; pulse 88, respira¬
tion 28 ; tongue white, skin cool, appetite good, bowels
confined.
Liq. ammon. acetatis and chloric ether; same, with
carbonate of ammonia and senega; calomel and colocynth.
Acute Bronchitis—Phthisis.—H onora D., let. 38,
married. Admitted January 2 ; discharged January 23.
In hospital 21 days. Recovery. Typhus 2 years ago ;
winter-cough 2 years ; cough 3 montns ; loss of flesh 8
weeks. On admission, pulse 96, respiration 36. Rhon-
chus everywhere over cnest ; large crepitation over left
side, in front ; 9 days later, diminished expansion of
upper part of right lung ; dulness under clavicle and over
supra spinous fossa, when gurgling crepitation, bron¬
chophony, and harsh breathing are audible; elsewhere
rhonchus and large crepitation.
Carbonate of ammonia, chloric ether, squills, and
senega (11 days); then cod-liver oil, and syrup of iodide
of iron. Brandy 4 oz.; turpentine stupes.
Emphysema— Acute Bronchitis.— 0. E., set. 13,
newspaper-boy. Admitted January 22. Died on January
29. In hospital 7 days. Always short-winded. Was in
King’s College Hospital, under Dr. Budd, 9 months ago,
for bronchitis. Previously ill 2 weeks, with increased
dyspnoea and slight oedema of legs. On admission, face
duticy ; breathing hurried ; much cough and puriform ex¬
pectoration. Chest very resonant; no cardiac dulness ;
breathing harsh in front, with sibilus and crepitation at
lower part ; behind coarse crepitation. Heart’s action
npfd. False 140 ; respiration 52. Five days later, dul-
mm at left posterior base ; sputa streaked with blood.
ByifMM increased, and ho died on 7th day after admis-
Post-mortem .—Lower lobe of right lung collapsed; upper
lobe very emphysematous; patches of pulmonary apo¬
plexy in left upper lobe ; about o.i. fluid in pericardium.
Auricular septum imperfect. Right cavities of heart
somewhat dilated. Bronchial mucous membrane red.
Stomach congested.
Aromatic spts. of ammonia, ether, and squills. Brandy
4 oz. Conium and henbane ; pulv. scainmon. co. Tur¬
pentine stupes and dry cupping to chest.
Acute Bronchitis. —J. D., set. 27, porter. Admitted
December 19 ; discharged January 27. In hospital 39
days. Recovery. Acute rheumatism 13 and 5 years ago ;
heart affected in second attack ; short-winded ; drinks 3
quarts of porter daily. Previously ill 10 days. Chest
very resonant ; rhonchus and sibilus over lungs ; crepita¬
tion at posterior bases ; diastolic bruit loudest at lower
end of sternum. Pulse somewhat collapsing; 16 days
later gout in left great toe and right ankle.
Carbonate of ammonia, chloric ether, and senega (19
days). Carbonate of ammonia, chloric ether, and liq.
ammon. acetatis (5 days). Then carbonate of ammonia,
sp. junip. co. and bark. Turpentine stupes.
REPORT ON WINE
AND ITS ADULTERATION.
[specially prepared for the medical press and circular.]
No. VIII.
It is now time that we describe the process of testing wine
to which we have so many times referred, and to which
our last article was devoted. In doing so, we shall con¬
cisely state the steps as they are regularly taken at the
Custom-houses, confining ourselves for the most part thus
to the results of our experience on an immense scale, and
which has been found thoroughly satisfactory.
The instruments figured and described in our last are of
sufficiently moderate price to come within the reach of all
of our readers who are inclined to experiment for them¬
selves.
The first step in testing wine is to pour some of the
sample to be tested into one of the receivers until the edge
of the liquor is on a level with the upper division. This
division is indicated by two short strokes, the lower for
the actual surface of the liquor, the upper for the elevated
ridge formed by the capillary attraction of the side of the
vessel.
The measurement, which should be very exact , haying
been taken, pour the whole carefully and without loss into
a still flask; then with a little clean water (it need not be
distilled), rinse the receiver, and pour the rinsings also into
the still flask, to insure having all the wine. The water
thus added after measurement makes no alteration in the
percentage result, and has the effect of protecting the flask
from risk of breakage, as there is that extra bulk of liquor
remaining after the spirit has passed over; while, should
the flask be emptied by evaporation, it would be destroyed
by the heat of the flame.
The flask is now to be screwed on to the neck of the
condenser, and the lamp lighted and placed under. It
should be observed that, in order to insure a steam-tight
joint, a wash of vulcanised India-rubber is placed on the
tube, and the pressure of the top of the flask against it
when screwed into place, prevents any escape of vapour.
In this, as in all other experiments, scrupulous cleanli¬
ness is of great importance, and cannot be too strictly ob*
served. With suen care as we may anticipate our readers
have learned during their chemical studies, there is little
likelihood of breakage of the glass vessels employed, and
altogether the process may be pronounced as simple as it is
effectual.
The short time.occupied by the method, its exactness,
and the ease with whicn many experiments may be carried
on simultaneously, commend it to the notico of all' who
desire to investigate the subject practically.
Ia a abort tim after theAtroe baa begun to act ©a %
i 68 The Medical Pres* and Circular. LONDON COLLEGE OF PHYSICIANS.
August 19,18*6.
wine, ebullition commences, and as soon as the first steam
has heated the junction tube sufficiently to prevent con¬
densation before reaching the descending portion, the dis¬
tilled liquor flows from tne delivery pipe into the receiver,
which must be previously placed underneath with the
spout well inserted to prevent loss. In some 8 or 9
minutes sufficient will have been distilled over to include
the whole of the spirit; this, in light wines, under 26
degrees, is about one-half, and in stronger wines, two-
thirds ; but as a rule, the latter proportion is the safest to
take for all kinds.
In boiling some wines, especially light French or
Rhenish, of low quality, the bubbles of steam have great
tenacity, and rise without breaking, so that,- unless great
care is taken in keeping the heat gentle, the wine itself
will be carried over unchanged, and the operation nullified.
In event of such a mishap occurring, the flask should be
removed, and some plain water distilled through the con¬
denser until the tube is cleansed of all trace of wine. This
should also be done in any case if an operation has been
stopped when the spirit was in transit, as another sample
passed through immediately afterward would be rendered
apparently stronger by carrying with it the spirit that
would be clinging within the tube.
The distillate over, the next step is to dilute it to the
bulk of the original wine. This is done with distilled
water poured in carefully so as exactly to reach the upper
mark. As any excess cannot be removed, it will be as
well to pour in carefully from a bottle until it nearly
reaches the point, and adjust the remainder with a pipette
specially kept to this use.
The distillate is now poured into the trial glass, and the
temperature and indication taken in the usual manner.
When Sykes’s hydrometer is used, the strength per
cent., as found in tables compiled for this purpose, and
which is invariably under proof in the distillate, is then
deducted from 100, and the remainder is the percentage of
proof spirit in the wine under operation. Thus let the
percentage strength found be 64*2 U.P., then 100—
64*2==33*8 which is the amount per cent, of proof spirit in
the wine, or, as called in the Act of Parliament, u Degrees
of Proof Spirit.”
In cases where the result is very close to the line dividing
the classes, viz., 26, 42, or the degrees above this, espe¬
cially if any doubt should exist, it will be necessary to
take the wine and the distillate at the same temperature
for the measurement. The most convenient temperature,
in many respects, is 60°, but any other average point will
do as well. If the temperature of the wine be much lower
than that of the distillate, the result will be a greater pro¬
portionate strength: if higher, the contrary will be the
case ; for in the former instance, the wine, being condensed
by the cold, will have more spirit bulk for bulk than at a
higher temperature. If, then, the distillate be warmer,
and consequently expanded in bulk, it will not require so
much distilled water to dilute it to the bulk of tne wine
at starting, and the percentage amount of spirit will be
proportionately greater. It requires, however, a large
margin of difference of temperature to produce any im¬
portant variation, generally speaking. In the custom’s
laboratories 60° F. is the temperature always used, and
this is the degree to be recommended.
The true indication should be very carefully read, and if
the stem of the instrument, on rising to its place after im¬
mersion, show the liquor standing in drops on it, as if from
the repulsion of the surface, it should be gently wiped with
a clean cambric or silk handkerchief, to remove any greasi¬
ness, or with the fingers moistened by the tongue, and in
some instances a difference of two subdivisions deeper im¬
mersion will be afterwards observed ; making an altera¬
tion of more than one per cent. A solution of carbonate
of potass is a very excellent thing to cleanse the stem by
gently rubbing it over with the finger and thumb, and
then wiping with a soft rag.
To a careful operator the process is very simple and easy;
care only and ordinary intelligence are needed to perform
the whole correctly. Practice will give confidence and
rapidity.
-♦-
CURRENT LITERATURE.
The second number of the Practitioner has appeared, and is
fully equal to the first. It contains communications by Drs.
Beale, Fraser, Hewitt, and Beigel, followed by several re¬
views, and the Clinic of the Month, with extracts from
British and foreign journals.
Messrs. Longman have issued an entirely new edition of
Thomson's Conspectus , adapted to the British Pharmacopoeia.
The mere announcement of this is sufficient to please all who
have been accustomed to Thomson. The new edition is edited
by Dr. Lloyd Birkett—an ample guarantee of its thorough
revision, and is got up as a small 8vo., which can be carried
conveniently in the pocket. The cloth cover is light and flexi¬
ble, and the edges are cut and marbled. We hope other pub¬
lishers will follow this example.
Messrs. Palmer and Howe, of Manchester, sends us a book
on Odontalgia , by Mr. S. P. Shaw, which they have lately
published.
We have also received the fifth edition of a pamphlet
on Water: its Impurities and, Purification , published by
the London and General Water Purifying Company (157,
Strand). Of course, it contains a full account of the
Company’s Cistern Filters, of which, after two years’ use,
we can report most favourably. At the same time there is
plenty of other information in the pamphlet, and as it only
costs 2d., it might be well for everyone to read it before
purchasing a new filter. We suppose it is not necessary to
say here that no one should drink unfiltered water.
THE ROYAL COLLEGE OF PHYSICIANS OF
LONDON.
When the necessity for a change in certain particulars of
College management forces itself on the minds of such men
as Sir Thomas Watson and Dr. C. J. B. Williams, the
Profession has a sufficient guarantee that such change is
urgently required. They are men far above any suspicion
of courting professional popularity, for they have long en¬
joyed all the advantages that great and honestly-earned
reputation could bestow. Such men are too philosophically
trained to allow an impulse to sway their judgment, and
too experienced in knowledge of the world, not to foresee
that without some change a coming crisis is inevitable.
All are interested (and deeply so) in the coming event—
the Fellows in upholding their scientific status, and the
reputation for fair play, accredited to the large majority*
and the members, in knowing that, in the future,
The Medical Preai and Circular.
REPORTS OF PRIVY COUNCIL.
August 10,1868. 169
favouritism nor prejudice will interfere with a proper re¬
cognition of their standing and their claims.
Most of our readers will, we think, agree with us that
the time has gone by when the irresponsible Council of
any College ought to be permitted to hold secret meetings
for the nomination of Fellows. A Council ought to be
placed beyond even the possibility of dealing unfairly with
the College members. That some members of Council have
heretofore dealt out their honours (?) “without fear” we tan
well believe, and would we could add, u without reproach”
The College of Physicians has tried, of late, to render
itself a public professional institution; the Profession has,
consequently, the right to demand an account of its stew¬
ardship, and an assurance that the College gates have not
been so suddenly and widely opened either from selfish or
other interested motives.
The large number of gentlemen admitted as “ Licen¬
tiates” ought to regard their College as one in which, with
the highest order, the highest honour should combine; but
they may justly claim excuse for any laxity of discipline
when they find that the good faith of some of their elder
brethren assumes at times so questionable a shape.
In our opinion, the real reform needed is an entire
change in the mode of election of the Council. Its mem¬
bers should be chosen by the general voice of the Fellows.
So long as the system of self-election is in force, so long
may abuses continue, and that abuses have been rife, is
the almost unanimous verdict of the Profession.
THE MEDICAL COUNCIL-
PARLIAMENT OR CONVOCATION.
The proposals for reforming the Medical Council grow
more mid more definite. It may therefore be well to keep
to eye constantly on its constitution and its action. What
has it done ? what is it like ? One reformer speaks of it as
" our Medical Parliament.” But does that phrase describe
it?
Three bodies have lately concluded their sittings—
Parliament, Convocation, and the Medical Council. Now,
Parliament possesses great legislative power. Con¬
vocation little or none. Parliament has been called “ a
talking machine,” but in this capacity is perhaps outdone
by Convocation, as well as by the Council. Parliament
professes to be the representative of the people, and in
order to make it so has passed its reform bills. Convoca¬
tion professes to represent the Church but is composed
only of a small number of ecclesiastics. That is one
reason why the nation will never give it any power.
Now look at the Medical Council. It professes to
represent the Profession, but really consists only of de¬
legates from the corporations. Unlike Parliament it
has refused to reform, itself. It possesses considerable
power in relation to the Profession, and so far may claim
to be a Medical Parliament. It ignores a large part of the
Profession, and spends most of its time in vain talk, and
in these respects resembles Convocation. The Profession
is much agitated at its shortcomings, and will infallibly
insist on reform. Sick of talk and impotent resolutions,
the practitioners of the country have come to the conclu¬
sion that they are not represented in the body they pay to
sup p o r t, and they demand their rights. We second their
rust-and natural cry of indignation at the results of the
fa a s Hi n y ears, with their enormous cost, and ask whether
Parliament or a Convocation?
We know well enough the answer that will come from
an immense majority, and we call on those who have de¬
termined to support no longer the present state of things
to take sides in the controversy.
Is the representation demanded to be direct or indirect?
That is a question several times propounded, but of less
importance than some think. If the indirect method should
be adopted, no one doubts that the Council would be more
efficient, while every Corporation would also receive new
life. We need corporate reform almost as the element of
every reform. This point constitutes the beauty of the
scheme put forth by Dr. Prosser James.
Its chance of success lies in the fact that it can be car¬
ried out without expense, and without legislation.
But there is something still more important than this,
and which should unite all in its favour—viz., that it is
not in itself necessarily antagonistic to the other plan. It
would, in fact, be a stepping-stone to the other. We have
never heard it alleged that indirect need supersede direct
representation, nor art we aware that Dr. Prosser James
has ever expressed himself as hostile to the plan of direct
representation proposed by Dr. Andrew Wood.
This much is certain: the present Council is satisfied,
with itself, though the Profession is dissatisfied with it.
Let the Corporations imitate the University of Cambridge,
so that the indirect plan may have a fair trial.
A Council elected in that manner would not only be
more likely to give satisfaction, but would almost of a cer¬
tainty reflect professional opinion, and that even on such a
question as its own reform. It would also be more like a
Parliament than a Convocation.
THE REPORTS OF THE MEDICAL OFFICER OF
THE PRIVY COUNCIL.
Mr. Simon never fails to excite considerable interest by
bis annual reports, and the tenth of these important blue
books, now before us, will be no exception to the rule.
This being the case, we beg to draw his attention to a
fact respecting the series which is not very creditable to
those who manage that department. We allude to the
difficulty often experienced in obtaining copies, and
their very unequal distribution. So much is this felt that
we happen to be aware that a person is engaged in collect¬
ing copies under the idea that a complete set will soon be a
curiosity. We have it, too, on the most reliable authority,
that of one report only 150 copies were printed. Now, a
work of this kind is national property. The expense of
producing it is by no means slight, and, when once pro¬
duced, surely the price of a little extra paper ought to be
allowed in order to produce an adequate issue.
Again, some journals are provided with early proof-sheets
of these reports, while others cannot have a copy before the
ublic—then only by purchase; and sometimes there has
een found a difficulty in getting them even by purchase.
The writer of this speaks from experience, having found
this unfair and unusual practice on the various journals
which have done him the honour to request his opinion
anent the blue books in question.
Of course we do not mean to say that it is the duty of
the Medical Officer of the Privy Cbuncil to personally
superintend the distribution of his reports, but we do feel
that he is interested in having them widely distributed
and fairly criticised in all quarters ; and, for this reason,
we ask his attention to the anomalies we have complained
of. We are sure he will agree with us that all journals
likely to comment upon tne reports ought to be supplied
with them as soon as they appear, just as publishers send
their books for review.
He will admit too that prets copies ought all to be dj*
1 70 The Medical Press and Circular. ARMY MEDICO-CHIRURGICAL SOCIETY.
August 10,1968.
tributed the same day, and that his subordinates who fur^
nish in advance proofs of their communications or abstract
of them to favoured periodicals, are guilty of a breach
of etiquette which would not be tolerated in other quarters.
Such tricks tend to sap the foundations of all true criticism,
and go far to make the reports less useful than they other¬
wise would be. Frequently, in this way, opinions obtain a
certain illegitimate support, while those who differ, and may
possibly be correct in differing, will not take the trouble to
criticise what has obtained a one-sided endorsement in
other quarters.
What we desire is, that the reports of Mr. Simon to the
Privy Council should be as widely distributed as possible.
We should like every Medical Officer of Health to be sup¬
plied with a free copy, as well as every journal likely to
distribute a knowledge of them. We would gladly see
these reports made the texts of able and conscientious essays
by experienced writers, their value thoroughly sifted, and
their facts made known to the whole thinking community.
Let Mr. Simon say the word, and we feel sure it will be
done. A few reams of paper, to utilise a large outlay, could
not be grudged by the most thorough-going economist.
Again, some care might be taken about distribution.
One medical friend of ours received gratis three copies of the
most scarce report (of which only 150 were printed). But
for his presenting us with one we should never have been
able to get one at all. This speaks much for the necessity of
a change. Perhaps some plan may be devised of ensuring
that all who legitimately would use it should find no diffi¬
culty in having a copy at the public expense. That is the
only way in which Mr. Simon can have justice done to his
labours.
medical department on that occasion there would have been no
army left to capture Magdala ; no officers or soldiers to receive
their well-merited honours and rewards. 1 * We wish that the
army medical officers at our other large military stations would
imitate the example set by their brethren at Portsmouth ; and
we venture to remark that by means of such societies they
would do far more to elevate the departments of which they
are members than by discussing in the public papers, as is too
often the case, so-called “ grievances,’* many of which seem
only to exist because individuals condescend to notice, if not to
seek for them.
If any encouragement were needed to induce Army Medical
Officers to imitate the example upon which we are commenting,
it would be found in the roll of army medical worthies from
the time of the siege of Troy to our own day ; and this kind
of encouragement formed the introductory address with which
the Portsmouth Society was opened by the principal Medical
Officer of the station, Dr. Gordon, C.B., and which the society
has printed and circulated. This address is before us, and,
inasmuch as it epitomizes much, we would fain say to our
army brethren, we hope it may be the subject of conversation
at all the stations. It counts the bead-roll of fame of military
surgeons, and enumerates the merits of some, that their civil
brethren may, amidst the cares of practice, be apt to forget-
Pard, Lowe, Woodall, Wiseman, Cleghom, all these were army
surgeons, as also, though it is seldom r em e m bered, JoH?
Hunter. When we get another Guthrie in the Council of the
College of Surgeons it is to be hoped he will be made Hunte¬
rian orator, and will take for his subject matters relating to
military surgery, as elucidated by the labours of the great
THE ARMY MEDICO-CHIRURGICAL SOCIETY OF
PORTSMOUTH.
Some of our readers may not be aware that a society under the
above title has for some months past been in active operation.
Its meetings are held monthly; papers are read on subjects
bearing upon military medicine, surgery, and hygiene ; officers
in the army and navy, and medical men in civil practice Li
and around Portsmouth, are frequent visitors on those occa¬
sions, and altogether, while the society is calculated to bring
the medical men of the army serving in that garrison into
contact with the military officers in reference to questions
which, as bearing upon the efficiency of soldiers, have a
mutual interest to both, it is no less so to preserve that con¬
nection which should ever exist between the members of our
own profession, whether in civil life or in the public service.
We are glad, therefore, to learn that the society in question
gains in interest, and that its meetings are on each succeeding
occasion becoming larger and longer. On the 5th of the present
month, the most numerously attended one that has hitherto
been held, took place at the Garrison Hospital, intimation
having been previously circulated, that among other papers to
be read on that occasion was one on “ The Medical Transac¬
tions in the 33rd Foot during the late Expedition to Abys¬
sinia,” by Assistant-Surgeon Ball, of that regiment. The
paper was an extremely interesting one. It detailed the
nature of the medical arrangements made at Bombay, but
which, as is usual, oould not be carried out when actual service
began; the nature of the country through which the force
advanced from Zuolla to Magdala ; the plants and a nim als
that were observed ; and gave many interesting particulars in
regard to the various races of people met with. But what was
of the greatest consequence in a professional point of view were
the details which Dr. Ball gave in regard to the orders issued
in Abyssinia itself, and other means to protect the health of
the soldiers, and to provide for the requirements of such as fell
sick or were wounded. It is, in reality, to the success of those
measures that England is now indebted for the glorious and
successful termination of the expedition* As well remarked
by a contemporary: “ had it not been.for the e xe r tions of the
anatomist, physiologist, and surgeon.
If we continue our enumeration we cannot do it better than
in the words of Dr. Gordon :—
“ Donald Munro, an army surgeon, and cotemporary f
Hunter, may be said to have placed the study of anatomy m
the University of Edinburgh upon a scientific basis; and it
may be mentioned here that he was the first of four gene»r
tions of his name who in succession filled the chair which he
in effect established.
“ Then comes the name of Brocklesby, of whom we learn
that he set to work to improve the wretched barracks and still
more wretched hospitals, into which in his days the troops
were crowded. He drew up a code of instructions for the
preservation of health, and especially enforced the observance
of cleanliness and good ventilation. To him the profession is
indebted for the plan of treating cases of fever by means oj
liberal quantities of wine, in supercession of the bleedings so®
depletions that up to his time had been in use.
“ I would remind yon that not until 1739 were barracks
erected in this country for the accommodation of soldiers.
Prior to that date the men lived in billets—-chiefly in beer*
houses and livery-stables; being there lodged in ‘genets,
lumber-rooms, or back sheds fit for no other purpose ;* abso¬
lutely without means of preserving personal cleanliness, and
destitute of those conveniences which are no less essential to
bodily health than they are to morality.
** Such being the conditions, it will hardly seem credible to
us of the present day that when in 1720 the first proposal to
establish barracks for the troops was made, it was violently
opposed ; the people of London declaring that they wanted
‘no red-coated nurses.* Perhaps,.therefore, it is not to be
wondered at that the buildings erected, after nineteen years “
discussion, and, as we are informed, ‘ angry suspicion in tne
public mind,’ were, as described by Dr. Brocklesby, ‘low ana
ill-ventilated—calculated rather to generate than cure disease,
and sweeping off the men like a perpetual pestilence.* To him*
in conjunction with Munro, Pringle, and Hume, is due tn
credit of instituting post-mortem examinations, at a time prior
to that when this method of investigating the action of disease
was 8ytematically adopted in civil hospitals. ,
“ Then came Dr. Girdles tone, who was the first to puwisn
work on liver disease and cholera, as these affect Bno*®
soldiers in India. . .
“ Dr. Hamilton, also an army surgeon, who was
advocate the abolition of corporal punishment, saying
it, ‘I wish it with all ©y heart abolished; it is
The Medical Prea and Owalar.
notes on current topics.
Aognst 19,1868. 171
thing, more fitting the nature of savages than civilised and
polished nations.' Such were the sentiments expressed by him
in 1787.
“ In 1791, John Bell, of the 26th Regiment, introduced into
Military Hospitals a scale of diets, suited to the requirements
of sick men, instead of the salt pork and beef which prior to
that time had been the food allowed to the soldier, whether at
his ordinary duties or prostrated with dysentery. He published
a work on the causes which produce, and means of preventing
disease in the West Indies—the title indicating the importance
which he attached to hygiene ; and to him, in a letter ad¬
dressed to Earl Spencer in 1798, is due the first advocacy of
one great school for military surgery. In that communication
he entered into various details in regard to the subjects which,
according to his views should be taught in such a school.
These were anatomy, military surgery, military medicine,
medical geography, including climates, seasons, the coasts of
various countries ; the manner of conducting soldiers in foreign
expeditions, the general care of their health, the choice of
encampments, the forming of hospitals on shore, how to con¬
vert churches and public buildings to this purpose, how to at¬
tend an army in the field, how to lay wounded in besieged
towns, and how to carry them off the field in a retreating
army. He would, moreover, have taught what he called mili¬
tary economics—as diet, clothing, exercise, general medicine,
and all methods of preventing disease. Surely, it must be ad¬
mitted that this army medical officer justly appreciated
the importance of preventive medicine, or hygiene, as this
branch of science is now more generally termed.”
Space forbids or we would gladly continue our extracts, and
show in detail how Robert Jackson wrote works valuable alike
to the military and medical officer, and devoted much attention
to the “ health of troops,” arguing that “health officers” were
needed by armies in the field ; how he was followed by Dr.
Reide, who introduced statistical returns ; how Dr. Rollo
pointed out the means of preserving health in the West Indies ;
how Somerville produced a work embracing the whole subject
of army hygiene ; and how Lemprihre, Borland, Pringle*
Blane, Wright, Guthrie, Hennen, Thompson, Bellingall, Mar¬
shall, Millingen, Burke, and others carried on the good work
which, we believe, is being continued by many earnest officers
at the present day, who cannot fail to be encouraged by such
societies as that at Portsmouth. Such examples as these, so
felicitously sketched by Dr. Gordon, and the hearty approval
and sympathy of their brethren in civil practice, we hereby
cordially tender them.
gtotrs an fcmtt fogies.
Representation of the Profession in the
Council.
This subject continually grows more important. Mr.
Gamgee, in a very able speech at the Oxford meeting,
pointed out the fruitlessness of the efforts of the British
Medical Association and its deputation. The profession
is gradually becoming educated, but it is a very slow pro¬
cess, and as yet there is no facility for quickening. What
is wanted is an association of three times the strength of
all the others, that exist, and as this is never likely to be
attained, nothing remains but for the professional press to
redouble its energies. The various schemes proposed for
placing the Council on a satisfactory bases have never yet
been fairly discussed by our contemporaries, and it is a
sad indication of the condition of medical journalism,
that in some quarters an attempt has been made to
smother the fill] expression of opinion that has already
been evoked.
Fonthe honour alike of the profession and of journal-
we rejoke to add, the bad example is producing its
pft ) ^|di(>inented punishment, while the life it attempted
it more vigorous than ever.
Medical reformers must be up and doing, they must no
longer wait for the sound of the trumpet to waken them
as of old by its warning voice. Tempora mutantur . We
have now fallen on evil days. New leaders must be
chosen for the new campaign, or it well assuredly be lost.
Let all who see the signs of the times rally around the
few who are prepared to lead the way.
The Fellowship of the Royal College of
Physicians of London. .
Our anticipations have been realized so far as the late
election of Fellows is concerned, but happily a movement
has been commenced that is not likely to be arrested.
It has been proposed by some of the most distinguished
Fellows that the Council should not be all-powerful in
promoting its friends. Those who are disposed for reform
would effect it by giving the body of Fellows at large the
opportunity of proposing names for promotion. Dr.
Williams and Sir T. Watson both agree as to the necessity
ofthis, and, the refore, some hope remains. An authority,
upon whom we rely, writes to us as follows :—
“ The long delayed election of members to the Fellowship
passed off this time without blackballing; but we may
fairly presume that no expression of opinion emanating
from so experienced and dispassionate an authority as Sir
Thomas Watson, as to the time having come for a change
in the mode of selection, will be lightly regarded. The
mode in which the Council has hitherto managed matters
may well be styled undignified and degrading.
M Some light, at least, has now been thrown upon the
character of these secret meetings, and ugly rumours are
afloat as to the reasons for some of the nominations.
“ Indeed, the entire matter requires serious and public
consideration. Evidently it is not much longer that
this College will be permitted to continue to defy profes¬
sional opinion so loudly and generally expressed.
“ One thing is certain, that since the ventilation of the
proceedings of the Council, the Fellowship is rapidly be¬
coming estimated at its proper value, and that not of the
highest to some of its possessors.”
The Chair of Botany in the University of
Dublin.
The Professorship vacated by Dr. A. Dickson (lately ap¬
pointed Professor of Botany in the University of Glas¬
gow) has already three claimants, and further competition
for its occupancy may be expected. The candidates, who
have as yet avowed their intention of seeking it, are Dr*
Edward Percival Wright, Professor of Zoology in the Uni¬
versity ; the Rev. Dr. Browne, of Aberdeen, formerly a
missionary and a well-known lecturer in popular science,
and Mr. M‘Nab.
Death of Dr. Mackenzie, of Glasgow.
Our record of the loss to the ranks of the profession of
Mackenzie, of Glasgow, and our eulogium on his worth
must be something more than a mere complimentary repe¬
tition of the trite phraseolgy of obtuaries in general, for
we feel that in his death the veiy small phalanx of real,
straightforward, sterling eye surgeons is reduced. Dr.
Mackenzie’s posthumous merits do not lie in great honours
or a gigantic fortune gained in practice, though his career
even in these directions was no ignoble one. It is in his
sterling worth as a surgeon, that his name ought to live in
the memory of the profession ; it is because he stood firm
to the erudition and experience, which great practice and
an intelligent judgment had taught him, and did v n<>fc
allow himself to be carried away bj* the overwhelming
172 The Hediod Press and Circular.
NOTES ON CURRENT TOPICS.
jLugott id,
flood, of what we must take leave to call ophthalmological
quackery, which has for many years almost swept practical
eye surgery out of sight or recognition.
The surgeon and author, one of whose pages of clear,
well-grounded information was worth volumes of the in¬
substantial Germanisms lately current, has lived to see
the wane of the ophthalmologic craze—the infrequent
oases of accurate theory and genuine practice left
visible here and there in the watery waste of useless and
mischievous guess-work. When half the ophthalmological
disquisitions of the last ten years will have completed
their mission in the chandler’s and trunkmaker’s, Mac¬
kenzie’s work will occupy the choicest comer in the library
of the oculist, and Mackenzie’s name will be recollected
as “ a material guarantee” for what it contains.
The Medicine of the Future.
Sir Jahe8 Y. Simpson, in his address to the new graduates,
has drawn a picture of the medicine of the future which
may at once inspire with hope and depress with doubt.
He anticipates eradicating tumours without the knife, ar¬
resting hsemorrhage without ligatures, or even his own in¬
vention of accupressure, and hopes that other departments
of human knowledge may make simultaneous and equal
advances, so that, Governments interfering to protect their
subjects from diseases that may be prevented, the genera¬
tions shall succeed each other slowly—each attaining the
full duration of existence. The learned Professor carried
his audience with him by his eloquence, and it may be a
good thing to enlist the enthusiasm of the young gradu¬
ates, but the question returns whether we have sober
reason for anticipating so much.
The Thames.
It would appear that Father Thames is not sure, even yet,
to attain that degree of pellucid purity which has so
often been promised. Recent analyses, by new methods,
go far to show that the impurities of the river are much
more serious than has been lately supposed, besides
which, the grosser test of the ordinary passenger’s nose
has detected, during the late hot weather, a very disagree¬
able smell. Whence does this arise? is a question the
chemists may be expected to reply to very shortly. The
upholders of our sewage system assert that it must be
from what is thrown into the Thames higher up, and not
from any part of the sewage being washed back by the
tide. Others are of opinion that both these sources con¬
tribute impurity. Whatever the cause, the fact having
been made known, should lead to immediate action.
Yellow Fever.
Another mail-ship has come in with less than its compli¬
ment of persons who set out, in consequence of yellow
fever having carried them off. The epidemic prevails at
Islay to the extent of 23 cases per day.
Lima and Callao are reported to be in a more favourable
condition. The late epidemic at these places destroyed
13,000 persons.
Real and Apparent Death.
The Marquis of Ourches, a French nobleman, with the
view, we presume, of guarding against the possibility of
the burial of living persons in a state of catalepsy or pro¬
longed syncope, has presented £1000 to the Academy of
Medicine of Paris, for a prize to the discoverer of an
accurate means of distinguishing between real and ap¬
parent death. He presents this very liberal prize, on the
condition that the means of diagnosis shall be open to
non-medical persons, and that the sum be reduced to
£200, if none but the profession can use it
Vaccination.
The action of the Medical Council in respect to the intro¬
duction of vaccination into the medical educational curricu¬
lum, has had the effect of bringing that subject within the
second examination for the Bachelor of Medicine Degree at
the University of London. In future a certificate from one
of the vaccinators authorized by the Privy Council will be
required of candidates, and vaccination will form one of
the subjects of examination.
The Onion as a Disinfectant.
A writer (Mr. Wolff) in a recent number of the “ Scientific
American” maintains that the volatile principle of the
onion is capable of destroying miasmatic gases. He states
that the juice of the plant will neutralise the poison of certain
snakes, and declares that he has used the onion as a disin¬
fectant in severe cholera epidemics on ship-board. Mr.
Wolff says :— u Onions placed in the room where there is
small-pox will blister and decompose with great rapidity;
not only so, but will prevent the spread of the disease. I
think, as a disinfectant, they have no equal when properly
used ; but keep them out of the stomach.”
Bathing.
In our remarks on this subject last week, the name of Dr.
Christison was incorrectly stated instead of that of Dr.
Christian as the author, with Dr. Sieveking, of the sugges¬
tions we published. We understand that the issue of
these rules for bathers of the Royal Humane Society was
effected at the request and cost of a benevolent lady well-
known under the signature of M. A. B. as a contributor to
our journal. We last year inserted suggestions from the
pen of the authoress on the subject, which were very
favourably received by the non-medical press.
Conveyance of Food.
The Society of Arts have, at the suggestion of their Food
Committee, offered the following prizes:—
1. For an improved method of conveying meat by isil
the Society’s Silver Medal and £10.
The object in view is to reduce to a minimum the de¬
terioration which meat now suffers in its transit by wL
The principal evils to be avoided are—excessive changes
of temperature, and injuries by pressure, by handling, ex¬
posure to dust, insects, &c. This prize may be awarded for
an improved railway meat van or for a travelling meat
larder suitable for railways.
2. For an improved method of conveying milk cans by
rail, the Society’s Silver Medal and £10.
The object in view is to reduce to a minimum the de¬
terioration which milk now suffers in its transit by rail in
the ordinary open trucks. The principal evils to be avoided
are—the heating and shaking of the milk cans.
3. For an improved railway milk can, the Society’s Sdrtr
Medal and £10.
The object in view is to reduce to a minimum the de¬
terioration which milk now suffers in its transit by rail in
the ordinary milk cans or u churns.” The principal evils to
be avoided ore—the beating of the milk, and all motion
Digitized by VjiOO^IC
The Medical Pre» and Circular.
NOTES ON CURRENT TOPICS.
August 19, 1868. 173
within the can which toay cause the buttery particles to
separate. -
Water Companies.
Mr. Simon, in his new report, makes a suggestion which,
while it may enlist the sympathies of some, will not fail to
astound, and even shock, others. He would make public
companies pay heavy damages to any one they may have
injured.
He sees, in fact, what all know os a familiar axiom on
jurisprudence—that a wrong proved, a remedy lies; but he
says “ years may elapse before any aggrieved person, unless
unusually rich and public-spirited, will be willing to incur
considerable legal costs in testing bis so doubtful claim to
redress.”
There is something more than this, however, to be con¬
sidered. Most people are aware that Mr. Simon and his
assistants have adopted as true, the hypothesis that the
last epidemic of cholera in London was due to the conta¬
mination of one company's water. This, of course, would
be a case for redress, and the Medical Officer of the Privy
Council appears to think that the relatives of all who
perished in that outbreak should be entitled to damages
from that company.
So far, the logic is good enough, but the premises are in
dispute.
Every one knows—at least every one whose reading has
not been confined to journals that have so scandalously
burked the truth—that there are plenty of authorities who
regard the hypothesis in question as an unjustifiable
assumption. Now, suppose for a moment Mr. Simon's
views to be in full operation : the first point for a com¬
plainant to prove would be that the water in question was
the sole cause of the case of cholera by which he suffered.
We venture to say that no such proof satisfactory to a
court of justice could be produced, and that in this case,
therefore, Mr. Simon's remedy would not be practicable.
That companies guilty of malfaisance are responsible
to law, railway companies have found to their cost; but
then, the injury has been easily proved.
In the case of the water companies, everything rests on
hypothesis, and men equal to, and even superior to, the
advisers of the Privy Council have asserted that the hy¬
pothesis is inconsistent with the facts. They would be as
ready to dissent from, as Mr. Simon is to subscribe to, the
assumption. What, then, could a jury do ? By all means
let us keep a tight rein on companies, and for knowingly
distributing poisonous water let us hold every director and
every servant concerned responsible. But let us not leave
facts, and try to legislate on hypotheses.
Sickness in Dublin.
The week ending the 8th instant has been an unhealthy
one in Dublin, and as might have been anticipated, the
great heat of the weather has produced its inevitable effect
on the public health. The deaths numbered 144, or 25
more than the corresponding weeks of the last four years.
The whole of this excessive mortality is chargeable to diar¬
rhoea, which not only exceeded in frequency the preceding
week as 32 to 18 cases, but that of the corresponding week
of last year by 26. Two of the cases are registered as
cholera, but we presume the real Asiatic type of the disease
«as wanting.
Tlrif Quarterly Examinations at the Royal College of Sur-
geo&ftia Inland commenced last week, and the first half or
Anatomical Examination terminated on Saturday. Fifty-
four candidates presented themselves, out of whom it was
found necessary to reject ten. The quality of the answering
was, however, on the whole, considerably better than was
elicited at the last examinations. The second half or
Surgical Examination has just commenced, and will pro¬
bably last for the whole of the current week.
We have been requested to announce that Mr. Grimshaw,
Fellow of the Royal College of Surgeons of Ireland,, the
eminent dental-surgeon, has retired from the active prac¬
tice of his profession.
We have no doubt that this announcement will be re¬
ceived with regret by the members of our profession, whose
working ranks Mr. Grimshaw has so long and so honour¬
ably adorned, and we believe all will honestly join in
wishing Mr. Grimshaw a long enjoyment of his well-earned
leisure.
What a delightfully refreshing phase in the great English
social ceremonial of dining is the ice-pudding ? How
charmingly do its cooling qualities, and its luscious flavours
replace the gusto of the " choleric meats ” which precede
it ? How agreeable it is for the gourmets who revel in
the luxuries of the diner a la Busse to learn that no ice¬
pudding can claim to have achieved the loftiest degree of
gastronomic perfection, unless the fruit which flavours it is
the habitation of a given proportion of maggots. A person
named Welch, charged before the Birmingham magistrates
for selling rotten pine-apples and maggotty melons, thus de¬
fends himself. He said that “ specked” fruit was always
used to make ice-cream and confectionary, and unless the
fruit was rotten it would not make delicacies so well, as the
juice could not be got from the fruit in sufficient quantities
unless it was “ very ripe.” All fruit, pears, apples, and
melons had more or less of maggots in them, and confec¬
tioners would not buy fruit unless it was rotten, as the
officer had termed it, but which he (witness) only considered
“ fully ripe.”
Between “ Pure Leicestershire catsup,” prepared from
putrid livers ; ice puddings from decomposed fruit; pastry
from the scrapings of filthy butter firkins, and all the
nameless horrors in which the dining public has been so
kindly instructed by recent authors, the paradise of gluttons
appears to be losing its attractions.
(Qvi fit moecenas?) —Who made Oscar Clayton, M.D.,
Surgeon-in-Ordinary to his Royal Highness the Duke
of Edinburgh last week, and Extra Surgeon-in-Ordinary
to his Royal Highness the Heir-apparent, before the second
ringing of the Church bell ? Who is the lucky rat that eats
the malt that lies in the house that Jack built ? Can their
Royal Highnesses be supposed to be jointly moved by a
sudden and irrepressible inspiration to place their lives and
the succession to the throne of England in the hollow of Dr.
Clayton's hand, or is our editorial vision so purblind, and
our ear so deaf that we have all these years been insensible to
the brilliant sunburst and the immortal fame of Dr. Clay¬
ton’s genius ? In abject and penitent submission we
await the admission of the light, and in helpless obscurity
we still puzzle over our enigma. Oscar Clayton, M.D., of
a foreign university, Fellow (not by examination) of the
Royal College of Surgeons of London, a worthy apothe¬
cary and general practitioner, does not seem to ns the only
eligible occupant of the pinnacle of court favour. Who is
^ Digitized by VjOOQ L€
174 The Medical Press and Circular.
ARMY MEDICAL DEPARTMENT.
August 10,1868.
it that keeps the second latch-key of the back-stairs wicket
of Marlborough House ?
The Registrar-General's returns are still unsatisfactory,
although London exhibits a more favourable condition.
Some towns show a largely increased mortality. Leeds
gives the highest death-rate—41*2 per 1000. Bristol is at
the top of the list. The 11 large towns rank as follows as
to rates:—Bristol 24*0, London 258, Newcastle 26*2,
Bradford 33*5, Liverpool 34*7, Sheffield 35*7, Birmingham
37*5, Hull 38*3, Salford 38*7, Manchester 40*3, Leeds 41*2.
It would thus appear that London is likely to soen again
show the favourable return on which we have so often
commented. A fortnight ago the deaths in the metropolis
were 1885; the mortality then declined to 1665, and has
now fallen to 1545. This is only 52 higher than the ave¬
rage for the last 10 years, corrected for the increase of
population. Zymotic diseases were fatal in 593 cases, the
average being 571. The deaths from diarrhoea were 294,
against 384 the previous week; 270 out of the 294 were the
cases of infants.
The highest day temperature at Greenwich was 90*5;
lowest night temperature 52*8. Rain only fell once, and
then only to the extent of 0*14 of an inch.
-♦-
gpfcl gjeprtatif.
EXAMINATION PAPERS.
ANATOMY AND PHYSIOLOGY.
Monday , August 10, 1868, 10 a.m. to 1 p.m.
Mb. Busk.
1. What spinal nerves enter into the formation of the cer¬
vical and sacral plexnseB ? Describe the general arrangement
of the nerves in each plexus, and enumerate those proceeding
from it. '
2. Describe the urinary bladder, and its relations to the
immediately surrounding parts; the differences of relation it
presents in various degrees of fulness, and at different periods
of life ; the arrangement of its muscular fibres, and the char¬
acter of the epithelium by which it is lined.
3. Describe the structure of the spinal chord (below the
medulla oblongata); and state what has been determined ex¬
perimentally with regard to the transmission of sensory and
motor impressions through it.
4. Describe the prostate, its relations and structure.
5. Mention the varieties in the origin and course of the
blood vessels, to be regarded in the operations of laryngotomy
and tracheotomy.
6. State the peculiarities of the blood in the hepatic, renal,
and pulmonary veins, respectively.
SURGERY.
Monday , August 1 Qth, 1868, 2 to 5 p.m.
Mr. Pollock.
1 . What would be the immediate symptoms, physical and
general, in a case, in which fracture of three or four ribs, with
laceration of the lung, had occurred on the right side, and
what would be the changes observed in the symptoms, under
a favourable progress ? Describe the treatment to be adopted
throughout.
2. A man was wounded by a rifle bullet, which entered at
the anterior margin of the deltoid muscle, and passed out be¬
hind the shoulder; in its course it comminuted the head, as
well as an inch and a-half of the upper extremity of the
humerus. State what treatment should be pursued in such a
case, and what would be the probable result.
8. A boy, in attempting to walk on the top bar of a rail-
fence, slipped, and fell across it, striking the perin&um :
shortly after, much swelling and discolouration of the part was
observed; nor could urine be passed when the desire to empty
the bladder became urgent. State the nature of the injury ;
the treatment to be adopted ; and what usually, is the ulti¬
mate result of such an accident.
4. Describe the symptoms, and course of a case of scrofu¬
lous disease of the upper cervical vertebrae (1st to 4thV At
what period of life does it usually occur and what are the
pathological changes observed after death ?
5. Describe the symptoms of stone in the bladder. What
are its pathological effects on the bladder and kidneys, if not
removed ? Under what conditions should the operation of
lithotomy, or lithotrity, be preferred ?
6. Describe the symptoms, and results of syphilitic iritis,
if neglected. What treatment should be pursued to arrest
its progress ?
MEDICINE.
Tuesday , August IDA, 1868, 10 a.m. to 1 p.m.
Dr. Pabkes.
1. Give an account of the Malarious Fevers, including the
presumed causes, the symptoms, and the treatment.
2. Give the stethoscopic signs of the following diseases:
pneumonia ; pleurisy, with effusion ; hydro-thorax ; pulmon¬
ary apoplexy ; coincident constriction and patency of the
cardiac mitral opening and similar conditions of the aortic
orifice.
3. What do you mean by the terms anaemia, chlorosis, and
leucocythaemia ? Describe carefully the state of the blood;
the condition of the various organs, and give the treatment
in each case.
4. Mention the chief conditions of the urine whish are im¬
portant for diagnosis, and describe a case of Acute Morbus
Brightii in an adult man.
5. For what purposes are conium, belladonna, and henbane
used in medicine ? Mention the chief pharmacopoeil prepar-
tions, and state what is known about the action of the active
principles.
6. What are the chief diseases which may come on in the
first week after confinement ? Give the chief symptoms, and,
briefly, the treatment.
NATURAL HISTORY AND PHYSICS.
Tuesday , August IRA, 1868, 2 to 5 p.m.
Dr. Thomson.
I. Zoology.
1. Enumerate the principal varieties of the Imman race, and
state their distinctive characteristics and geographical distribu¬
tion.
2. Describe the principal modifications in the form and ar¬
rangement of the placenta, and state how far its various forms
are useful in classification.
3. Give the characters of the class ccelenterata; mention its
primary divisions, and name a genus belonging to each.
4. What is meant by spontaneous generation ? Give some
account of the experiments which have been made to prove or
disprove it, and of the arguments that have been used for and
against it.
5. Give an account of the'geographical distribution of some
of the larger divisions of the mammalia.
II. Botany.
1. Give an account of the process of impregnation in pbe*
nogams.
2. Describe the structure and functions of leaves.
3. Contrast the reproductive process in ferns and mosses.
4. Give the natural characters of passes and cyperacea,
pointing out where they agree and differ.
5. What is the geographical distribution of the following
families of plants ?
Proteace®.
Melastomace®.
Magnoliace®.
Umbellifer®.
Ranunculace®.
III. Physics.
1. Describe the way to make a thermometer. How do
Fahrenheit’s, Reaumur’s, and the centigrade thermometers
differ, and how can observations made with any one of them
be converted into the other scales ? What precautions ne *
cessary to get the true temperature of the air ?
Thft Medical Press and Circular.
MEDICAL NEWS.
August 19,1866. 175
2. What are the different hygrometric conditions of the air ?
What is saturation and the dew point ? Describe the kinds of
hygrometer in common use.
3. Explain the cause of the trade winds, and of land and sea
breezes.
4. Give an account of the arguments employed to show the
convertibility of light into heat and vice vend.
5. What is coal geologically and physically, and what are
the principal products of its distillation ?
6. Describe the process of brewing, and the theory of fer¬
mentation.
-♦-
Cjorrmpnimm.
REPRESENTATION IN THE MEDICAL COUNCIL.
TO THE EDITOB OP THE MEDICAL PRESS AND CIRCULAR.
Clonmel, county Tipperary, Lie. 1868, and Lie. Midwifery, 1868, K. Q.
Coll. Phys. Irel., Lie. E. Coll. Sorg. Irel., 1868.; David John Forbes,
4, Grande Parade, Cork, M.D., Queen’s Univ. Irel., 1867 ; Robert
Henry Robinson, Parson^town, Kang’s county, Lie. 1867, and Lie. Mid¬
wifery, 1867. K. Q. Coll. Phys. Irel., Lie. R. Coll. Surg. Irel., 1867;
James M&ybury Beamish, Lahara House, Drimolegue, county Cork,
M.D., 1868, and Master-Surg., 1868, Qu. Univ. Irel.; Edward Wolfenden
Collins, 28, Harcourt-street, Dublin, M.B. Univ. Dublin, 1868, Lie.
1868, and Lie. Midwifery, 1868, K. Q. Coll. Phys. Irel., Lie. R. Coll.
Surg. Irel., 1868; Henry Stannard, 18, 8helbourne-road, Beggar’s
Bush, county Dublin, Lie. R. (Joll. Surg. Irel., 1867, Lie. 1868, and
Lie. Midwifery, 1868, K. Q. Coll. Phys.Irrl.; John William Moore,
40, Fitzwilliam-square, West, Dublin, M.B , 1868, and Master-Surg.,
1868, Univ. Dublin; Francis Richard O’Grady, Churehfleld, Ballyhan-
nis, county Mayo, Lio. R. Coll. 8urg. Irel., 1867, Lie. K. Q. Coll. Phys.
Irel., 1868, Charles William Shaw, Castle Blayney, county Monaghan,
Lie. R. Coll. Surg. Edin., 1868; Robert Little, jun., Combermere
Lodge, Lifford, county Donegal, Lie. R. Coll. Surg. Irel., 1868; Patrick
Lynch Walsh, Kilflnane, county Limerick, M.D., 1868, and Master-
Surg., 1868, Qu. Univ. Irel., Lie. Midwifery, K. Q. Coll. Phys. Irel.,
1868; William MacDonnell. Broadford, county Clare, Lie. R. Coll,
Phy». Edin., 18*8, Lie. R. Coll. Surg. Edin. 18n8; James Francis Ryan,
9, Harr> mount, Kingstown, county Dublin, M.B., 1868, and Master-
Surg., 18 o 8, Univ. Dublin.
Sib,—M uch confusion prevails about the Cambridge University.
Dr. Ashe is not altogether right. He seems to regard the
Senate and the large constituency as two distinct bodies. They
are in reality one. The Senate is the elective body, and con¬
sists of all M.A.’s and all doctors who have kept their names
on the books. The number exceeds 5400, as stated by our
able representative in the Council, Dr. Paget. All these may
vote at the election of Dr. Paget, and, therefore, our Univer¬
sity is one of the most liberal bodies. If the other Corpora¬
tions did as much the plan of indirect representation would
be carried. The advocate of this plan would do well to revise
his scheme so far as Cambridge is concerned.
The election by the Senate at Cambridge is really a fair
illustration of the popular election for which Dr. Prosser
James is contending in the Medical Corporations, and which
exists in some degree in the College of Physicians. There is
no intermediate smaller body to control the election at Cam¬
bridge, as Dr. Ashe supposes. The original constitution of the
ancient Universities was very popular, and much of the popu¬
lar spirit survives in the customs and regulations of Cambridge,
and, I believe, of Oxford also. Almost nothing can be done
without the consent of the whole body of the Senate.
These points are worthy the attention of Medical Re¬
formers.—I am, &c.,
A Member op tiie Senate op the University
op Cambridge.
“FISTULA IN ANO.”
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
SrB,—Having lately seen several operations for fistula, and
also having remarked the great difficulty the surgeon experi¬
ences in keeping the buttocks separate, the idea struck me
that the operator might be greatly assisted by having a broad
piece of adhesive plaster attached to each buttock as far up
towards the anus as possible. When these are firmly attached,
an assistant at each side of the patient making extension with
ends of the plaster will, I think, effectually keep the buttocks
separate, and thus facilitate the operation greatly. If Rome
of the numerous readers of your valuable journal would make
a trial of this suggestion, they would greatly oblige, yours
obediently, A Medical Student (Dublin).
-♦-
gptol gfrfos.
List of Entries in the Register of the Branch
Medical Council (Ireland), for the month of July, 1868 :—
James Dunlop, Edenderry House, Lisburn, county Antrim, Lie. R.Coll.
Phys.Edin., 1887, Lie. R. Coll. Bur*. Edin., 1867, M.D. Qu. Univ. Irel.,
1868; William Henry Goode, Fiuglas House, county Dublin, M.B.,
1867, and Maater-8org , 1867, Univ. Dublin; James Chatterton, Bally-
namote,Cork, M.D., 18>8, and Master-Sutg., 1868, Qu. Univ. Irel.;
James Crawford, Templeton, Killashee, co. Longford, Lie., 1868, and
Uc. Midwifery, 1868, K. Q. Coll. Phys. Irel.. Lie R. Coll. 8urg. Irel.,
1886; Richard Dawson Bennett, Union Hall, Leep. county Cork, Lie.
&. OoU. Surg. Irel., 1868, Lie. Apoth. Hall, Dublin, 1868; Patrick
Thomas Lyster, King-street, Athlone, Lie., 1866, and Lie. Midwifery,
1886, K. Q. Coll. Phys. Irel., Lie. R. Coll. Surg. Irel., 1866 ; Frederick
Fttagfbbon, Castle Belem, Ro-scarberry, connty Cork, Lie. R. Coll. Sure.
• InL, 1867, Lio. 1867. and Lie. Midwifery, 1867, K. Q. CoU. Phys. Irel.;
AmekKhiphy, Mitchelatown, county Cork, M.D., Qu. Univ. Irel.,
EflBBl Charles Gore Purcell, Tramore, county Waterford, M.D., 1867,
* f., 1867, Qu. Univ. Irel.; William Henry Sannderson,
... Bjicounty,M.D., lt-68,and Master-Surg., 1868, Queen’s
U>i Uxtc Midwifery, K.Q.C.P.I.; John Joseph Crean, Glenview,
The Director-General presents his compliments
to the Editor of The Medical Press and Circular, and begs
to enclose for insertion a list of candidates of her Majesty’s
British Medical Service who were successful at the competi¬
tive examination in February, 1868, and have passed through
a course at the Army Medical School.—Army Medical De¬
partment, 11th August, 1868:—
Names.
Studied at
No. of
Marks*
Lewis, T.
... London and Aberdeen
... 6452
Dobson, G. E.
... Dublin .
... 4*65
Fraser, J.
... Belfast
... 4563
Williamson, N. A. ...
... Edinburgh
... 4376
Walker, J.
... Dublin
... 4295
Ryafc, G. W.
... Do.
... 4177
McSwiney, E. N.
... Cork .
... 4170
Conyers, J. 8.
... Edinburgh
... 4155
Fitzgerald, R. G. ...
... Dublin
... 4137
Ussher, J. H.
Do.
... 4008
Leader, J.
... Edinburgh and Cork
... 8980
O’Brien, J. A. G. ...
... Cork
... 3976
Gas ken, W. C.
... Dublin ...
... 3968
Anderson, R. F.
... London ...
... 3910
Geoghegan, W.
... Dublin
... 3825
U Estrange, A. K. ...
... Edinburgh and Dublin
... 8627
Kirwan, A.
... Dublin .
... 8667
Jones, C. E.
Do.
.... 3503
Knox, J. M.
... Do.
... 8460
Craig, R. M.
Do.
... 8423
Rahilly, J. R.
Do.
... 8362
Brown, A. L.
Do.
... 3310
Macrobin, A. A.
... Aberdeen
... 3281
Waghom, F.
... London ...
... 3176
Jennings, C. B.
Garde, w. H.
... Dublin
... 3165
... Cork .
... 3073
ReynoldsjJ. H.
Burford, H. H.
... Dublin
... 2950
... London ...
... 2916
Jackson, T. W.
... Glasgow ...
... 2913
Thornton, D.
... DubUn .
... 2910
Latchford, J.
Do.
... 2775
L'Estrange, G. W. ...
... Do.
... 2732
Frazer, P. F.
Do.
... 2668
Campbell, W. G.
Do.
... 2670
Samuels, W. F.
... Do.
... 2614
L’Estrange, F. A. ...
Do.
... 2484
Eager, O. S.
Do.
... 2428
Parke, Duke
Do.
... 2379
Military Hospital Arrangements in Prussia.—
Professor Esmarch, of Kiel, has substituted the ordinary shirt¬
ing triangle for the bandage which Prussians soldiers used to
carry in their knapsacks. He has managed the triangle in
such a way that the first dressing of wounds and fractures
can, behind the firing line, be instantly applied, guns and bayo¬
nets being used as temporary splints. M. Wittmaack has
sent to the exhibition of Kiel an oil painting representing an
action, and the manner in which the triangle should be UBed.
The picture has attracted much attention, and it has been
ordered to be printed on each of the triangles given to the
troops, so that they may, on the very linen used, see the man¬
ner of employing it.
Early Pregnancy. —Dr. Horwitz was called to
a pregnant girl who had scarcely reached her 12th year, and
of whose age £here could be no doubt. The menses first ap¬
peared during her 10th year and continued regularly. She
went through her pregnancy very comfortably. The pelvis
was well formed and capacious. The labour proceeded very
favourably, and terminated in ten hours with the birth of a
strong living male child. She went on very well, and had a
plentiful secretion of milk. References are given to other
remarkable cases of the kind on record.— Petersburg Med.
Zcittehrift, 1867, No. 9.
176 Hit Medical frm and Circular.
MEDICAL NEWS.
August 19,1808.
How to Utilize Leeches.— The German doctors
have lately been playing their leeches a droll trick—making
one worm do the work of many. When the little blood-sucker
has taken his fill and is about to release his bite, he is tapped;
a small incision is made in his side, that serves as an outlet for
the blood, and he goes on sucking, in happy ignorance of the
cause of his abnormal appetite, as long as the doctor pleases.
Bdellatomy is the name given to the practice, and it is urged
that it is not cruel, but contrarywise, since it does the leech a
good turn by enabling him to enjoy his rich feast indefinitely.
He does not die under the operation, but with proper treat¬
ment is soon healed, and may be incised over and over again.
There was once an alderman who wished he had been a camel,
that he might have been blessed with the seven stomachs
vouchsafed by nature to that animal. If such a gourmand still
exists, let him seek surgical aid in some such treatment as that
practised on the leeches, that he may eat and drink ad libitum,
and feel no worse.— Once a Week.
Vital Statistics of the Navy.— The statistical
report of the health of the Navy just issued gives a very
favourable view of the sanitary condition of the force afloat in
1865. The total force was 51,210 men ; the cases on the sick
list numbered 69,315, which is in the proportion of 1368 per
1000 of mean force, being slightly below the ratio of the pre¬
vious year. The total number invalided was 1687, or 32'9 per
1000, a reduction, as compared with the previous year, of 2’5
per 1000. Of those invalided 181 were for wounds and in¬
juries. There were 580 deaths, 416 being the result of dis¬
ease, and 164 of wounds, injuries, and drowning, The total
death-rate was 11 *3 per 1000 of mean force, which is a reduc¬
tion, as compared with the preceding year of 2*7 per 1000.
The mortality from disease alone was 81 per 1000. The
lowest sick-rate was on the Mediterranean station, 33*4, and
the highest on the China station, 80*4. On the west coast of
Africa yellow fever was epidemic, and in China small-pox pre¬
vailed in the squadron at Japan. At the former station, fever
increased the mortality to the extent of 28*4 per 1000. Cholera
appeared in the Mediterranean, and occasioned great mortality
among the civil and military population of Malta. The loss
annually sustained by the navy from small-pox has caused Dr.
Mackay to suggest the propriety of considering whether it
may not be advisable to introduce a system of periodical re¬
vaccination into the service. The death-rate on the home
station from disease was 5*8 per 1000, and from violence 1*3 ;
on the Mediterranean station, from disease 6*2, from violence
2; North America and the West Indies, from disease 7*7, from
violence 4*8; South-east cost of America, from disease 7*6,
from violence 3*8; Pacific, from disease 3*8, from violence 3*4;
West Coast of Africa, from disease 38*2, from violence 10;
Cape of Good Hope and East Indies, from disease 9*4, from
violence 5*5 ; China, from disease 17*7, from violence 5*5 ;
Australia, from disease 4*4, from violence 6*2; and in the
Irregular force, from disease 2*5, from violence 4*4.
Disease caused bt Heat in America.— The num-
ber of persons reported as having been prostrated by the heat
during the past 24 hours in this city, Brooklyn, and Jersey
city exceeds 100. Over 50 per cent, of these have proved
fatal. Dr. Harris, Registrar of Vital Statistics of the Board
of Health, makes the startling announcement that 250 deaths
are known to have resulted from the excessive heat of the past
three days within the metropolitan district. The highest range
of the thermometer in this city yesterday was 94. In Pough¬
keepsie it was 103, in Baltimore 102, in Montreal 105, and in
Richmond, Virginia, 96. In a note addressed to the President
of the Metropolitan Board of Health, on Wednesday after¬
noon, Dr. Harris, the Registrar and Corresponding Secretary
of the Board, suggests the following brief precautions against
sunstroke :—1. When exposed to excessive heat the natural
perspiration or sweating must not be checked. Let the sweat
flow, and do not throw off all the flannel garments. 2. Wash
the head and neck frequently in cold water, and, if exposed in
the sun, or in any very hot place, wear upon the top of the
head, under a hat or otherwise, a light handkerchief or
other thin folds of cloth wet with cold water. Remember
that the head and neck must be kept cool, and also be free
from the pressure of tight clothing. 3. If headache, dizziness,
a feeling of tightness across the forehead, a failing of sight, or
a feeling of weakness and prostration (‘ giving out’) occurs, let
the person immediately go to a cool place and lie down, with
the back and the feet covered, and have a few quarts of cold
water poured slowly upon the head and the sides of the neck. If
the symptoms are not at once relieved send for the nearest good
physician. 4. What to do until the physician comes.—If the
patient is still sweating let him drink freely of cold black tea
or coffee ; tea is best. But if sweating has ceased there is very
great danger. Then the head, face, neck, and entire chest
should be rapidly sponged with ice-water, and a bag of
powdered ice, well covered with a towel, should be kept under
the head and the back of the neck ; give a mixture of the car¬
bonate of ammonia (hartshorn) and muriate of ammonia, eight
or ten grains of each in water, every ten or fifteen minutes
until the physician comes or until the patient rallies and
sweats. Enfeebled, intemperate, poorly-fed, over-fed, and irri¬
table persons, are most in danger of the fatal effect of heat
People who live and sleep in foul air and unventilated places,
and who are overworked and underfed, and who use intoxicating
drink, suffer greatly. Instead of intoxicating drink and the habit
of morning and evening drams, let good black tea and coffee,
and good; nourishing, and well-cooked food be regularly taken.
Bathe the whole body early in the morning in order to have a
clean skin and good natural sweating during the day.
Labourers and others who have much to do should rise so
early that they can have several rests and keep in the shade
from eleven till four in these very hot days ; and let this most
important fact be remembered—namely, that by natural
sweating (perspiration) the body is kept healthfully cool when
exposed to these terrible heats, and that over-exertion, passion,
and all kinds of intemperance must be avoided. In his note to
the President of the Board of Health, Dr. Harris justly urge*
that the contractors, builders, and other great employers of
labour should be urged to be considerate to their men, and
give them the advice and the opportunity for rest which they
now need. The fact that the first fifteen days of July have
had an average or mean temperature ten degrees higher than
has been experienced in more than 25 years Bhoul lead all our
fellow-citizens to use every means possible to encourage or
enforce sanitary cleansing and tfye observance of the rules of
health. Especially should these suggestions concerning sun¬
stroke be heeded.”— New York Herald.
British Association at Norwich.— It has been
for some time past generally known that an unusual influx of
foreign savants is expected at Norwich this week. The follow¬
ing are some of the names most intimately connected with our
own profession :—Dr. Carl Vogt and Dr. Appia, from Geneva;
Professors B£hier and Broca, from Paris ; Drs. Laage, Boor*
gaard, and Heinsius, of Leyden ; Professor Fayre, of Lyons;
Professor Sartorius Walterhausen, of Halle; Professor Nilsson,
of Sweden, etc., etc. Several of these distinguished professors
have important communications to make, and will take an ac¬
tive part in the proceedings of this, the thirty-eighth annual
meeting, which promises to be one of the most brilliant in the
annals of the association. The first general meeting will beheld
on the 19th inst., at 8 p.m., when his Grace the Duke of Buc-
cleuch will resign the chair, and Dr. Hooker, F.R.S., will
assume the presidency and deliver an address. The Interna¬
tional Prehistoric Society will also hold its meetings at Nor¬
wich during the week.
The amount of work which will here pass muster
for a fair day’s toil is far beyond what is expected of a man in
Great Britain. This is no country for foreign idlers to come
to. The Americans hate physical exertion themselves, and
are willing to pay Englishmen, Irishmen, Germans, or any¬
body else to come here and do the hard work for them, but
they will take great care to get as much out of the people they
pay as can be either wheedled or forced from their bones. I
have been very much struck here by the fact of the evident
dislike of hard.work which animates the real American. . If I
have noticed a man in a workshop or in the open air driving
at his work with a will and an apparent relish, as is so com¬
monly seen in England, I have said to myself, that man’s grand¬
father was not an American citizen ; and upon inquiry I have
seldom found that I was mistaken. The dry climate may
have something to do with it, for I have observed elsewhere
that dry climates do not seem conducive to an appetite for
manual labour, but they seem to make people more nervously
active than the denizens of a damper region.— English Work
iny-man's Letter in Daily News.
The Army and Nary Gazette states that at the
Curragh instructions have been received that, as a sanitaiy
measure, patients in military hospitals are to be allotted 1200
eubic feet of space each, and arrangements are being made ta
give effect to these instructions as soon as possible.
Digitized by VjiOOQ LC
fjtjWial grass & (fund at
“ SALUS POPULI STJPREMA LEX.”
WEDNESDAY, AUGUST 2 6, 1 86 3.
CONTENTS.
LECTURE.
Is the Administration of Wine in Acute
Disease a mere Fashion! By Thomas
Wrigley Grimshaw, M.D.Dub., Lecturer
on Materia Mediea in Dr. Steer ens'
Hospital, and one of the Physicians of
Cork-street Fever Hospital. page 177
ORIGINAL COMMUNICATIONS.
How shall we make our Daily Experience
Advance Science ? By Thomas King
Chambers, M.D., F.R.C.P.Lond. 179
Practical Schemes for Extending the
Contagious Diseases Act to the Civil
Population. By Henry W. Williams,
MD..C.M. 160
On the Nature of the Phenomena of
Paroxysm and Intermission. By H.
Freke, A.B., M.B., M.D., T.C.D.,
M.R.I.A. 182
Epilepsy.—Case of Spinal Origin : Obser¬
vations upon its Pathology and Treat¬
ment : Bromide of Potassium and
Bichloride of Mercury. By P. C.
Little, F.R.C.S.I., &c. 184
HOSPITAL REPORT.
Kisq’s College Hospital—
Cases under the care of Dr. Beale, F.R.S. 186
LITERATURE.
“ The British Army in 1868.°.... 187
LEADING ARTICLE.
Ciiolkha and Water ... 188
NOTES ON CURRENT TOPICS.
Oxford University.—London Hospital.—
The '* Dreadnought” Hospital Ship.—
The West Middlesex Coronership.—
The British Association for the Ad-
PAGE
vancement of Science.—The Annual
Report of the Scottish Registrar-
General.—The Penalty of Unqualified
Practice.—The Chair of Botany in
Trinity College, Dublin.—The Naval
Medical Service.189-91
CORRESPONDENCE.
M. P. A. on the Representation in the
Medical Council. 192
A Conservative M.D.Edin. on Reform of
the Medical Council—Direct and In¬
direct . 193
Phelan on Puerperal Fever in Lying-in
Hospitals. 193
MISCELLANEA.
Report on Wine and its Adulteration.
No. IX. 192
The Abergele Catastrophe. 197
Gleanings and Medical News. 194-6
Notices to Correspondents, &c. 197
IS THE ADMINISTRATION OF
WINE IN ACUTE DISEASE A MERE FASHION?
By THOMAS WRIGLEY GRIMSHAW, M.D.Dcb.,
LECTURER ON MATERIA MEDICA IN DR. STBRVKNS* HOSPITAL,
ASD ONE OP TUB PHYSICIANS CF COBK-STBEET FEVEE HOSPITAL.
(Abstract of one of a Course of Lectures on Materia Mediea and Thera¬
peutics delivered in Dr. Steevens’ Hospital during the Summer
Session of 1868.}
Gentlemen —In yesterday’s lecture I detailed the varieties
of wine and fluids containing alcohol, classifying these fluids
into weak wines and beers, strong wines, and ardent spirits.
I pointed out to you that weak wines have peculiar tonic, and
invigorating properties, independent of the slight stimula¬
ting powers which they possess, owing to their contained
alcohol. I informed you that the stronger wines possess
these properties, and that they also possess in a consider¬
able degree the powerful stimulating and antiseptic proper¬
ties of alcohol. I shall now proceed to direct your atten¬
tion more particularly to bhe physiological and therapeutic
effects of alcohol, or rather of fluids containing alcohol in
sufficient quantity to give a special character to their
action, and entitle them to the popular term of alcoholic
fluids. The great characters of an alcoholic fluid are
stimulant and antiseptic, and if given in excessive doses
narcotic. The combination of stimulant and narcotic pro¬
perties in the same agent is not new to you, as I have
already in past lectures remarked on such a combination,
especially in the case of opium.. Alcoholic fluids, however,
are seldom employed therapeutically as narcotics, but fre¬
quently as stimulants; whereas opium is nearly always
employed as a narcotic, and seldom as a stimulant. You
therefore in your classifications of remedies usually find
opiam in the list of narcotics, and alcoholic fluids in the
list of stimulants. It is chiefly as a stimulant we have to
deal with alcohol in these lectures, although I shall also
have a few words oft commendation to say of its antisep¬
tic, and a few of caution to give, with regard to its narcotic
properties. These considerations of the properties of
•WhoMc fluids, as well as when, where, and how they are
to be made available in therapeutics, I shall leave for con-
tidmtioa in a future lecture, and I only ask you at
prwwit to take it for granted, that alcoholic fluids are stimu¬
lants (not of course denying that they are also narcotics).
As alcoholic fluids are our main-stays as stimulants, and are
in much more common therapeutic use at the present than at
former times, I shall point out how it happens that they
have come to occupy so important a place in our materia
mediea, as compared with that of our predecessors. Tbeslight
use made of alcoholic stimulants by the physicians of past
ages must have depended upon, either the medical opinion
of the day, or upon the kind of diseases then prevalent. If
upon the latter, either diseases of former times differed
from those we now meet with, or we are altogether wrong
in our extensive use of stimulants; but we are not wrong
(as, for the sake of argument, I shall now assume, leaving
the proof to the next lecture), therefore diseases differ from
those of former days, or medical opinions differ; and,
assuming we are right in our opinions, the physicians of
former days, from Hippocrates to Sydenham, and from
Sydenham to our own times, must have been ignorant of
the treatment of many of those diseases which they pro¬
fessed to know how best to cure; not only ignorant, but so
grossly ignorant, that in many cases they pursued treatment
which we know must have been absolutely injurious, and
even dangerous. Can we possibly believe that such igno¬
rance existed among those who have been first in the im¬
provement of medical science; who, with small means at
their disposal, were accurate observers of disease; and
who, without chemical tests, stethoscopes, ophthalmo¬
scopes, laryngoscopes, endoscopes, thermometers, or sphyg-
mographs, clearly described symptoms and made accurate
diagnoses—frequently as accurate as our own with all
these aids of physical science ? The answer is that these
great men were not ignorant, and that they themselves
have given proof of their knowledge in their works, which
have come down to us. Not only have they proved their
knowledge of, and ability to treat disease, but they have
left sufficient evidence, that if they had had the same kind
of disease to deal with in their day, as we have in ours,
they would have followed pretty much the same prin¬
ciples as we do, and that in the administration
of stimulants they did follow these principles. Although
wine was not their commonest stimulant, yet they
frequently used it, alone or in combination with other
agents, or artificial cordials composed of many stimulants,
sometimes including wine or spirits of wine.
The question of the use of stimulants by our predeces¬
sors is necessarily mixed up with the consideration of the
Use of agents of the contrary character, such as blood-let¬
ting, emetics, and other depressants.
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178 The Medical Press and Circular.
GRIMSHAW’S LECTURE.
Angoit 96,18S8.
Those who tell us that stimulants are useless or in¬
jurious accuse us of ignorance in their use, or of being the
mere followers of fashion, and tell us it used to be the
fashion to bleed, vomit, and purge patients in fevers, ery¬
sipelas, exanthemes, and inflammation of the lungs ; now
it is the fashion to give them wine, brandy, whiskey, and
all sorts of stimulating agents, and that by this treatment
we kill as many, if not more, than our predecessors, and
that, on the whole, we are all ecpuilly bad (not equally
good) with those who went before us. The answer is, that
our predecessors were as good (considering the means at
their disposal) as we are, and that we have not changed in
fashion, but while following practice similar to that of our
predecessors, disease has changed its nature (or fashion,
i£ you like) ; that we deplete less, and stimulate
ldore than they, because there are fewer to be depleted, and
more to be stimulated than formerly ; and, lastly, that it
is not true that they gave no stimulants in cases similar to
ours, but that they usually did give stimulants in such
cases ; and this I proceed to prove by reference to authors
of past ages, remembering that the question of the use of
stimulants and depressants are inseparably connected when
we discuss their use in those diseases, which sometimes
assume the sthenic, sometimes the asthenic (known by the
various terms putrid, putrescent, malignant, or, more
scientifically, adynamic) type. The diseases to which I
shall chiefly refer are fevers and erysipelas. It would be
quite beyond the scope of this lecture to quote all the
known instances in which wine was used therapeutically
by our predecessors. I shall, therefore, confine myself to
a few authors of special mark.
To begin with the father of physic, the great Hippo¬
crates, we find that he discusses the use of wine in fevers,
mentions the different kinds of wine, and when each is to
be used. Although he does not detail as accurately as we
could wish, the exact cases for the administration of wine,
yet he tells us it is useful under particular circumstances,
and, from his reference to the use of wine in anxiety, and
under other circumstances, it is quite clear that he
used wine in much the same way as we do at present—
namely, to counteract debility. In the Aphorisms he warns
us “ to consider if the patient will support the diet,” and
cautions us to “ purge sparingly in acute disease,” showing
that he quite understood the dangers of depletion.
Aretaeus tells us, in his chapter on “ The Therapeutics
of Acute Disease” :—“ But if converted into syncope,
• . . . (the powers of life being loosened . . .) we
must disregard the delirium—which he had previously
stated contra-indicated stimulants —and be on our guard.
.Then the only support is wine, to nourish
quickly by its substance, and to penetrate everywhere,
even to the extremities ; to add tone to tone, to rouse the
torpid spirit, warm that which is cold, brace what is re¬
laxed, restrain those portions which are flowing and run¬
ning outwards, .... most excellent to soothe the
mind in delirium. Wine, when drunk, accomplishes all
these good purposes, &c.” A
Alexander Aphrodisiensis (quoted in the Sydenham
Society’s edition of “ Paulus ^Egineta”,) inquires how it is
that wine which is of a hot nature proves useful in fever,
and believes the wine acts by strengthening the powers of
the system. 8
Paulus iEgineta recommends a stimulant mixture con¬
taining wine, myrrh, ammonia, and aloes for the treatment
of plague. 3
Celsus III., 7.—Recommends wine and water alternately
to prevent, and hot, undiluted wine to cure, plague.
Although there are many more examples to be found in
the writings of the ancients of the use of wine in acute
disease, yet, I think, I have given sufficient to show that
wine was used thousands of years ago in the same way as
it is at present—namely, when the cases required it, which,
1 The Extant Works of Aretaeus the Cappadocian, by F. Adams,
LL.D., Sydenham 8ociety, 1856, page 386, ana sequel.
2 Pauli b JEgineta, with a Commentary, by Francis Adams, Syden¬
ham SobietyTl844, page 239.
8 Page 278, Op. Cit.
fortunately for our predecessors, was not- so often as at
present.
Passing from the ancient writings, we come to those of
more modern times, and I shall confine myself to examples
taken from the practice of the physicians of our own
country, as it is they who are especially accused of deplet¬
ing cases belonging to the class which we now stimulate.
As we began the consideration of the use of stimulants in
ancient medicine by the father of physic, so we shall begin
this part of our investigation with exainples from the
practice of the father of English medicine, Thomas Syden¬
ham, who was born in the year 1624, and flourished in the
middle and towards the end of the 17th century. When
writing of the fever of 1661 to 1664 he tells us, “ Whenever
I have to deal with a patient whose blood is of itself of a
weak character (as it is for the most part with children), or
else deficient in animal spirits (as it is with men in the de¬
cline of life, or youths who have long been invalids), I keep
my fingers from the lancet. If I order venesection, the blood,
weak enough without being diminished, would be rendered
incompetent to the work of dispumation. -Thence would
arise the degeneration of its whole volume, whilst the death
of the patient would probably come next. ... In
stating this, I am aware that there are patients upon whom
rash blood-letting have been inflicted; that, by the help of
proper cordials have out-lived the treatment,” &c.*
From the foregoing statement, it is evident Sydenham
was quite familiar with the cases of fever which could not
bear depletion. In the following paragraph he mentions
those that can bear depletion, and afterwards refers to a
class of cases where depletion may be first used, and
cordials afterwards. 8
In the same chapter he again refers to the use of cordials
and gives a caution—“ As regards cordials, I am cautious
in their exhibition,” &c.
Again, in the same chapter, he directs (in a chest com¬
plication, in fever) “the patient to drink old Malaga wine,
some Falemian, or Muscatell.” 3
Writing of pestilential fever of 1665, he mentions a case
where malignant symptoms set in, and he ordered “ strong
alinipharmics.” 4
\\ hen writing of erysipelas, we find him concluding
with the following statement:— ft I may also make a re¬
mark, by the way. Although the affections of which we
are speaking, . . . easily give way to this treatment,
and take themselves off after the repetition of a purge and a
venesection, there are others of the same kind which must*
be treated in a manner wholly opposite.” 6
Farther on, in treating of a vanety of erysipelas, he re¬
commends wine and digestible animal food, and condemns
refrigerants.®
I think I have thus shown you that the father of British
medicine used stimulants in suitable cases, and frequently
wine in his practice as such.
We now come to consider a few authors of the eighteenth
century—
Huxbam, about 1730, recommended the use of generous
red wine in the treatment of erysipelas of a low type.
Heberden writing concerning erysipelas, and probably of
cases which occurred in his practice about 1750, says:—
“ This distemper seems to partake of the nature of those
which are called malignant, more than of the infiammatofy,
by which I mean, that in general it does not require nor
bear much evacuation.” 7
We next come to Cullen, the greatest systematic writer
on practice of physic of the last century. Cullen, writing
of erysipelas, as he met with it, probably between the years
1760 and 1770, seems fully to appreciate the possibility of
erysipelas assuming an adynamic type, such as Hehiden
had met with, he writes—“ We have hitherto considered
erysipelas as in a great measure of a phlegmonic nature;
1 Works of Thomas Sydenham, M.D., by B. G. 2LD.,
Sydenham Society edition, 1818. Vol. I., p 46.
2 Op. Cit. Vol. I., p. 47. 8 Op. Cit. Vol. I., p. 58.
4 lb. Vol. I., p. 113. 6 lb. Vol. I M p. 282. 0 lb. VoL I ,P-
7 Commentaries on the History and Cura of Die— see. P. 188. 2nd.
edition. London, 1800.
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Hie Medical 'Prtm tnd Circular. CHAMBERS ON THE ADVANCE OF SCIENCE.
August 26,1868. 179
and, agreeable to that opinion, we have proposed our
method of cnre. But it is probable than an erysipelas is
sometimes attended with, or is a symptom of, a putrid
fever ; and in such cases the evacuations proposed above
may be improper, . . . and the use of the Peruvian
bark may be necessary ; I cannot be explicit upon this
subject, as such putrid cases have not come under my ob¬
servation.” 1
From what Cullen says in other places of wine as a
stimulant, it is pretty certain that if he had met with these
cases of putrid erysipelas (as he called them), he would
have employed wine m their treatment.
These instances of the treatment pursued by Huxham,
Heberden, and Cullen, all bear upon the same point, and
prove how exactly they practised according to the prin¬
ciples laid down by the best physicians of our own time.
In his chapter “On the method of cure in fevers,”
Cullen writes, “ the most suitable is that which forms the
indications of cure upon the view of obviating the tendency
to death.” 3
In following out this plan, he tells us 1 (according as the
circumstances of the fever shall admit)—
“ 1st.—To moderate the violence of the reaction.
“ 2nd.—To remove the causes, or obviate the effects of
debility.
“ 3rd.—To obviate or avert the tendency of the fluids to
putrefaction.”
To fulfil the second of these indications, after mention¬
ing the Peruvian bark, he says—“ Another set of medi¬
cines to be employed for obviating debility and its effects,
are direct stimulants. These, in some measure, increase
the tone of the moving fibres, but they are different from
the tonics, as more directly exciting, and increasing the
action of the heart and arteries.” 4
“ What are the stimulants that may be most properly
employed, I am uncertain, as the use of them in this age
has been rare; but I am disposed to believe that of all
kinds wine is the best.
“ Wine has the advantage of being grateful to the palate
and stomach, and of having its stimulant parts so much
diluted, that it can conveniently be given in small .doses ;
so that it may be employed with sufficient caution : but it
is of little service unless taken pretty largely.” 6
A more concise and correct account of why wine is of
so much value as a stimulant is not to be met with in
medical literature. It would be well for those who tell
us that Dr. Todd originated the fashion of using wine in
disease, if they would go a little further back and study
the writings of the physicians of the last century.
Cullen further tells us that “ wine has an action ana¬
logous to that of opium and some other narcotic medi¬
cines. It may indeed be said, we can distinctly mark its
stimulating power only, which renders its effects in the
phrenitic delirium manifestly hurtful, and in mild de¬
lirium, depending on debility, as remarkably useful.” 6
Cullen also recommends wine in malignant small-pox,
“ commonly proper to give wine very freely.” 7
In the prevention of plague :—“ Some means may be
employed for strengthening the bodies of men, and there¬
by to enable them to resist contagion. For this purpose
it is probable that the moderate use of wine, or spirituous
liquor, may have a good effect.” 8
In the foregoing quotations and remarks, I believe I
have not failed to prove, that wine has been used as a
stimulant through a long series of years, and I have, I
think, returned a decided negative answer to the ques¬
tion—Is the administration of wine in medicine a
mere fashion ? I have proved the falsity of the
charge; that our great predecessors in the healing art
had no idea how to use wine, have shown you how
closely we follow the principles for practice 'laid down
by our great masters of various ages, and lastly, have
1 OqDen'a First Lines of the Practioe of Medicine. By J. Rotherham,
1CJ>. Tel. It, p. 289. Edinburgh, 1791.
t Op. CXfc. voL I., p. 169 and sea. 8 lb. Vol. II., p. 160,
4 {». TgS. L|p.M. 6 lb. Vol. J..P. 228. 6 lb. Vol. I, p. 224.
i ib.Y4.ft> 9* 19*. f rn &, p. 24& W& m-
pointed out to you the means of confuting the great stock
arguments of the most pernicious, spurious, and ignorant
cavillers at the use of alcoholic stimulants in medical
practice. In our next lecture I shall point out some more
of the errors of these mischievous allies of teetotal bigots,
and the worst enemies to the progress of temperate habits
among the mass of the public. To-morrow we shall enter
more minutely upon the physiological action, the scientific
employment of alcoholic stimulants in disease, and the
when, where, and how they are to be used with benefit to
our patients. ^
(Drighial Cjamwitiriraliflita.
HOW SHALL WE MAKE
OUR DAILY EXPERIENCE ADVANCE SCIENCE?
By THOMAS KING CHAMBERS, M.D., F.R.C.P.Lond.
(Read at the Meeting of the British Medical Association at Oxford,
August, 1868.)
Our presence here in Oxford shows that we are all anxious
to aid the progress of our common art and science. But
many of us—most of us—are at the same time willing to
confess that we do not know very well how to set about it.
Our country cannot spare us, even if we ourselves wished
to devote our lives to the mere cultivation of knowledge;
and we are tempted to despair of seeing anything less than
a complete devotion produce fruit. Are we justified in this
despair ? I think not. I think it not at all impossible to
extract, from the gigantic waste of our daily routine of
business, constituents of truth as important as any dug
fresh from the mine of devised experiment. I believe we
shall, like our manufacturing industry, advance chiefly now
by utilising our waste products.
Let us begin first by saving them, instead of letting
them run off into the sewers of forgetfulness. I think it
is the duty of a practitioner of medicine to take notes of
every case that comes under his charge. It is especially
those which superficially appear commonplace and repeti¬
tions of one another that need to be thus recorded. Ban-
ties are common enough, and are enshrined by wholesale
in the storehouses of our periodical literature; but when
one comes to look for accounts illustrative of any point
about the daily events of life, they are wanting. Let a
man, for example, ask of those who have been giving aloes
all their lives, for any evidence of the truth of the state¬
ment, which we have been repeating after Fallopius for
250 years, that the drug causes haemorrhoids and morbid
uterine haemorrhage—in what cases it cures them, and in
what it makes them worse—let him ask how often it elicits
solid, how often liquid stools—in what cases the former,
in what the latter—and I fear he will get none but con¬
jectural answers. Or let him ask those who are daily ad¬
ministering some expectorant, whether the expectoration
is increased or diminished under its use, and he will hear
a strange absence of consent in the reply. Let him ask
how often ascarides produce symptoms, and in how many
persons they are found without symptoms—whether bron¬
chial catarrh most frequently precedes or follows measles—
what is the period of latency of gonorrhoea—and in short,
almost any question about almost any common illness, and
he will have it answered much more rarely from personal
observation than if he inquired about some strange com-
E lication, of which not five instances are seen by a man in
is lifetime. Yet it is the common diseases which are of
real importance for us to lighten and shorten. Moreover,
it is in common diseases only that we can learn the thera¬
peutical value of drugs, for it is in these cases only that
we know the natural <*mrse of the malady, and^ can judge
how far it is modified by our means.
Medical men are often deterred from keeping a syr«
tematic record of their private practice by the idea that to
do so necessarily involves a considerable expenditure of
time. I doubt the fact. Certainly the careful annotator
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186 The Medical Press and Circular ON THE CONTAGIOUS DISEASES ACT.
August 96,1868.
is longer over his first visit to a patient, than is a hurried
prescriber ; but then subsequent visits are much shortened,
for the refreshing of the memory by a repetition of ques¬
tions is avoided. But still the time thus spent is an im¬
portant part of the question, and it is very desirable to
reduce it to a minimum by mechanical contrivances. The
plan 1 myself adopt is as follows:—I write all my pre¬
scriptions and papers of advice in a copying-book, which
preserves a duplicate of them by means of transfer paper
(Delarue’s Copying-book) ; and at the back of this tran¬
script I write, usually with the patient before me, always
before I attend to the next case, the history, so far at least
as to explain my reasons for the advice, before I go on to
the next page. The periodical indexing of these pages is
an easy job for an hour of weariness ; and the whole time
consumed is so crumbled up that it is never missed, and
neither business nor amusement can complain of the rob¬
bery.
borne people suppose they can make their notes of the
day’s work more fully and scientifically when it is over,
and they quiet in their studies. I do not like the plan so
well. For one thing it interferes with the relaxation need¬
ful to keep the mind healthy and broad. That time be¬
longs to rest, and should not be wasted on labour. An
instinctive feeling of the truth of this causes a duty which
is put off to such an opportunity to be put off often still
further, often altogether. Again, unless an immediate
note be made, the new and the strange in the day’s expe¬
rience are stamped in the mind deeper than the common¬
place, and they are apt to take up more than their fair share
of room in the diary ; while personal friendship, the social
standing of the patient, and other considerations, will
sometimes blot out, sometimes unduly brighten our recol¬
lections of the case.
What should be recorded ? Not everything of course,
or there will be a want of perspective in our sketch. The
best rule is to note first the prominent important features
in the case in our technical eyes, those features which have
guided us in our treatment, and which distinguish it from
others. Other features may follow, receding from the
history in inverse proportion to their prominence. A
separate paragraph at the end may contain the symptoms
which appear the chief to the patient, for the purpose of
allusion in a future visit.
What are the uses of these notes ? They serve as correc¬
tions to our memories—they make available to the increase
of real knowledge that which is otherwise just as likely as
not to lead to imperfect, and therefore false, knowledge.
They turn a stumbling-block into a stepping-stone. What
a satisfaction, when a new question is raised in our own
minds by some chance patient, or suggested by a colleague,
to be able to answer “ litt ra scripta manet, :> here is the
contemporary evidence of the fact! How pleasant in an
hour of leisure to live over again one’s days of joyful
labour ! But above all, bow iuvigorating to be able to
contribute true bricks to the palace of knowledge which
we are uniting to build up !
One of the most important matters for inquiry in the
present day is the action of drugs on the human body.
There are questions concerning these reagents which prac¬
titioners only have the opportunity of testing, and in no
other way can they do* it so satisiactory as by daily notes,
which can with ease at any time be reduced to a tabular
form.
This brings me to another part of my subject, namely,
the administration of medicines. I wish to offer a few sug¬
gestions which may tend to make this daily business of
ours more available in increasing therapeutical science. 1.
Let us aim at giving only one drug at a time. I do not
say this is always possible ; but at all events let us keep
the desire in our minds, and reckon a prescription good in
• an inverse ratio to the number of ingredients. This sim¬
plicity conduces not only to the good of scieuce, but of our
individual patients, for it soon makes us much more ready at
suiting the special remedy to the special case. 2. It is
important when we change our treatment to allow a certain
sufficient interval, different in different instances, between
leaving off one medicine and beginning another. The ex¬
periments of Bocker and others have shown us, first an
action of the drug lasting after its apparent disappearance
from the body, and, secondly, a reaction of the system op¬
posite to, though weaker than, the original action. Ad¬
vantage will accrue to the patient, as well as to science;
often from this rule, too, less medicine will be needed.
For instance, liyoscyamus given for hypochondriasis or
mental depression may be left off almost directly it has
begun to produce its beneficial effects, and those beneficial
effects will still go on towards restored health. Hydro¬
chlorate of strychnia will continue to invigorate the peri¬
staltic motions of the stomach and intestines, so as to pro¬
duce steady digestion and evacuation for days after such a
soluble salt must have passed away. 3. It is advisable for
each observer to have as short a pharmacopoeia as possible.
The best workmen use the fewest tools—aye, and those
who use the fewest tools become the best workmen. They
become more adroit with them, know them better, and are
able to instruct others in their employment. 4. The union
and co-operation together of those who are working at the
same subject is of incalculable value. Incalculable—
because you have not tried it. The skeleton of the ma¬
chinery exists in the British Medical Association. Why
should not each branch or group of branches take up a drug
and let us know after two or three years their experience
of its action ?
PRACTICAL SCHEMES FOR
EXTENDING THE CONTAGIOUS DISEASES ACT
TO THE CIVIL POPULATION.
By HENRY W. WILLIAMS, M.D., C.M.
Public immorality has obtained such magnitude, espe¬
cially of later years, that it is quite time the State adopted
some means to bring it under control—a very difficult mat¬
ter, indeed, in this country; for to do so the Government
must more or less sanction prostitution.
It must be done in some manner or other, and that very
shortly, too—
First. To prevent public decency from being outraged to
too great an extent.
Secondly. To ameliorate, cut short, and finally eradicate,
if possible, primary disease amongst the original offen¬
ders.
Thirdly. To ward off and counteract the baneful effects
of a vicious life, as so frequently developed in the innocent
offspring of those who have contracted syphilis and been
imperfectly cured.
Licensing houses in England for prostitution is repug¬
nant, more or less, to the feelings of all of us; how much
more horrible does the idea seem of licensing each indivi¬
dual woman. Bad as it is, I can see no other way of truly
meeting the social evil, and bringing it under thorough and
efficient control, than by licensing, in the first places indi¬
vidual women with either an ordinary or a special license;
secondly, to license houses, such bouses to include regular
brothels, night-houses, also receiving-houses, coffee-houses,
hotels (known as houses of resort for prostitutes), tea-
gardens, music-halls, &c.
With regard to the ordinary and special license, I mean
the first is for women living in houses with two or more
inmates; the second for women living in private rooms.
Every woman who is known to live totally or partially by
prostitution should be registered, numbered, and licensed;
and if to live in a house with others, she should pay for
such license five shillings, which would stand good for one
year in any part of the United Kingdom. If a woman re¬
quires a license as a courtesan to live singly in apartments
where there are no others but herself in the house (kept
women, ballet-girls, shop-girls, &c., are included under
this head), such a license to be considered special, and to
cost tive-and-twenty shillings. Of course there will be
numbers of girls who will evade the law, and partially
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The Medical Press end Circular.
ON THE CONTAGIOUS DISEASES ACT.
August 26, 1866. 181
practice prostitution without a license. If such infect men,
and are found unregistered, they must be punished.
Every brothel with two inmates should pay five pounds
a-year for a license, such license to allow the keeper
thereof to sell wine and spirits (to be drank on the pre¬
mises), and the women in such a house to be inspected
weekly by the surgeon, for which five shillings for each
visit, including such inspection, would be charged in addi¬
tion to the license; for every additional woman over two,
a shilling extra for inspection would be charged. All other
houses enumerated above, not regular dwellings for cour¬
tesans, but yet resorted to by them for accommodation, to
be taxed according to their rental. The proceeds arising
from the licenses and inspections to pay the expenses
of examination, and the surplus to be devoted to
the erection and maintenance of a National Lock Hospital
and Magdalen Asylum in the metropolis, with branches in
the various towns of the United Kingdom ; so that those
courtesans who are diseased may receive board and lodging,
with medical treatment, free of expense when ill, and, at
the same time, the Magdalen affords those who may repent
of their vicious course of life, an opportunity of reformation,
inasmuch as they can enter free either after illness or any
time they like, and be kept until drafted into various situa¬
tions or sent to the colonies, where old habits forsaken, the
past forgot ten, they may lead not only virtuous lives but be¬
come, mayhap, in time, good wives, happy mothers, Christian
women, and useful members of society, the consequence of
their being helped out of the mire by the kind hand of
charity when they stood the most in need of it, having a
free place of refuge to fly to when prompted by their good
angel to forsake their wicked manner of living and to try
and do well once again. I feel convinced if the hand of
charity were offered more frequently than it is to our fallen
sisters, a great many more might be reclaimed. Only give
them the opportunity of getting an honest living, and there
are very many who would gladly avail themselves of the
offer ; and yet, on the other hand, there are numbers who
would not, nay, could not, be quiet and decent if they were
paid for it.
At the same time that I am advocating the licensing of
courtesans, I would deal most severely with that class of
persons, both male and female, known as Procurers and
Procuresses, villains of the deepest dye, who undertake to
supply the market of prostitution by entrapping young girls
and systematically causing their min. Transportation for
life would be none too great a punishment for such sinners,
who, for the sake of gain, lead a maiden (very often under
the influence of alcohol, caused by their infernal means,) to
the couch of seduction, thus giving them the first plunge
into a career of iniquity, introducing them to a vicious
course of life, in fact, teaching them—compelling them, to
sin, and glossing over their atrocious act by pointing out
the freedom of life which they, poor creatures, will for the
future enjoy, showing forth all the gaieties and pleasures of
this world, and using many other diabolical means to min
innocence, accomplish their vile ends, and justify them¬
selves in the eyes of their deluded and unfortunate victims.
If a girl, of her own free will, chooses to sin and lead a
life of riot and dissipation, and others who through mis¬
placed affection commit their first error by losing their vir¬
tue, and then follow up a gay life, why, no one is to blame
save themselves. Courtesans have existed from time im¬
memorial, and one may depend upon it they will con¬
tinue to do so as long as the world lasts in spite of
Church endeavours to reform them, or State attempts
t° suppress them. So, of two evils choose the least,
and, if we cannot put down prostitution, we can, at
any rate, bring it under surveillance and official con¬
trol with the greatest benefit not only to the demi¬
monde done, but to society at large. Licensing and in¬
spection would have to be carried out by a body of medical
mea appointed especially for the purpose, consisting of—
Kruiona] Surgeons, Superintendent Surgeons, Inspecting
Burgeons, Chief Inspecting Surgeons, the Inspecting-
ouigeon-in-Chief.
The Divisional, Superintendent, and Inspecting Sur¬
geons would be appointed according /o the number of
houses, and a Chief-Inspecting Surgeon would be allowed
for England, Wales, Scotland, and Ireland respectively,
the whole to be under the immediate and absolute control
of the Inspecting Surgeon-in-Cbief. To the best of my
knowledge, upon the authority of Dr. Charles Drysdale,
there are 10,000 courtesans in London, say 8000 are
regular bona fidt prostitutes, the remaining 2000, whom
we will style “ irregulars,” consist of, we will suppose,
kept-women, shop-girls, &c., living for the most part by
themselves, the 8000 living in regular brothels, and so
allowing four to a house on the average, gives the number
of houses as 2000 ; each of which houses would have to be
inspected weekly, and licensed yearly at the rate of £7
eacn, which gives per annum ... ... £14,000
Allowing seven shillings a-week for examining the
inmates in each house, that would bring in
annually the sum of ... ... ... 36,500
Then the 8000 ordinary licenses would average
per annum ... ... ... ... 2,000
Then the 2000 irregulars with special licenses
would amount yearly to ... ... ... 2,500
Irregular courtesans would be examined at the
consulting-rooms of the Divisional Surgeon at
the rate of Is. 6d. a-week on each examination.
Such brings in yearly ... ... ... 7,800
Such women would have to come to be examined
at appointed times, or they would be charged
more than the Is. 6d. if they came out of hours ;
or if they were visited at their own homes, such
extra fee to be considered the perquisite of the
Divisional Surgeon.
Coffee-houses and public-houses, &c., used for
immoral purposes to pay a shilling in the pound
on their rental. Now there are 500 in London,
I believe, known to the police, and these would
bring in (extra per year) ... ... ... 2,000
Thus giving for London only for the year a total J qqq
Say a Surgeon could inspect fifty houses a week, and ex¬
amine the inmates, that would allow him ten a day, and
leave Saturdays for making up books and examining irre¬
gulars at his consulting-rooms.
Forty Divisional Surgeons would thus be required for
London, with salaries varying from £400 to £500 per
annum, allowance (extra) being made for travelling ex¬
penses, rent of rooms, and use of instruments, &c.
Say that each Divisional Surgeon, on the average, had a
salary amounting to £500 a-year, that would make a
yearly total for the forty of ... ... £20,000
Every ten Divisional Surgeons to have a Super¬
intendent at £500 per annum, with £100 for
travelling expenses, &c., equals for London,
yearly, ... ... ... ... 2,400
Every forty Surgeons to have an Inspecting Sur¬
geon at £600 a-year, with £200 for travelling
expenses, &c., gives for the year ... ... 800
Thus the London inspecting expenses would be as fol¬
lows :—
40 Divisional Surgeons’ incomes, ... ... £20,000
4 Superintendent Surgeons’ incomes, ... 2,400
1 Inspecting Surgeon’s income, .. ... 800
For stationery, licenses, and stamps, ... ... 2,600
Making the total amount ... ... £25,800
Thus, after paying all expenses for examination, &c.,
there would be a surplus of £39,000 a-year, which would
go a long way towards supporting a National Lock Hospi¬
tal and Magdalen Asylum.
The four chief Inspecting Surgeons to have a yearly
salary of £900, with £300 for travelling expenses, &c.
The Inspecting Surgeon-in-Chief to have, yearly, £1500.
with £500 for expenses. Surgeons of all grades to be bound
down not to practise to the detriment of their daily occu-
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182 The Medic* Press and Circular. FREKE ON PAROXYSM AND INTERMISSION.
August 26,1866.
pation, under penalty of fine. Seeing patients at their
own residences after the duties of the day, or even visiting
such at their own houses at that time, would be sanc¬
tioned, provided it did not interfere with their Govern¬
ment work.
Women found guilty of prostitution, without a license,
to be fined or imprisoned, according to the frequency or
gravity of the case.
All houses to be open at any hour of the day or night to
the Surgeons of the various grades.
Divisional Surgeons to take the money for the weekly
examinations at the same time that suen examination is
made—the number of the house (by license) and the sum
to be entered in a book kept for the purpose by him.
The keeper of any house guilty of misconduct in keep¬
ing such house, say, permitting robbery or disgraceful riots
to take place in such house, to be fined, say twice, and then
have his or her license suspended as long as may be
thought fit by the Inspecting Surgeon-in-Chief.
AU monies for licenses to be paid to the Superintendent
Surgeons, and the monies received by them, and those
received by the Divisional Surgeons to be paid monthly to
the Inspecting Surgeons, who in their turn pay it to the
Chief Inspecting Surgeons. All books and accounts to be
open to inspection any time during the day by the
Inspecting Surgeon-in-Chief.
In cases of illness on the part of any of the surgeons,
he may appoint a deputy, subject to the approval of the
Inspecting Surgeon-in-Chief.
Three weeks holiday to be allowed during the year to
Divisional Surgeons, but they must find a deputy and pay
him out of his salary, as his pay g^es on all the time
he is away from duty, either for pleasure or on account of
sickness. In case of any violence offered to the Divisional
Surgeon, he may call in the Police to work with him, and in
case of any prostitute refusing to be inspected, she can be
given in charge there and then. Clerks to make up books
can be kept by any of the surgeons, provided such pay the
incurred expense.
Any surgeon found guilty of immoral conduct, appro¬
priating monies to his own use, making false entries, or
otherwise breaking his trust with Government, to be repri¬
manded, suspended, or cashiered, and then dealt with as !
the civil law might determine, according to the nature of
the charge proved against him.
Divisional and Superintendent Surgeons to be Hono¬
rary Surgeons to the Lock Hospital.
Inspecting and Chief Inspecting Surgeons to be Go¬
vernors of the Magdalen Asylum.
Surgeons of every grade to have access to the Lock
Hospital and Magdalen Asylum any time during lawful
hours.
ON THE NATURE OF THE PHENOMENA OF
PAROXYSM AND INTERMISSION.
By H. FREKE, A.B., M.B., M.D., T.C.D., M.R.I.A.,
FELLOW OF THE KINO AND QUEEN*8 COLLEOE OF PHYSICIANS IK
IRBLAKD; PHYSICIAN TO DH. STKEVENS' HOSPITAL, DUBLIN; LECTUBEB
OK THE PRACTICE OF PHYSIC AND ON CLINICAL MEDICINE
IN BTEEVEHS* HOSPITAL SCHOOL OF MEDICINE, ETC.
It has ever been the opinion of observing and reflecting
physicians, that among the phenomena of disease most in¬
volved in obscurity and presenting greatest difficulty
of interpretation, are to be placed what are known as
periodic and paroxysmal phenomena.
The convulsions of epilepsy, the intermissions of ague,
the remissions and spontaneous subsidence of fever, &c.,
afford examples of the class of phenomena referred to ;
and the most eminent authorities on pathological ques¬
tions have long been of opinion that their correct inter¬
pretation was among the difficult problems of medicine.
One of the greatest ornaments of the medical profes¬
sion in this or any country—namely, Dr. Stokes of this
city, who, as an accurate interpreter of pathological
phenomena, is second to no physician existing, speaks in
his able lectures on fever, in 1854, of “this mysterious
law of periodicity.”
Other great authorities might be quoted to the same
effect, but it is needless, inasmuch as the difficulty is uni¬
versally admitted.
The subject is one that had for some time occupied my
mind, and in the years 1851-52 and *53, when contem¬
plating it exclusively in its relation to fever, I bestowed
pn it much thought, and at length satisfied myself that I
had arrived at its correct solution, which I published in
The Dublin Medical Press, 25th of May, 1853. That
solution is, I believe, now considered by many to be
correct.
The purport of what I advanced, may be briefly epi¬
tomized thus, viz. :—
1st. That the time during which any of our organic
tissues, say a ganglionic nerve centre for example, is
capable of manifesting its function must of necessity be
limited, that is to say, no such tissue can go working in¬
cessantly, or beyond some definite period of time.
2nd. When that limit has been reached, or in other
words, when that ganglionic centre has completely exhausted
its function or expended its entire nerve force, it is impos¬
sible that a similar function or a similar expenditure of
nerve force can take place, till after a period of pause, in¬
termission, or rest; during which pause, intermission, or
rest, a new ganglionic centre must be developed by the
process of nutrition in order to admit of a repetition of
that function; namely, a second expenditure of nerve force.
And consequently,
3rd. That after the complete exhaustion of its function,
or complete expenditure of its nerve force by any gan¬
glionic centre*, there must be a period of pause, intermis¬
sion, or rest, during which a new ganglionic centre is being
developed by the process of nutrition or renewal, which
new ganglionic centre, when completely developed by that
process, will be capable of re-manifesting its function ;
that is, will be competent to redevelop nerve force.
The same is equally true of muscles and of animal
organic tissues universally. Such is the nature of all in¬
termitting paroxysmal phenomena.
To illustrate these statements, take, as an example of a
paroxysmal and intermitting disease, that terrible affliction
known as epilepsy. Epilepsy is a well-marked paroxysmal
intermitting disease. In each paroxysm of epilepsy it is well
known there is an active development of function, or ex¬
penditure of nerve force, by the motor nerve centres of the
medulla oblongata and spinal cord.
Now, in such paroxysm we see that so soon as those
motor nerve centres of the medulla and cord have com¬
pletely expended their function, or exhausted their nerve
force in producing convulsions, there is a pause, intermis¬
sion, or interval of rest before a second fit or paroxysm
occurs.
Such is what we see to take place in epilepsy. Such,
I submit, is what must take place in all paroxysmal dis¬
eases. After the expenditure of function in paroxysm
there must, in all instances, be an interval of rest before
the occurrence of a second paroxysm, and this interval of
rest is what constitutes the intermission.
And why the necessity for this interval of rest ?
For this reason—it is during, and only during, this inter¬
mission, or interval of rest, that a new ganglionic centre is
being developed by the process of nutrition. When such
new ganglionic centre has been developed, and not till
then, it may give rise to a new display of function, a new
expenditure of nerve force, in a word, to a second fit, or
paroxysm of the disease.
I would submit that nothing of this nature was recog¬
nised as the true explanation of the phenomena of
paroxysm and intermission till some years subsequently to
[ay, 1853.
I shall now submit the terms in which I expressed those
ews in May, 1853, and would ask the reader to observe
>w closely I have adhered in the foregoing resting to the
nguage originally employed.
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Th» Medical Press tad Circular. FREKE ON PAROXYSM AND INTERMISSION.
August 26, 1668. 163
Having dwelt at some length on the well-known and
long established physiological fact that our organic tissues,
such as nerves, muscles, &c., while in the act of giving
manifestation to their respective physiological functions,
themselves undergo the process of di.>integration, or what
is termed retrograde metamorphosis.
I thus observe 1 :—“ An organised structure adapted for
developing physiological phenomena, is competent to give
development to the phenomena in question (be their nature
what it may) only to a limited or definite extent. No indi¬
vidual organised structure, in other words, whatever be its
nature, or whatever be the nature of the phenomena it is
specially designed to develop, could, by possibility, develop
those phenomena to an unlimited or indefinite extent. The
same proposition may be otherwise expressed thus—viz.,
die limit or extent to which any individual organised struc¬
ture is capable of developing its physiological function, is
strictly defined and cannot be exceeded.”
Applying this observation to nerves, muscles, &c., I re¬
mark :— 4 Suspend the process of ‘ nutrition’ in any one of
those structures, and what is the result ? The result is,
that the function of that structure must soon be suspended.
Now what, in physiological language, is the process of
‘nutrition V It is nothing more or less than the process of
regeneration or renewal. A continuance, then, for an in¬
definite period, of the process of ‘nutrition’ in any indivi¬
dual structure, is, in physiological language, nothing more
or less than a re-generatiou or renewal of that individual
structure an indefinite number of times. Consequently, as
is obvious, when the function of any organised structure,
Buchas muscular fibre, &c., &c., is developed to an indefinite
extent, it is not the same individual tissue which in that
case has been exclusively employed in giving development
to that function ; but, on the contrary, that function has
been developed by a succession of renewed or' re-gene rated
tissues.”
I then went, at some length, into detail on the applica¬
tion of these observations both to muscular fibre and to
the ganglionic centres of nerves.
In reference to their application to muscles I observe: —
“What I mean to express by the terms ‘during a given or
definite period of time,’ may require to be somewhat further
explained. What I am desirous of conveying is this : by
the words given or defined, as applied to the period of time
during which any muscle is in physiological action I wish
to express— that period of time during which any indivi¬
dual muscle is undergoing the process of de-generation. I
shall endeavour to render my meaning more intelligible.
By the repeated exercise of his muscles, an indefinite
number of times, after definite intervals of rest, the same
individual may develop an indefinite amount of muscular
force—may, for example, raise an indefinite weight, or draw
an indefinite load. During the course of a year, for instance,
I could move a much greater weight than an elephant
could move in an hour. True : but mark this distinctly,
it is not the same muscular fibres which in this instance
have developed all the muscular force which has been ex¬
pended by me during that year ; but, on the contrary, a
succession of muscles, altogether distinct from each other.
For the first fibres so employed have long since ceased to
exist, having, during the discharge of their function, under¬
gone the process of de-generation, and have been eventually
removed from the system to give place to a new set of fibres.
This new set in their turn have undergone the same pro¬
cess of tfe-generation, giving place to a third set, &c.
In this quotation, I would solicit the reader’s special
attention to the words “given or defined period of time,”
and to the woids, “ after definite intervals of rest.”
These are the two topics of importance in relation to the
phenomena of paroxysm and intermission.
Thus, in the case of an epileptic paroxysm, the “ given
or definite period of time” is the period of time during
which it is possible for that paroxysm to last. At the
expiration of this period of time there of necessity comes
1 Dc» in Medical Pbesb, 26th May, 1853, Yol. XXIX, pp. 822-23.
a definite interval of rest, which interval of rest constitutes
the intermission.
Such definite interval of rest may be succeeded by a
second paroxysm, and so on indefinitely. Paroxysms
which can last but for a definite period of time must be
succeeded by definite intervals of rest or intermission.
Such is the nature of the phenomena of paroxysm and in¬
termission. In a word, as in each fit of epilepsy, so in all
paroxysms, there can be an expenditure of a definite, and
only a definite, amount of either muscular or of nervous
force, but the fits of epilepsy may be repeated or renewed
an indefinite number of times provided, and only provided,
there be definite intervals of rest or intermissions be¬
tween e ich such repetition of the fit.
During the intermission or interval of rest , new tissues
are formed which may give rise to a renewal of the fit,
and so on indefinitely.
In continuation of this subject I further observe :—
“ Let us suppose one single individual muscular fibre de¬
tached from all others, and contemplate that fibre in rela¬
tion to the following question—viz., as to the measure of
the period of time during which that individual fibre can
discharge its physiological function. That period of time
is measured or defined by what I have termed the de- genera¬
tion of that individual fibre. For that muscular fibre,
while in the act of discharging its function, is itself under¬
going a process which must eventuate in a total inability
on the part of the same individual fibre, to give further
development to muscular force. When that process (viz.,
of degeneration) has been completed, the individual fibre
under consideration is degenerated, and in its degenerated
condition it is incompetent to develop muscular force.
Consequently, for the further development of muscular
force, there is required a rc-generation of muscle ; or, in
other words, the formation of a new and altogether distinct
muscular fibre. Hence it is obvious that the process of
de-generation puts a limit to the time during which any
individual muscular fibre is competent to develop muscular
force. Now, it is obvious that the duration of that time
will be longer or shorter according to the degree of activity
with which the process of degeneration takes place in that
fibre ; or which amounts to the same thing, according to
the degree of activity with which that fibre discharges its
physiological function.”
I would submit that the foregoing quotations must, at
once and without effort, be intelligible to the most ordinary
and commonplace understanding.
There can be no difficulty in understanding that if, at any
time, a single individual muscle ora single individual gan¬
glionic nervous centre be worn out in the discharge of its
function, there must be a period of pause for the growth of
a new muscle or new nerve centre before the functions be¬
longing to a new muscle or nerve centre can be discharged,
and until such new growth has taken place there will be
the intermission.
On the same subject I further observe :—“ What I am
desirous, then, of conveying by the tenns, ‘ in a given or
definite period of time,’ as applied to the time during
which a muscle is discharging its function is this—viz.,
the period of time during which the de-generation of any
individual fasciculus of muscular fibres (irrespective of, and
in contradistinction to, new or re-generated fasciculi) is in
actual progress, or in the act of taking place.”
On the application of the foregoing observations to gan¬
glionic nervous centres, I thus observed :—“ Now what is
true of all organised structures, is true of the ganglionic
system of nerves, and it is upon that account I have dwelt
thus long upon this topic. The reader will have the good¬
ness to reflect upon the bearing of this fact— viz., a ganglion
is capable of developing but a limited amount of nervous
influence or force. Let me be distinctly understood. No
singte individual ganglion (irrespective of renewed or re¬
generated ganglia) could, by possibility, give development
to more than some fixed and definite amount of nervous
influence or force.”
Adding, on the same subject:—“ The ganglionic system
Digitized by VjiOOv?I0
184 The Medical Presi and Circular.
LITTLE ON EPILEPSY.
August 96,1686.
of nerves are capable of developing only a given or definite
amount of nervous influence or force during a given or de¬
finite period of time.”
And further on, observing in relation to the ganglionic
nerves :—“ They, too, as I regard it, can develop but a
limited amount of nervous influence or force during the
definite period of time I refer to ; that is, during the
period of time which is defined by the de-generation of in¬
dividual ganglia, irrespective of new or re-generated
ganglia.”
And adding—“Hence the process of de-generation
(as in the case of an individual muscle) puts a limit to the
time during which any individual ganglion can develop
nervous influence or force. Hence, too, it is obvious (in 1
like manner as in the case of muscular fibre) that the dura¬
tion of that time will be longer or shorter, according to
the decree of activity with which the process of degenera¬
tion takes place in that ganglion ; or which amounts to the
same thing, according to the degree of activity with which
that ganglion has discharged its physiological function of
developing nervous influence or force.”
Thus, tnen, it is obvious that when once any given
ganglionic centre has expended, or exhausted, its entire
nerve force, say in the production of convulsions, there
must be a pause, intermission, or rest, before a similar ex¬
penditure of nervous force can take place—namely, until a
new ganglionic centre has been developed by the process
of nutrition.
I might introduce many more quotations to the same
effect, but it is needless. I may, however, be permitted to
add, that throughout the papers referred to, which ex¬
tended over a period of upwards of two years, I had gone
at great length into the subject of nutrition. I had re¬
marked extensively on the nature of that process, how it
took place, and what it accomplished. I had pointed out
at considerable length how, after the complete expendi¬
ture of muscular force by a muscle, or of nervous force by
a ganglionic centre, a new muscle, or a new ganglionic
centre must be developed by the nutritive process. And
I had further extensively entered into detail as to the man¬
ner in which those results were brought about by that pro¬
cess. It is unnecessary to add more on this subject, but
what I desire to impress on the reader is this—namely,
that in 1853 I pointed out in as simple, clear, and intelli¬
gible language as could be employed for that purpose, the
following physiological principles, viz.:—
That in the discharge or performance of their re¬
spective physiological functions, by muscular fibre, by
ganglionic nerve centres, jlnd by animal organic tissues
universally, “time defined” manifestations of function
must necessarily be followed by “definite intervals of
rest,” during which rest a re-development, or renewal of
the tissue employed, must be effected by the process of
nutrition before a repetition of that function can take
place.
EPILEPSY.
CASE OP SPINAL ORIGIN .* OBSERVATIONS UPON ITS PATHO¬
LOGY AND TREATMENT : BROMIDE OF POTASSIUM AND
BICHLORIDE OP MERCURY.
By P. C. LITTLE, F.R.C.S.I., Ac.
In continuation of my remarks upon epilepsy in Vol. III.,
No. 25, of your journal, I beg to contribute the following
case of spinal origin, which manifests some remarkable
epileptic phenomena not noticed in my former paper.
June 20, 1867.—A. B., aged 23, a professional gentle¬
man of ability and studious disposition, consulted me for
those conditions :—A constant irritation and painful weari¬
ness at pit of stomach, occasionally relieved by the falling
down, as it were, of something from the chest, followed by a
tickling sensation about the stomach; has “ always a wish to
breathe,” much difficulty in that act, mitigated by bending
forward; habitual sighing and yawning ; pain down the
spine and around the lions; great distress in sitting erect
for any considerable time ; giddiness on prolonged mental
or physical exertion ; noise in the head, flushing of face,
congestion of hands, muscular tremors, irritability of mind;
frequently dislike of conversation or company ; insatiable
appetite, unrefreshing sleep, hideous dreams, drowsiness
and increased discomfort at noon.
His features appear pretty healthy ; eyes dull, watery;
pupils slightly contracted, conjunctiva? bloodshot; gait
inclined forward ; hands blue, cold ; pulse 78, small,
nervous. The chest presents a striking appearance. It is
very lean, flat anteriorily, contracted, ana almost of the
same circumference from clavicles to false ribs. Below tb©
latter is a notable dilatation reaching to the hips. Respira¬
tion, 14 per minute, is diaphragmatic and abdominal;
inspiration prolonged and laborious, expiration short and
bellows-like. The thoracic respiratory muscles are almost
quiescent and "poorly developed, excepting serratus
magnus ; those of the abdomen are active, large, and well-
defined. Support around the diaphragm affords comfort,
and facilitates breathing. The heart and lungs are healthy,
the vesicular murmur feeble. The spine is red, congested,
and hot; deep pressure upon either side of seventh and
eighth dorsal vertebrae creates much pain.
The patient dates his malady ten years back, when he
over-heated himself at play, and caught cold. Vertigo
and uneasiness about the stomach thenceforth became
the prominent symptoms. About two years passed,
he fell in a fit in the street, lost consciousness, was
convulsed, foamed at the mouth, and so continued for
nearly a quarter of an hour. Five weeks ago, he sustained
“a fearful nervous shock in the back,” so enervating that he
was obliged to keep his bed for several days, has been
since incapacitated for mental labour, and dreads every
moment a similar visitation. He lives regularly, but in
earlier days applied himself too constantly to literary pur¬
suits. One of his parents inherits consumption ; the other,
in years gone by, was subject to fits, ana has yet many
epileptic conditions.
The following was my general line of treatment:—I pre¬
scribed bromide of potassium, in doses of Jss. to 3L
ter in die , in a tonic mixture; counter-irritation to the
spine, by vessicating collodion; a wide belt around lower
ribs, as a support to the diaphragm; bland, nourishing
food; gentle outdoor exercise, and quiet of mind.
Under this course he improved for the first fortnight,
after which he failed so much in strength and nervous
energy, appetite and taste for food, that, at the end of the
month, he thought himself “ worse than ever.” I therefore
discontinued the potash, and gave, instead, bichloride of
mercury (1-12th gr.ter in die) in Dark. By gentle perseverance
in this alterative and tonic treatment for about three weeks,
his distressing symptoms gradually disappeared; and by a
change of air and scene, a short sojourn at a distant sea¬
side, bis long-impaired health was re-established.
This case manifests important epileptic symptoms, espe¬
cially affecting the respiratory functions. Pulmonary dis¬
turbance is characteristic of this disease, and is best exem¬
plified in a typical case. A fit is ushered in with a strong
contraction of respiratory muscles, “the epileptic cry,”
closure of the glottis, and cessation of breathing. Convul¬
sive and irregular pulmonic efforts follow, which end in
slow, laborious breathing, and recovery. In the inter-
paroxysmal periods the respiration is frequently obstructed,
inspiration usually difficult. Those abnormal conditions
find a general explanation in widely-accepted principles re¬
garding the medulla oblongata.
The co-relation of this structure with other cerebro-spiail
centres is thus laconically described by Flourens:—“The
cerebrum feels and wills, the medulla oblongata executes,
and the cerebellum co-ordinates.” The oblong medulla is,
therefore, the starting-point of all convulsive movements of
epilepsy, 1 it also embraces the respiratory >tract»8
is the centre of the reflex motor system, 3 and I son.
0 1 Admirably elucidated by Van der K61k in his work on “The
Spinal Cord, Medulla Oblongata, and on Epilepsy/*
2 Sir Charles Bell.
3 Dr. Marshall Hall on “The Nervous
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LITTLE ON EPILEPSY.
August 96,1868. 185
tempted to add, appears to be the organ (if there be
any special one) through which the mind directly commu¬
nicates with matter. Speculators upon the latter intricate
question may find that, the medulla oblongata has stronger
claims to this eminent position than either the heart, cere¬
bral hemispheres, or pineal gland. Extirpate the brain,
spinal cord, or heart, and may not phenomena of life still
be produced? Isolate from other nervous centres the
medulla oblongata—nay, injure slightly its lethal point,
calamus scriptorius, and will not all vitality at once cease?
The part which the oblong medulla acts in the production
of epilepsy seems to be clearly, though indirectly, demons¬
trated by one of our learned transatlantic brethren. In
1862^ Professor Josh. Jones, University of Nashville, U.S.,
wishing to ascertain the therapeutic action of prussic acid,
performed upon alligators very many experiments, which
conclusively proved that the poison only produces its fatal
effects when carried by absorption or directly applied to the
medulla oblongata, and that the first and most marked
phenomena (the spasms) and the respiratory disturbance
which rapidly extinguish life are the immediate effects of the
poison upon the medulla oblongata. 1
It is chiefly in its relation to respiration that we have at
present to regard this structure. To it is specially ascribed
inspiration, while to a yet undetermined segment of the
spinal cord expiration is referred. Analogy supports this
view. Observe the compensating organic and functional
forces of the system, and the character of respiration, which
in a manner resembles the alternate rising and falling of
the scales of a balance. The muscular mechanism by which
this twofold movement is carried on is so directly controlled
by the medulla oblongata that, excitement of the latter,
whether arising from a nervous centre, or periphery, in¬
creases the respiratory function, and is reflected in spas¬
modic or convulsive actions of the muscles of respiration,
which destroys their harmony of action. Viewing respira¬
tion as an automatic movement, its regularity depends
proximately upon the faithful discharge by the inspiratory
and expiratory organs of their reciprocal functions. In
epilepsy, the effects of the undue action of the medulla
oblongata are more strongly marked in the inspiratory
apparatus, which is more directly opposed by a counteract¬
ing force than the expiratory. This force originates in the
anatomical and physiological relations of the thoracic respi¬
ratory muscles. For instance, the internal intercostals
which proceed upwards and inwards act in pulling down
the ribs, and so assist in expiration, in opposition to exter¬
nal intercostals, which go downwards and outwards, and
elevate the ribs in inspiration. The result of such imme¬
diate antagonism is a comparatively fixed state of the
thorax. On the other hand, where such counteracting
forces are less evenly balanced, or where the usual action
of a certain set of muscles is less disturbed, their function is
more natural, as, I think, is exemplified in this disease in
expiration, which is carried on so strongly by the diaphragm,
the abdominal muscles, and perhaps by serratus magnus,
acting from a fixed scapula.
Thus, in epilepsy, the spinal manifestations of functional
derangement of medulla oblongata appear to find an ex¬
planation. In the same way the cerebral disturbance may
be accounted for. Drs. Kussmaul and Tenner are of
opinion “ that both the loss of consciousness and the con¬
vulsions of epilepsy, are the result of sudden and extreme
anaemia of the brain.” 2 I cannot reconcile that conclusion
with more widely known facts. The most fearful bleed¬
ing, as from wounds of large arteries, or from rupture of
aneurisms, or of the heart by a shell in war; the appalling
flooding occasionally met with in the puerperal state, the
profuse and rapid haemoptysis which sometimes ushers in
polmonaiy phthisis, are not necessarily attended with con¬
vulsions and insensibility. On the contrary, such cases are
mote frequently marked by mental acuteness, and physical
relaxation, or composure. The latter condition is often affect-
| TU American Medical Jiecord, December 16, 1867.
KpJtaXic OogYUlsfop from Sftmonb»6 e r K ew Sydenham
I 860 *
ingly apparent after death from gun-shot wounds of the heart,
or from bursting of aortic aneurisms. Kussmaul and Tenner
have endeavoured to prove their theory by tying the arteries
which supply the brain in animals, whereby epUeptic symp¬
toms were produced. Are we, therefore, to refer those
conditions solely to anaemia ! Certainly not. They may,
and often do, arise from hyperamiia, as in some forms of
apoplexy and laceration of the brain. Ligature of the
arteries to that organ arrests its circulation, but how such
results in anaemia and epilepsy is not evident. Such con¬
ditions, could we conceive them to exist, would be in vio¬
lation of a great principle of the “circulation ”—the avoid¬
ance of a vacuum in the heart and great vessels—so
admirably provided against by contractility and elasticity,
molecular attraction, and vis a tergo. This anaemic theory
is also opposed to a generally accepted opinion, endorsed by
Brown-Sequard, that, in a fit the pulmonary functions are
interrupted, the right side of the heart engorged, and the
venous blood reflected upon the brain. It is unnecessary
to pursue those theories any further. The sum of the
labours of many great minds engaged upon this subject,
has afforded a simple and rational explanation of epileptic
phenomena, and has been announced by the persevering
Van der Kolk, who fixes the starting point of the malady
in the medulla oblongata—an impulse from which is com¬
municated on the one side to the muscles of the extremi¬
ties, causing convulsions, and on the other to the cerebral
lobes, inducing loss of consciousness. In bis pathological
investigations of epilepsy, Van der Kolk found enlarge¬
ment of the capillary vessels, and granular degeneration of
medulla oblongata ; and M. Hall remarks that, “every
function of the nervous system is involved in the pathology
of epilepsy.” Hence, a slight increase of tonic condition of
the sympathetic nerves will diminish the vascular supply,
and may so suspend consciousness.
Viewed under those aspects, we find a gratifying
solution to the many difficulties of the present case.
Here the disease assumed a chronic character. It wanted
the frequent repetition of fits and insensibility, which
usually characterize acute epilepsy. It was, nevertheless,
serious, perhaps rare, in its presenting permanent epileptic
symptoms which, under certain circumstances, might end
in the more lamentable type of the disease. A careful in¬
vestigation of the case rendered pretty certain the diagnosis,
which would have been doubtful had examination of the
spinal region been neglected. The history of the case
appeared to point to hereditary taint, rather than to cold
caught after violent exercise, in youth, as predisposing to the
malady. If it originated in the former, according to Dr.
Russell Reynolds, and other high authorities, the attacks
should assume the more grave form, the haut mal. Such
was not the case. Whatever may have remotely led to this
illness, there can be little doubt that the proximate cause
was chronic congestion, or a low inflammatory condition of
a portion of the cord, as above indicated. The grounds,
a priori , which sustained this opinion were—the tenderness
and other abnormal conditions of the spine, and the con¬
stitutional symptoms referrible to derangement in that
region. The result of my alterative, and counter-irritant
treatment has, I believe, confirmed the diagnosis.
The pathological view which I had taken of the case, sug¬
gested the much-extolled bromide of potassium, for its alte¬
rative and hypnotic qualities, as the most suitable remedy.
After having given it, in large doses, for about a month
without benefit, I discontinued it, and resorted to the less
fashionable,but more venerable bichloride of mercury, which
here and in similar cases proved so satisfactory to me. No
doubt there are instances, as from nervous irritability, in
which this salt may effect a cure. But to hold, as some
do, that it is always a specific in a disease so variable in its
causation and pathology is unreasonable. As well may
we say, the same medicine will remove every pain, or
the same hat fit every head. In my former paper, I men¬
tioned a case of the petit mal , then under my observation,
which has since completely recovered by the use of quinine
and iron, with hygienic and tonic adjuvants. It originated
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186 Hi© Medical Press and Circular.
HOSPITAL REPORT.
August 26,1868-
in leucorrhcea and general debility. Dr. Chapman, of Lon¬
don, has relieved some epileptics with the spinal ice-bag.
Vascular and nervous excitement of the spine appear to have
been the pathological causes in these examples. Brown-
Sfcquard effected cures by various means : in one case, by
paring off a small bit of highly sensitive cuticle from the
under part of the great toe. Dr. Duncan, of this city, found
mercury successful when syphilis originated the disease.
Dr. O’Rorke, of Etiniscorthy, speaks very highly of artemcsia
vulgaris and mug-wort beer, which he administered with
great advantage to the epileptic inmates of the workhouse
under his care. In fine, there are some cases which defy
all remedies. Such a one is recorded as haring ended
fatally a short time ago. A post-mortem examination
proved it to have originated in irritation of the liver,
caused by a pin long previously swallowed, and which had
penetrated that organ.
_ The vast importance of this obscure subject, and my de¬
sire to contribute, even in a very small degree, to elucidate
it, are my apologies for encroaching so much upon your
space, and taxing so largely the patience of your many and
intelligent readers.
♦
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Bronchitis.— Caroline C., set. 27, servant. Admitted
January 12 ; discharged January 27. In hospital 15
days. Recovery . Subject to winter-cough. Previously
ill 6 weeks. Cough and scanty expectoration. A little
sibilus over lungs. Pulse 80 ; respiration 20. Head¬
ache ; no appetite ; tongue red ; sleeps badly.
Carbonate of ammonia, chloric ether and coninm (14
days). Then quinine and sulphuric acid.
Bronchitis—Laryngitis.— Mary A. M., a?t. 23, ser¬
vant. Admitted March 29 ; discharged April 16. In
hospital 18 days. Recovery . Hoarseness and cough 3
nfonths ; stridulous inspiration 3 weeks. On admission,
scanty eruption on face ; pains in bones, worse at night;
skin hot and dry. Headache ; bad appetite ; tongue
coated, red at tip and edges; noisy inspiration ; no larvn-
f eal tenderness; slight dysphagia ; wheezing all over chest.
> ulse'124, respiration 24.
Liq. auimon. acetatis, sp. ammon. arorn. and chloric
ether ; steam inhalation ; turpentine stupes ; afterwards
iodide of potassium.
Bronchitis.— Ann D., ret. 46, cook. Admitted Febru¬
ary 5 ; discharged March 19. In hospital 43 days. Re¬
covery. Winter-cough 3 years ; worse last month. On
admission, expiratory sibilus over lungs ; copious frothy
muco-purulent expectoration. Pulse 96. Tongue slightly
furred.
Chloric ether, ammonia, and aramoniacum (8 days);
same with squills and henbane (16 days) ; then syrup of
iodide of iron and cod-liver oil; turpentine stupes.
Chronic Bronchitis.— E. P., set. 33, King’s College
Hospital nurse. Admitted October 29, 1863 ; discharged
January 20, 1864. In hospital 83 days. Much relieved.
Winter-cough 18 years. Previously ill 4 weeks. Rhoncbus
and sibilus all over chest. White frothy expectoration ; 48
days later well and able to work ; 11 days later fresh cough
and shortness of breath.
Carbonate of ammonia, chloric ether, liq. ammon. ace¬
tatis, and senega.
Chronic Bronchitis.—E. P., set. 33, nurse, King’s
College Hospital. Ke-admitted February 11 ; discharged
June 6. In hospital 115 days. Recovery. Previously ill
10 days. On admission face puffy; considerable dyspnoea.
Rhoncbus and sibilus all over luDgs ; orepitation at bases,
fulso 118, respiration 35.
Chloric ether, ammonio-citrate of iron, aromatic spta. of
ammonia and squills ; quinine and sulphate of iron ; sp.
ammon. aroin. and ammoniaeum ; chloric ether, ammonia,
and tinct. lobelke ; henbane and coniurn. Brandy. Tur¬
pentine stupes.
Emphysema and Bronchitis.—W. D., ret. 58, tripe-
dresser. Admitted March 28 ; discharged May 7. In
hospital 40 days. Relieved. Short-winded 12 months.
Previously ill one month. Severe rigors ; cough and
expectoration ; oedema of legs three weeks. On admission
cough troublesome ; urine one-half albumen, turbid with
lithates ; pulse 68, respiration 28 ; physical signs of mode¬
rate emphysema ; slight crepitation and rhonchus at bases
of lungs ; appetite bad ; urine free from albumen a few
days before discharge.
Chloric and sulphuric ether (13 days); carbonate of
ammonia (four days); dilute muriatic acid, chloric ether,
squills, and bark ; purgatives.
Emphysema and Bronchitis.—D. D., net. 59, waiter.
Admitted May 23. Died on May 25. Subject to winter
cough ; worse last few days. On admission, face dusky,
nails and lips blue ; great dyspnoea ; much wheezing over
front of chest; pulse 108, locomotive, respiration 44; urine
albuminous ; no dropsy.
Carbonate of ammonia, chloric ether, and decoction of
senega ; aperients ; dry cupping to back.
Emphysema and Bronchitis.—M aria S., aged 38,
married. Admitted Nov. 9, 1863. Died on Jan. 18, 1864.
In hospital 70 days. Was discharged relieved about a
month ago. Increased oedema of legs and dyspnoea 14
days. On admission, face livid ; legs oedematous ; slight
ascites ; much cough and shortness of breath ; frothy
expectoration ; pulse 104, respiration 36 ; sibilus all over
chest; crepitation at lower part in front and left posterior
base $ dulne«s at right posterior base ; trace of albumen in
urine; the dropsy increased; dyspnoea became severe about
fiftieth day ; six days later the right external jugular vein
became bard, swelled, and painful ; two days later right
subclavian vein swelled and painful; face and right arm
cedematous ; four days later skin sloughing in places;
gradually sank and died on January 18.
Post-mortem, —Right lung universally left partially ad¬
herent ; lungs gorged ; o.i. fluid in pericardium ; right
auricle and ventricle full of blood and much dilated;
tricuspid orifice dilated ; firm clot in right innominate
subclavian, axillary, and internal and external jugular
veins ; much fluid in peritoneum; liv6r slightly cirrhosed ;
kidneys congested.
Carbonate of ammonia, chloric ether and senega (50
days) ; then ammonia and ether ; brandy 12oz.; purgatives,
sedatives, mustard emetics, turpentine stupes, pepsine.
Emphysema and Bronchitis.—J. K., ret. 37, hatter.
Admitted January 2. Died January 4. In hospital 2
days. Formerly in King’s College Hospital for bronchitis.
On admission much ascites and anasarca. Face blue;
severe cough and dyspnoea. Became comatose.
Post-mortem .—Fluid in pleura?, pericardium, and peri¬
toneum. Lungs gorged and emphysematous. Heart 19 oz.
Right ventricle as thick as the left. Tricuspid and aortic
valves thickened.
Carbonate of ammonia,, chloric ether, squills, and senega.
Brandy 6 oz. Jalap and bitartrate of potass. Turpentine
stupes.
Pleurisy. —Maria L., at. 9. Admitted February 17 ;
discharged February 27. In hospital 10 days. Re¬
covery. Has angular curvature of spine at 11th dorsal
vertebra ; anaemic. Previously ill 1 week. Pain in upper
part of abdomen, and general feeling of illness. On ad¬
mission dulness and feeble bruit at right base. ToDgue
slightly furred. Pulse 80.
Cod-liver oil and syrup of iodide of iron.
Pleurisy. —Mary A. R., set. 24. Admitted June 7;
discharged June 25. In hospital 18 days. Recovery .
Acute rheumatism 3 years ago. Previously ill 2 days.
Acute pain and tenderness at right scapular angle ; pain
in knees ; vomiting ; cough ; and- expectoration^ On ad*
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The Medical Press and Circular.
LITERATURE.
August 26,1668. 187
mission tongue furred. Pulse 106. Rhonchus over lungs;
slight dulness at right posterior base ; 2 days later pleu¬
ritic rub at right scapular angle ; 3 days later free from
pain, no rub. Pulse 80.
Chloric ether and Uq. ammon. acetatis (7 days); qui¬
nine and iron.
Pleurisy. —Harriet T., aet. 27, drapers assistant. Ad¬
mitted February 26 ; discharged April 2. In hospital 36
days. Recovery, Previously ill 14 days. Pain in right
side ; paroxysms of dyspnoea ; occasional vomiting ; ex¬
pectoration sometimes streaked with blood. On admission
pallid ; frequent cough ; greenish expectoration. Pulse
108, respiration 36. Dulness, feeble bruit, and faint cre¬
pitation below angle of right scapula ; 3 days later no
vesicular bruit below right scapula ; pleuritic rub at right
anterior base ; 10 days later no crepitation or rub.
Liq. ammon. acetatis and chloric ether. Afterwards
quinine and iron. Cod-liver oil.
Pleurisy. —Benjamin B., beggar. Admitted June 27 ;
discharged July 20; In hospital 23 days. Recovery.
Four attacks of pleurisy (right side) in last five years, the
last 18 months ago. Previously ill 6 weeks ; shivering ;
pain in right hypochondrium ; dyspepsia ; thirst ; loss of
appetite ; dry cough. On admission weak and drowsy ;
sordes on lips and teeth ; tongue dry and brown. Pulse
108 ; respiration 36 ; dim-expansion of right side ; dulness
and absent vocal vibration over lower part of right lung ;
breathing absent at base ; distant above ; crepitation over
upper part of posterior lobe ; line of dulness extending to
1 inch above angle of scapula, and 1 inch below nipple ;
chest free from abnormal sounds on July 16th.
Carbonate of ammonia and chloric ether (8 days). Then
quinine and dilute hydrochloric acid.
Pleurisy. —A. A. T., a;t. 21, porter. Admitted Febru¬
ary 13 ; discharged March 19. In hospital 35 days. Re¬
covery. Previously ill 3 weeks ; shivering; headache ;
vomiting ; dyspnoea ; pain in right side. On 3rd day
after admission slight dry cough ; pulse 92; respiration
32 ; dulness and absence of breathing and vocal vibration
below 3rd rib in front, and 1 inch above scapular angle
behind ; tongue dry and red ; appetite bad ; bowels con¬
fined ; urine one-half albumen (free from albumen 3 days
later). 23 days later, dulness over whole of right lung ;
friction sound below right nipple.
Liquor ammon. acetatis, sp. ammon. arorn., and tinct.
camph. co. (12 days). Then dilute muriatic acid, quinine
and chloric ether, ol. morrhuoe. E. L. to right side.
Pneumonia. — E. N., aet. 62, carpenter. Admitted
January 29; discharged February 20. In hospital 22
days. Recovery. Three weeks ago, after rigors, was laid
up for a few days. Four days ago, vertigo, nausea, dysp¬
noea, cough, and rusty sputa. On admission, cheeks
flushed ; skin hot and dry; headache; shortness of breath;
pain in upper part of abdomen. Pulse 104 ; respiration
32. Dulness and medium crepitation over right lung, be¬
low 4th rib in front, and scapular angle behind ; bronchial
breathing and bronchophony behind, pleuritic rub in front; 3
days later crepitation up to scapular spine behind, and
2nd rib in front; 9 days later crepitation to 1 inch below
scapular angle; 7 days later breathing clear ; appetite
good.
Liquor ammon. acetatis, chloric ether, sp. ammon. arom.
and tinct. scillse. Afterwards quinine and dilute muriatic
acid. Brandy 12 oz. Turpentine stupes.
Pneumonia. —H. H., aet. 17, groom. Admitted Decem¬
ber 1 ; discharged December 31. In hospital 30 days.
Recovery. Subject to cough. Previously ill 3 days. Pain
in limbs and left side of chest; cough ; expectoration ; loss
of appetite, and feverishness. On admission, skin hot;
headache; tongue coated. Pulse 116. Dulness; dimin¬
ished vocal resonance, and thrill; fine crepitation, and
some bronchial breathing below left scapular; blood streaks
in expectoration. Much epistasis after admission. Lung
normal on 15th day.
Ido* ammon. acetatis (7 days); aromatic spts. of am*
ynqma, chloric ether, and liq. cinchona (9 days); then
quinine and dilute hydrochloric acid. Blisters. Aperi¬
ents.
Pneumonia* —Henry M., ret. 17, no occupation. Ad¬
mitted March 28; discharged May 28. In hospital 61
days. Recovery. Has lived badly of late. Previously
ill 1 week. Shivering and lassitude; deafness and
drowsiness. On admission, face flushed ; skin hot and
dry. Pulse 120 ; respiration 40. Expectoration more or
less rusty till 37 th day after admission ; deeply tinged
with blood on 17th day after admission. Dulness ; fine
crepitation, and increased vocal resonance over right base ;
10 days later bronchial breathing and crepitation below sca¬
pula; 19 days later lower two-thirds of right lung dull; bron¬
chial breathing and fine crepitation at scapula angle ; dul¬
ness and harsh breathing at left base; 17 days later breath¬
ing everywhere vesicular.
Liquor ammon. acetatis, arom. spts. of ammonia and
squills ; afterwards dilute muriatic acid, squills, chloric
ether, and liq. cinchona; cod-liver oil. Aperients. Brandy
12 oz.
-»-
librdim.
THE RECONSTRUCTION OF THE ARMY.
That the entire system under which our army is at present
recruited, officered, and administered will at an early date be
subjected to a more severe criticism than it has yet undergone,
is now evident Mr. Trevelyan has already prepared the
House of Commons for what promises to bo a successful on¬
slaught against the disposal of commissions by purchase. The
Treasury and a large portion of the press have condemned the
double government under which this branch of the public service
is administered; and now Sir Charles Trevelyan 1 has published
an excellent treatise, in which he clearly points out the exist¬
ing defects and their remedies, having in view nothing short of
the reconstruction of the entire military machine.
In no other state of society than the army of this country do
the old usages of feudalism still remain in force. Between the
officer and the private a great gulf exists. The distinction is
essentially one of caste; but like many other usages of medi¬
aeval times, it must give way with the advance of opinion. That
the army should be anything else than a representation of thp
nation; that it should be either more aristocratic or more
democratic than the rest of English society, seems mon¬
strous ; and that perseverance and proved worth should
not obtain the Bame position of fortune and distinction in the
military service that they command in other positions in life,
is a principle far behind the spirit of the present time. The
question comes to be, how are these conditions to be improved?
The answer immediately follows, abolish purchase, and in¬
crease the pay of all ranks sufficiently to enable them to live
upon it in a suitable manner ; or, in other words, make the
infantry and cavalry branches of the service what the artillery,
Royal engineers, and several departmental corps are, a life
long profession for the officers who join them. Another in¬
novation, in regard to present usagts, would be the promotion
of an increased proportion of non-commissioned officers to com¬
missions, a measure which, probably more than anything else,
would serve to induce the yeomen class of our countrymen to
enter the army, and thus indirectly undermine much of that spirit
of restlessness , to call it by no harsher name, which, it is to be
feared, is sown somewhat freely among the partially educated
of our population.
As to the question of retirement, there need be no greater
difficulty than now exists in regard to the corps and depart¬
ments in which promotion by purchase is not now observed ;
and it may be assumed that as with them the applications are
few to retire, or for leave of absence, in times of active service,
the country would considerably gain by the substitution of
such a state for that which was attributed to purchase officers
during the Crimean war and the Indian mutiny.
That the volunteers and militia are, in their present condi¬
tion, utterly useless as a means of defence seems to be all but
universally acknowledged, and that our regular army is ham¬
pered and burthened instead of strengthened, by the numbers
of old soldiers in its ranks, is a fact which has, perhaps, become
more apparent than it was before, since General Trochix called
1 “ The British Aray in 1868." London; Lon gm ans, Green, and Co.
Digitized by vJivJvJV Lv^
188 The Medical Press and Circular.
CHOLERA AND WATER.
August 96,1868.
attention to a similar defect in the French army. Sir Charles
Trevelyan would remove both evils by instituting an army of
reserve, upon a footing which he details, and which is in many
respects different from the principles in which the force under
that name is now being instituted. He would reduce the term
of first enlistment from twelve to seven years, thus young men
would generally leave the service at twenty-five, most of whom,
he thinks, would join the reserve and settle down as married
men. It is to be feared, however, that only in the United
Kingdom, if even there, would his hopes be at all realised.
Abroad, and especially in India, the greatest rate of mortality
prevails among men under twenty-five years of age, and
those who survive that period would, in all probability, not be
generally disposed to return to Britain. Another of his sug¬
gestions is a most excellent one. He would have regiments
quartered in the counties to which at present they but nomi¬
nally belong ; he would have the regiment of militia somewhat
in the nature of a second battalion to that of the line, instead
of the present anomalous depot battalion system, he would
have regimental depots as of old ; and we may add that, ac¬
cording to our view, were the corps of militia to be officered
by line officers in the reserve list, as the soldiers of that de¬
scription, the bond of union between the various branches of
our military forces would bo much more intimate and
stronger than it now is.
On the subjects of marriage in the army, and on the vice of
drunkenness among the soldiers, we cannot now enter. Suffice
it to observe that the pamphlet on which our present remarks
are based is an able and suggestive one, and well deserving
the serious attention of all who are interested in the question
of the military force of our country.
Kbgistered for Transmission Abroad.
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, AUGUST 26, 1868.
CHOLERA AND WATER.
It will naturally be expected that a journal which has
devoted so large an amount of space to the theories of
cholera, should notice the last manifesto in favour of the
water theory. Dr. Farr of the Registrar-General’s office,
has summed up in his report, which, w ith the appendix,
extends to 400 pages, the account of the epidemic of 1866,
and his conclusions from the facts recorded. We may
state at the outset that Dr. Farr remains of the same
opinion as he has hitherto expressed as to the outbreak
having been due to the distribution of unfiltered water by
the East London Company.
It is not our object here to controvert his conclusion;
indeed, we have no wish to take either side in the con¬
troversy. We have given full space to the several theories;
we have discussed the objections to Dr. Farr’s hypothesis,
because too many of our contemporaries had closed their
columns to all that did not agree with it, but we have no
intention of imitating their tactics, by refusing to give cur¬
rency to Dr. Farr’s opinions, which are entitled to the
greatest respect, and which, we are sure, that able officer
would himself wish to see subjected to criticism.
We shall, therefore, give to some extent, in his own
words, a brief outline of the report in question. It starts
with the statement that in the East London water-field
nearly 4000 persons were carried off, while in other dis¬
tricts the epidemic was not more severe than might be
anticipated from the diffusion of cholera-matter through
sewers and other modes of distribution.
Dr. Farr speaks of the objections that have been urged
to his views under the head of statistical fallacies, but no
doubt his opponents will be ready to argue that his own
conclusions would be correctly described in those terms.
He says :—
“ One fallacy necessarily makes a strong impression upon the
mind. House after house supplied with East London water
can be taken in which no death, or even ^ase of cholera, oc¬
curred ; and here the reasoning takes this form :—These houses
were supplied with the East London water during the epi¬
demic ; they were not visited by cholera ; therefore the East
London water was not the cause of cholera. This fallacy turns
on the use of the word ‘ water* in two totally different senses.
No one for a moment pretends that pure ‘water* can be the
cause of cholera. It is some matter in that ‘ water,* the word
serving to designate in chymistry a compound of oxygen and
hydrogen, but in common usage a fluid consisting of the most
various compounds, inorganic and organic, in the Btate of germ,
of fuU life, or of death ; and compounds, too, which must
necessarily, from the nature of the water supply, be unequally
distributed in the waters—in one house in inconceivably small
quantities, in other houses in large doses, in one house among
susceptible, and in other houses among insusceptible people. To
show that a portion of this water is taken with impunity, and
still less to show that the people in certain houses in East Lon¬
don did not die of cholera, is ng proof whatever that the cholera
leaven was not present and fatal in other portions of the East
London water supplied to other houses. Eels, as we have seen,
were found in the water of a certain number of houses in East
London. To argue that in hundreds of other houses no eels
were found, and that, therefore, the company never distributed
eels in the district, would be absurd. The fallacy of such
reasoning is transparent. It assumes the form—if no eels are
found in the waters of a certain number of bouses, none exist
in the waters of any houses. As the eels are limited in num¬
ber they cannot be distributed universally, and the fact that
they were discovered in one house and not another would de¬
pend on laws and circumstances so intricate as to make the
ascertained distribution anomalous, but not necessarily more
anomalous than the distribution of the lower forms of organ¬
ised matter to which the phenomena of cholera in man are
due.’*
Now here it will be observed many conjectures are taken
as if they were well -ascertained facts. We do not think
objectors can be fairly charged with using the word
water ia the loose way stated. We have read more
that has appeared on the subject, and that fault has not
appeared to us so palpable. Again, the comparison with
eels is altogether beside the mark. Granting that there
may be a ponderable, physical, poison as the cause of
cholera—and this is granting more than can be proved—
is it fair to compare eels, of dimensions large enough to
stop up the pipes, with the minute, invisible particles con¬
jectured to exist, and which Dr. Farr himself calls
“ leaven,” and in other ways describes as necessarily pol¬
luting the whole mass of water to which they have gained
access ? It seems to us, as impartial spectators of the con¬
troversy, that this argument is of no value. It might as
well be asserted that because particles of sand or dirt are
found in our cisterns, therefore cholera-poison is also there
Indeed, this would be more pertinent, for small particles
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NOTES ON CURRENT TOPICS.
August 26,1868. 189
like this find access to every cistern in London, simply, w£
fancy, because, they are small, and are thus easily carried
along in the stream. Why, then, should not the infinitely
smaller and lighter cholera-germs be as equally distributed?
This question will be seen to be of greater force if we
look to the explanation offered us of the immunity of North
Woolwich and Stamford Hill, though drinking the same
water. Dr. Farr writes as follows:—
“As the direct distance from the Old Ford reservoir to
North Woolwich is above four miles, and the water appears
to travel along one low arterial main, which is kept always
full, it is evident that if suspended cholera matter undergoes
any change it will be modified before it reaches North Wool¬
wich, and will necessarily be diluted as the heavier molecules
fall down on the way. The main leading up to Stamford Hill
(about three miles and a-half) wilTby gravitation be prevented
from conveying all the matter of a heavier specific gravity than
water up to the height of that reservoir. But such a sudden
influx of the pond water of Old Ford as is described by the
witnesses would be injected at once with some velocity into
the near empty pipes, yielding water on the intermittent sys¬
tem. And here one of the many advantages of the constant
system of supply is evident: under it fresh zymotic matter is
less likely to be thrown into people’s dwellings at a distance.
“ In the two remoter regions the epidemic took the milder
form of diarrhoea, and this may be due either to the accidental
diversion of the matter from their mains, or from its greater
dilution and age.”
Now, we think it would be quite fair to reply that the
cisterns at Woolwich and Stamford Hill contain plenty of
mud—particles of matter that have been brought by the
water, and have settled down after it is at rest ; particles,
too, thousands of times heavier than the germs supposed to
be distributed so irregularly, and some of which are thus
suggested to have settled on their way by mere force of
gravity.
If it be also assumed that these germs rapidly propagate
at ordinary temperatures, out of the body, the argument of
dilution loses much of its force, but this assumption seems
almost too much to ask, and therefore Dr. Farr sets him¬
self to account for the facts on the less daring hypo¬
thesis
M It may appear at first sight impossible that the cholera
flux of one or more patients should produce any effects in the
waters of a river like the Thames. The average quantity of
this flux is large, but it has not been determined directly, and
it varies with the severity or the duration of the disease.
Applying Pacini’s data to the fatal cases of different durations,
it is found that the average volume of the dejections in a
cholera case Is equivalent to 8*24 litres. How many cholera
corpuscles this quantity contains cannot be calculated. They
are exceedingly minute. By Pacini’s estimate 1000 millions
would not occupy more space than a cubic millimetre ; and
there are a million cubic millimetres in a litre of water. The
number of litres in the river Lea at high water is 1416 millions ;
at low water, 142 million litres. And,•according to Vierordt,
one litre of blood contains about 5069 million globules, con¬
sequently, the corpuscles in the eight litres of the flux from a
patient, if in equal density, would run up to 41,566 millions.
It is certain that the flux finding its way down the sewers
would not be equally distributed in the river Lea for instance,
hut in the water would be in irregular masses like clouds in
the sky; and that at some points a quart of the waters might
contain hundreds or thousands of corpuscles capable of propa¬
gating their numbers by millions in the mucous membranes of
the stomach and intestines. Whether the cholera corpuscle
°an propagate itself in sewage water at a high temperature is
n °t yet known, but its diffusion is adequately accounted for
on the hypothesis that it is only propagated in the living
organism.”
Nothing could show better fhan this quotation the in¬
finitely small particles with which the hypothesis deals, and
consequently the force of the contrast we have ventured
to oak* between them and the grosser, visible, palpable
particles of matter that are distributed so equally in all
our cisterns.
In running rapidly through this important report, we
have thus, as will be seen, noted a few things to which we
venture to take exception. There are other points to us
equally doubtful or hypothetical, but we need not dwell
further upon them, as we have no doubt that able men will
at once examine and sift the facts and conclusions. It is
from the conflict of views that may occur that we may hope
for some further enlightenment.
The report contains a vast mine of facts and statistics,
and will, no doubt, be the armoury whence both sides will
draw their weapons. The statistics, as a whole, of the
several water-fields, for instance, present figures that will,
in the opinion of many, amply justify all that has been
said by Dr. Farr ; and after what we have written, it is
but fair to state the summary. We find, then, that the
mortality from cholera in 1866 in each of the water-fields
of London thus given:—The proportion of deaths to 10,000
inhabitants was four in the field of the Chelsea Company,
four in that of the West Middlesex, three in that of the
Grand Junction (the proportions being nearly the same
where the districts were supplied conjointly by these com¬
panies), four in that of the West Middlesex and New
River, eight in that of the New River, thirty-four in that
supplied conjointly by the East London and New River,
seven in that of the Southwark, fifteen in that of the Kent,
three in that of the Lambeth, six in that of the Lambeth
and Southwark conjointly, six in that of the Lambeth,
Southwark, and Kent conjointly, and seventy-three per
10,000 inhabitants in that of the East London Company.
Figures like these certainly deserve serious attention,
and whether the assailants of what we may now, we sup¬
pose, call the official theory of cholera, succeed in disprov¬
ing it or not, it is well that they should be published as
widely as possible. Indeed, all statistics of this descrip¬
tion have a high value, and we regret that want of space
prevents us from entering at present upon many other sub¬
jects which are opened by the report before us.
We can only here add that much information is to be
found in this volume, not only about the epidemic in Lon¬
don, but throughout the country; while in connection with
the former part, the various plans for supplying the Metro¬
polis with water are discussed, and the propriety of seeking
our supply from a distance is urged, although full justice
is done to the attempts of the several companies to comply
with the Water Act.
-♦-
grits on Current legits.
Oxford University.
Tiie gates of the University of Oxford are to be no more
closed to all who cannot afford to enter her aristocratic
Colleges, or will not submit to their rules. The youth of
the country are freely invited to enter the Mediaeval Univer¬
sity, select their own tutors and their own lodgings, live in
the manner they have been accustomed to do, or may wish
to try and avoid or choose associates as they please.
“Unattached” undergraduates will be free to select any
of the “licensed tutors,” who will, as it were, be the
“ heads” of colleges or communities having no fixed resi¬
dence.
We cannot doubt that there are many who will see in
this a great stride, and will rejoice to see an Qxford career
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190 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
August 26, 1868.
thus freely opened to all; and we hope the University may
attract its share of the young men who may adopt the
Medical Profession.
We can well afford to increase the small proportion of
Oxonians in our ranks. A single year at Oxford before
beginning professional study must prove of great value,
but we hope many will go and take a degree in arts as
their preliminary examination.
London Hospital.
At a recent Court of the Governors, it has been resolved
that in future the style of Physician or Surgeon shall be
conferred on those members of the assistant staff who have
held office for seven years.
Under this regulation, Dr. Langdon Down and Mr.
Maunder will henceforth have respectively the title of
Physician and Surgeon to the Hospital.
An additional Assistant-Physician and Surgeon is about
to be appointed.
The “Dreadnought” Hospital Ship.
Wb regret to learn that the Committee of the Seamen’s
Hospital Society, despairing of obtaining funds to build on
the site which they purchased some time since, or obtaining
from the Government any suitable accommodation in
Greenwich Hospital, are putting the old “ Dreadnought”
into repair for an expected continuance of its occupation.
The patients have been temporarily transferred to the
“ Belleisle,” and, we believe, only wait the repairs of their
former quarters to be sent back to it. It is a standing pub¬
lic disgrace that the sick of the merchant service should
have no more suitable refuge than an old hulk, cramped
and inconvenient as a ship must necessarily be, and en¬
veloped from year’s-end to year’s-end in a fog of Thames
miasmata.
The West Middlesex Coronership.
The legal question in connection with the lata election of
Dr. Diplock as coroner has again been before the Middle¬
sex magistrates. As yet, Dr. Diplock, though he discharges
the duties of the office, has not obtained a shilling of
salary, and the magistrates have again declined pendente life
to take the responsibility of paying over the money. On
this occasion, Dr. Diplock offered the magistrates an indem¬
nity for the amount, but his request was refused again,
and we learn that after all, if the election should be
declared invalid, the sitting coroner will not get a shilling
for his services, but the salary will go to Dr. Hardwieke.
It is a valuable privilege of suitors at law, that they are
permitted to work hard, while their attorneys are spinning
the endless thread, and that they have the agreeable in¬
centive of knowing that very possibly the fruit of their
labours will go to their antagonist.
The British Association for the Advancement
of Science.
The great Norwich meeting, referred to in our last, has
taken place, and will unquestionably rank as one of the
most successful.
Norwich has, indeed, this year been highly favoured,
for in addition to this great gathering of scientific men, it
has been able to show what its own Fine Art Association
can do.
It has further inaugurated a Norfolk and Norwich Hor¬
ticultural Society; and the third session of the Interna¬
tional Congress of Prehistoric Archaeology is now sitting in
the quaint old city.
The routine business having been transacted during the
day, in the evening the Duke of Buccleuch, in a brief
speech, yielded the office of President for the year to Dr.
Hooker, who then delivered his inaugural address. This
was an able review of the past year’s progress in science,
especially in fossil botany and vegetable physiology, and a
masterly criticism of the Darwinian philosophy.
The Annual Report of the Scottish Registrar-
General.
This report has been completed for the year 1865, and the
curious wrill there find abundant information on the births,
marriages, and deaths.
To the last item we turn first, as that most thoroughly
within our province, though the two others are almost of
equal concern to us.
In Scotland, the death-rate for 1865 was one-and-a-half
per cent above the average of nine years. The country
districts showed a much lower proportionate mortality
than the towns. In the death-rate of the eight principal
towns, the variation is very great. Leith is at the bottom
of the scale, with 24-9 in the 1000, and Greenock is at the
top, with 39*5 per 1000. When we come to the statistics
affecting the infants under one year of age, Greenock still
shows the same high-rate, full of foul smells, bad living,
overcrowding. In Greenock, out of every 1000 children bom
in 1865, it is recorded that more than 25 per cent, perished
in the first year of their age. Figures like these demand
the attention of the local authorities.
The Penalty of Unqualified Practice.
The Medical Practitioners of Oldbury, who have taken so
decisive a position in respect to the scale of sick-club re¬
muneration, have succeeded in striking a further severe
blow against the underselling system. They prosecuted a
person named Holland for having, without qualification
under the Medical Act, issued a death certificate, in which
he described himself as Surgeon; and secondly, for having
acted as Surgeon to a Friendly Society. Despite every effort
of the prisoner s counsel to raise a technical defence, both
charges were declared proved, and a fine of £5 imposed in
each case. There were nine other accusations, but they
were all w ithdrawn, the object of the prosecution having
been attained.
The Chair of Botany in Trinity College,
Dublin.
The election to this chair, to which we recently alluded,
is necessarily postponed to a distant period by the regula¬
tion which requires that it shall not take place for at least
three months from the advertisement of the vacancy. To
the names of Dr. Edward Percival Wright, Dr. Browne,
and Mr. McNab, which we have already mentioned, those
of Mr. Cleghorn and Mr. William Archer, the well-known
physiological botanist of Dublin, have been mentioned.
W r e are in a position, however, to state that the latter
gentleman has no present intention of seeking the vacant
professionate. As the interval before the election is so
distant, and the position is now open to the competition of
“ all persons,” without religious, professional, or Academic
reservation, it is not improbable that other candidates may
yet present themselves.
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The Medical Prose and Circular.
NOTES ON CURRENT TOPICS.
Augusta#, 1868. 191
The Naval Medical Service.
Be the causes of the dearth of Naval Surgeons what they
may, there can be no doubt that the Admiralty is at this
moment in a state of blockade, and the garrison is all but
starved out. Their beleaguered Lordships are hard pinched
for medical nutriment, and they are—if the simile be not
considered disrespectful—almost brought to the alterna¬
tive of what is known as boot-eating. The choicer morsels
of the Profession have long since been strange in Somerset
House, and the medico-educational dietary of their Lord-
ships comes to be selected on the simple principle of taking
what they can get, and thanking Providence it is not worse.
If we are to accept the report of the Naval Medical
Competitive (save the mark l) which we have received
from a reliable source, we should denounce the examination
a3 a farce played out to satisfy the public with the poorness
of the actual performance. We narrate our story from the
lips of a successful candidate who has accepted service, and
is an entirely unprejudiced witness.
On a stated morning the candidate presents himself at
Somerset House, and submits his certificates to examina¬
tion by a clerk, who, we will suppose, is satisfied with them,
and orders the candidate to be brought up for the ordeal
the next morning at a specified hour. In a state of semi-
collapse, inadequately neutralised by a diffusable stimu¬
lant, the trembling candidate punctually appears. He
waits an hour (stimulant effect passed and gone, and the
reaction of depression developed), when he is handed a
single written question of the simplest kind, to which with
pleasurable alacrity he writes an answer at the clerk’s
desk on the back of a ledger, and is charmed to learn that
he may depart, which he does with remarkable nimbleness
—and thus his second day of examination. On the morn¬
ing of the third day he is put through a physical investiga¬
tion, and stowed away in a musty waiting-room for half-
an-hour. He is then summoned to the presence of the
dread Triumvirate, who proceed to examine on muscular
anatomy, and wind up with turn questions in surgery.
Having answered or missed these questions, the candidate
is again remitted to solitary confinement for a short time,
during which period, it is presumed that he is declared
learned in the whole art and mystery of anatomy and sur¬
gery. The same process then followed with questions in
physiology, practice of medicine, and midwifery, and the
prisoner again remanded to a new examination in botany,
materia raedica, and chemistry. An awe interval for the
consideration of sentence, and the happy chosen is an As¬
sistant-Surgeon in her Majesty’s hospitals and fleets. The
entire process, with intermediate delays, occupied less than
two hours, and, be it said with horror, left the impression
on the irreverential mind of the candidate that' the whole
-affair was a farce, and that two out of the three examiners
accepted his answers sub silmtio t being a little doubtful in
their own minds whether the reply was right or wrong.
No record of the answering was kept, as far as the candi¬
date could observe, and the question is cogently asked, on
what principle does the Admiralty carry out its guarantee
to promote the best answerers to their surgeoncies at an
earlier period than would occur under ordinary circum¬
stances.
The examinations for the admissiofi of Assistant-Surgeons
into the Army were concluded last week, and in our last
Wie we gave the printed papers, which have been read
iatoreit. For the first time the test for the selection
of candidates has been really competitive, for the Director-
General has been in the position of rejecting eligible candi¬
dates, the entire number of vacancies having been filled up.
At the Chelsea examination 39 candidates presented
themselves for 21 vacancies, of these a greater number
than the 21 evinced sufficient proficiency for the service,
but were sent back for want of room.
It would appear not only a hardship on these gentlemen
to compel them to go through a second examination, hav¬
ing once tested their competency, but injudicious on the
part of the authorities to refuse suitable candidates at a
time when they experience so great a difficulty in meeting
the requirements of the service.
We are favoured by Mr. Richard Griffith, resident at Mr.
Barter’s Hydropathic Establishment at Blarney, with a
printed copy of his “ reasons for objecting to the process
of vaccination,” published by him as a protest against a
prosecution instituted by the Cork Guardians for omitting
to have his child vaccinated. With every desire to do
Mr. Griffith justice, we cannot transfer to our columns
arguments and statements against which not only the en¬
tire profession, but (with an utterly insignificant exception)
the whole educated community have made up their minds.
We cannot, however, but notice the fact that the entire
basis of the anti-vaccination argument is ridiculously illo¬
gical, when regarded from practical grounds. It is per¬
sistently declared by the opponents of vaccination that it
ought to be discountenanced, because it implies the delibe¬
rate introduction into the system of a poisonous virus.
We need not proceed to argue the totally unproven state¬
ment that the vaccine virus is neither, in its effects on the
system, or in any real sense of the word, a poison. It ap¬
pears sufficiently ridiculous for any person to declare that
it is “ sinful ” to substitute a comparatively harmless anti¬
dote for the risk of a loathsome and dangerous disease
We presume that no one would vaccinate if there were
nothing to be avoided by the process, yet is pure non¬
sense to fulminate against the adoption of a safeguard,
even if we are to call it a poison, for an enormously dis¬
proportionate risk. If the anti-vaccinators have no better
reason than such special pleading, and no better scientific
testimony to adduce than that of Dr. Collins and Dr.
Marsden, their cause is unworthy even of discussion. In
our opinion it is perfectly right and proper that no indi¬
vidual who may foster a delusion which he has had every
opportimity to neutralise, should be permitted to extend
the ill results of his monomania to the detriment of the
health, or the endangerment of the lives of those whom
he may be in a position to control.
The Cattle Plague Orders.— A splendid heifer,
a present to her Most Gracious Majesty the Queen of Great
Britain, from his Serene Highness the Duke of Saxe Coburg,
arrived in Hull by steamer on the 14th inst. The orders of
the Privy Council as to cattle, direct that all foreign cattle
landed at Hull shall, after a specified time, be slaughtered.
The heifer from Saxe Coburg, although consigned to the
Queen, was therefore detained, and is still in Hull in the keep¬
ing of the Custom-house authorities. Fortunately for the life
of the heifer one order of Council has a clause allowing the
cattle to go seaward, so on Saturday next her Majesty’s pre¬
sent will, under a bond for £100, be forwarded by steamer for
London, and there she will be transhipped to Southampton,
from whence, after a quarantine of 28 days ahe will, under a
certificate, be taken to the Royal farm at Windsor. This case
affords an illustration of the practical difficulties of administer*
ing the cattle-plague orders of the Privy Council
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192 The Medical Press and Circular.
CORRESPONDENCE.
AngtutM, 1868.
REPORT ON WINE
AND ITS ADULTERATION.
[specially prepared fob the medical PRESS AND CIRCULAR, j
No. IX.
When treating last year of port, it will be remembered
that we drew special attention to the prevalent custom <tf
over-fortifying, and our observations called forth such con¬
fident denials and out-spoken resentment, that we felt
constrained to give copious quotations from official reports
in confirmation of the conclusions at which we bad arrived.
These conclusions are, we may fairly boast, now undeniable,
and we are confident that what we have to say now upon
sherry will be hereafter recognised as equally authoritative.
Yet, as there are plenty of captious persons abroad who
know not to what our experiments tend, and are more
deferential to authority of a different kind, we shall pre¬
cede our own statements by those of an official sent to in¬
vestigate the wines of Spain and Portugal, and to whom
we have before had occasion to refer. We allude to Mr.
Charles Bernard, assistant - surgeon at H.M. Customs,
whose accuracy has never been impugned, and from whom
we extract the following paragraphs, which contain a just
estilnate of the matter up to the time of our taking Up the
inquiry:—
“ The large shippers and vineyard proprietors of Spain and
Portugal are, and have been for a long period of time, manu¬
facturers rather than simple producers of wine. The practice
said to be followed in other countries, of merely watching and
aiding nature in the development of fermentation, has here
superadded to it a system of mixing and fortifying that tends
to produce an intoxicating rather than a purely exhilarating
beverage.
“ An opinion seems generally prevalent among the growers and
shippers that natural wines will not maintain themselves sound
unless assisted by the addition of distilled spirit. Even to
some extent, where it is not the practice to add spirit to the
‘ must,’ as in the case of the Montllla, Val-de-penas, &c., it is
usual, and considered necessary, before the wines are made up
for exportation, to add spirit to a greater or less amount. I
am not prepared to endorse this statement fully.
“ It may be as well to give here a resumd of the general prac¬
tice in the Xeres districts of preparing wine.
“ No spirit is added to the * must* during the process of manu¬
facture or pressing the grape at the vineyard, unless it is in¬
tended to be made ‘ sweet wine,’ and then six arobas (equal
to about twenty-one gallons of spirit, about 60 per cent, over
proof.) are added, in order to prevent fermentation, and to re¬
tain its sweetness ; and when this sweet wine is drawn off the
lees, about six months after it is made, three or four gallons
more spirit are added, making in all between twenty-four and
twenty-five gallons spirit to the butt. This sweet wine is not
usually exported, but is used for the preparation of other
wines intended for the English market, and is added to other
wines to give body, flavour, and strength, in such proportion as
is deemed necessary according to the style and taste required.
“ The wines intended for white dry wines, and eventually
to be made up into what is known in England as * sherry,’
have about two gallons of spirit added to the butt when drawn
off the lees in the month of March or April following the vin¬
tage, and during the rearing of them further small quantities,
from time to time, as required. Those wines selected for vino
fino, Amontillado, and Manzanilla, in lieu of having spirit
added to them, are thrown on to Soleras; or fine old mother
wines which, by age, care, and attention, have acquired a body
and character, and which are used in mixing with other wines,
to improve them. The stocks of Soleras are always kept up
in the following manner:—
Say 20 butts, 1841; half drawn off for use.
20 butts, 1842; half thrown into 1841.
20 butts, 1843; half thrown into 1842.
And so on from year to year, the younger wine being thrown
on to the wine of the year previous.
“ Notwithstanding the quantity of spirit (two gallons) used in
rearing wine (net AmontUlado, vino fino, and Manzanilla), it
is usual, when it is made up into sherry for England, to add
at the time of using it, from two to four gallons more spirit,
according to the quality and age of the wine. There is, how¬
ever, no standard sherry made up, and no regulated quantity
of spirit used, as that depends both on the character desired by
the purchaser, and (a most important consideration) on what
the wine itself requires.
“ A butt of sherry for England is made up in 40 jars in
various proportions ; thus, for example :—
1 Jar, spirit, about 60 over proof.
8 Jars, of the sweet wine or dulce.
7 Jars, soleras, or mother wine.
10 Jars, dry wine, 1854.
14 Jars, dry wine, 1859.
40
“ The Amontillado is entirely a chance wine, that is, it can¬
not be made as a matter of course, or reckoned upon with
any certainty, insomuch as out of 50 butts of wine made at
the same vineyard, under the same circumstances and with
the same kind of grapes, probably only two or three will turn
out to be wine of this character. No reason, however, can be
assigned for its partaking of the peculiar flavour, Ac., of
Montilla wine, from which it derives its name.
“ When the wines are classified in the spring, those which
from their taste and style are likely to turn out Amontillado
and vino fino are marked in a certain manner, put aside, and
are carefully watched and reared, but it does not unfrequentlv
happen that, after the selection, they fall off, and become rick
and out of order, when they are treated in the same way as
other ordinary white wines, and spirit is added in the propor¬
tion deemed requisite to secure them from spoiling; should
the wine, however, not recover under this treatment, and
acetic fermentation supervene, it is then sent for distillation
into brandy.
“ The wine of Benicarlo intended for exportation is forti¬
fied to the extent of five gallons per pipe, though two and a-
half gallons would be considered sufficient to preserve it for
home use. Here, again, but little stock is kept on hand, each
year’s produce being generally sold for exportation, or con¬
sumed by the time the new wine is made; and it was impos¬
sible to procure samples of natural wine of former vintages.”
-» - -
(&fnxn$snx)nixtt.
REPRESENTATION IN THE MEDICAL COUNCIL
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —I do not quite agree with all that has been stated by
yourself and your correspondents as regards the representa¬
tion of the profession in the Medical Council. I must say
that I think it a bad thing to try to reform the Universities
and Corporations as well as the Medical Council all at once.
I go in for the direct representation of the registered prac¬
titioner in the Council, as distinct from the Crown nominees
and Corporation delegates.
The Corporations are not likely to permit their delegates to
be chosen by the great body of their constituents, for that
would revolutionize the Corporation as well as give direct (not
indirect) representation in the Council. Let us then agree to
fight for a representative principle in the Medical Council, not
for details. If the Corporations will allow their alumni to re¬
turn their member to the Medical Council, well and good-
direct representation of those alumni takes place, but for my
own part, I know that the Corporations and Universities are
dead against the scheme, except perhaps Cambridge, therefore
I would not ask for the reform of the Corporations as well as
the Council. I think it only right, if the registered practi¬
tioner is represented that the Corporate bodies should be
represented also, and that if the body of the profession is well
represented, that they will require an opposition to keep them
from going too far. This opposition they would get from the
Corporation delegates, as ht present constituted, therefore I
am not favourable to the plan urged by Dr. Prosser Jama,
until after that of the British Medical Association has gained
the day. It is a question where to begin. I say, reform the
dounoU first, then agitate for reform of the Corporation*. It
Digitized by
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ftifi Medical Press and Circular.
CORRESPONDENCE.
Angrut 36,1888. 193
is now dear that all agree that reform is needed, why then can
we not settle the relative merits of the two schemes, and all
unite oar forces to carry one. Splits in the camp are bad
things, for our enemies make use of them to neglect or post-
spone our claims.
I have no wish to push my views, or do anything but aid in
promoting unanimity. If the advocates of both schemes
joined their forces, sinking details, or discussing together a
common base of action, a grand reform would result.—I am,
Ac., M. P. A.
REFORM OF THE MEDICAL COUNCIL-DIRECT
AND INDIRECT.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sib,—T he two plans of reforming the Medical Council have
been distinguished by you and others as the direct and the
indirect. The names may in some sense serve the purpose,
but are not exact.
If the plan of Dr. Prosser James, which you call indirect,
should be carried out, what would result ? As I understand it,
the representative of each body would be elected by the per¬
sons who held its diploma. Now, these are all medical prac¬
titioners; and as all medical men have some diploma, all would
have a vote. Those who had more than one diploma would
get more than one vote.
Now, is it not clear that persons thus elected would directly
represent the Profession ?—quite as directly, I feel sure, as
MP.’s represent their constituencies.
It seems & mere question of electoral districts or constitu¬
encies. What is the use of cutting up the country into new
divisions, and bringing up the ghost of equal electoral dis¬
tricts,” to serve one political party, as Dr. Andrew Wood
proposes, and as would be the end of the British Medical
Association's plan ?
We have good and trustworthy constituencies ready made to
our hands. University constituencies have now acknowledged
claims. Cambridge—all honour to her for it!—has already
done justice, according to the letter of one of the Senate in
your last number. Let the other universities and the corpora¬
tions follow the example.
Such constituencies as these are, in my view, most in accord
with the constitution, and deserve to be extended. I therefore
regard the scheme of Dr. Prosser James as more constitutional,
and therefore more conservative, than the revolutionary plan
of l)r. A. Wood and the British Medical Association.
Therefore, although he belongs to the Liberal party in gene¬
ral politics—as we so much need medical men in Parliament,
and as our Council, without some change, is as useless as Con¬
vocation, I shall vote for him at the election, and hope many
others will do the same.—I am, Ac.,
A Conservative M.D.Edin.
PUERPERAL FEVER IN LYING-IN HOSPITALS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —In The Medical Press and Circular of the 13th
March, 1867, you noticed some observations that I had re¬
cently published “ on the comparative advantages of afford¬
ing obstetric attendance to poor women in lying-in hospitals,
and in their own homes.” I have since made further inquiries
on the subject, and as all the documents that I have, beer* en¬
abled to examine, seem to leave no doubt that the mortality
of parturient women is much greater in Dublin, comparatively
with the number of births, than in London, or in other large
town populations in Great Britain, I shall state, as briefly
as I can, the data on which that conclusion is founded. These
data are :—1. The returns of the English and Irish Registrars-
General. 2. The published Parliamentary Reports of the
Board of Superintendence of Dublin Hospitals. And, 3. The
printed Abstract of the Registry of the Rotundo Lying-in
Hospital
The mortality of parturient women is assigned by all the
Rseistrars-General to two causes—metria (puerperal fever),
and “the accidents” of childbirth, such as convulsions,
hmnorrUage, &c., and, as the first, puerperal fever, prevails
more in some years than in others, it is necessary, in order to
form fair comparisons, that the returns for each country be
for th* same years, and also that they be for similar com-
njuaftiiser populations. With this view I will compare the
bartfct and deaths of parturient women in London and in 21 of
thtnuntpcpoloffs cities and towns in England for the three
ymrs ended 1866, with those in the returns of the Irish
Registrar-General for the Dublin registration district for the
same years. I have not yet seen the English returns for 1867,
and, of course, cannot compare them with the Irish returns
for that year, which have been published.
1. The London births amounted to about 306,000 in the 3
years ended 1866, and 1617 women, or 1 in 189 births died in
childbirth in London in these years ; 666 of puerperal fever ;
951 of the “ accidents ” of childbirth. The births in the 21
towns amounted to about 396,000 in the 3 years, and 2192, or
one in 180 births, died ; 737 of puerperal fever ; 1455 of the
“ accidents.” In all these populations, 3809 women are re¬
turned as having died in childbirth, which is in the proportion
of 1 to 184 births ; 1463, or 1 in 500 births died of puerperal
fever; 2406, or 1 in 292 births, died of the “accidents.”
These births, and this mortality, include all that occurred in
lying-in or other hospitals in London, and in these 21 towns;
but I have seen no account of the number of births, nor of the
mortality in these hospitals.
The returns of the Irish Registrar-General show that 24,538
births took place in the Dublin Registration district during
these three years, and that 207 women, or 1 in 119, died in
childbirth; 134, or 1 in 184, died of puerperal fever; 75, or 1
in 340, died of the accidents of childbirth. This high rate of
mortality in the Dublin district caused a loss of 74 lives more
than if it had been the same a3 in the English populations,
1 in 184, in which case only 133 would have died. These
24,538 births include 5546 that took place in the Rotundo, and
in the Coombe Lying-in Hospitals, as we learn from the pub¬
lished reports of the Dublin Hospitals Board, by which re¬
ports the mortality in these hospitals can be compared with
that which took place in the remaining 18,992, or the home
births, in the Dublin district. 3908 women were confined in
the Rotundo in these three years, and 1638 in the Coombe; 82,
or 1 in 59 births, died in the Rotundo; 12, or 1 in 136, died in
the Coombe; and 113, or 1 in 168, of the home births died.
It will be seen by these returns that the mortality in the
18,992 home births was nearly as low as that in the English
populations, and that, if the rate had been only the same,
one in 168, in the Rotundo, 58 less would have died in it, or, if
only one in 136 had died there, as in the Coombe, only 29
would have died, and 53 lives would have been saved.
2. The published reports of the Board of Superintendence of
Dublin Hospitals show that, in the ten years ended March,
1867, there were 17,605 births in the Dublin lying-in hospitals,
and that 426, or one in 41, died in childbirth in them. 12,714
of these births were in the Rotundo, where 364, or one in 35,
died ; 4891 were in the Coombe, where 60, or one in 81, died.
215, or one in 60, births died of puerperal fever in the Rotundo,
and 29, or one in 168, died of it in the Coombe. 153, or one
in 83 births, died qf the “ accidents” in the Rotundo ; 31, or
one in 157, died of them in the Coombe. Now, if the mortality
in these 17,614 hospital births had been only the same (one in
168) as in the 18,992,home births in thesame district in the three
years ended 1866, 321 lives would have been saved in these ten
years, as only 165 would have died ; or if the rate of mortality
in the Rotundo had only equalled that in the Coombe (one in
81 births), 228 less would have died in the Rotundo. But, if
only one in 184 had died, as in England, 330 lives would have
been saved.
3. The printed Abstract of the Rotundo Lying-in Hospital
shows that, from 1758 to 1864, both years inclusive, 182,179
births took place in that institution. On a rather laborious
examination and analysis of this important document (which
gives the births and deaths for each year) I find that, in 49 of
these years, not successively, but at intervals, the mortality
averaged one in 142 births—the highest in a year being one in
102 births, the lowest one in 223. In the 58 other years, the
proportion of deaths to births averaged onJy one in 51. In the
49 years, there were 90,444 births, and 635 died ; in the 58
years there were 91,735 births, and 1797 died, and the mortality
in these years ranged from one in 99 births in one year to one
in 13 4-51 in another. It is remarkable that, during the eleven
years ended 1864, the mortality in the Rotundo in any year
has not been lower than one in 66 births, and in the three
succeeding years (1865-7) 100, or one in 37, died in the
Rotundo, out of 3713 births.
Now, if only one in 184, as in England, had died in the
Rotundo in those 58 years, 1293 lives would have been saved,
or even if the death rate had been only the same as in the 49
years (one in 142), 1151 less would have died ; and coming to
the last fourteen years, if the mortality had been only one in
142, there would have been a saving of 247 lives in that time.
This high mortality is not confined to the Rotundo Lying
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194 The Medical Press and Circular.
GLEANINGS.
August 26,1868.
in hospital; it is reported to have been even higher in those
of Paris (one in 18$), in Vienna (one in 25^1, in St. Peters¬
burg (one in 2G), in London (one in 31), Ac., and in all is
chiefly attributed to puerperal fever. For instance, in 18G2,
39 or 40 women died of that disease in the Itotundo, 2 of
typhus fever, 4 of pyaemia, and 11 of scarlatina : in all 80, or
one in 12 i of the births, died. In 1863. 3 died in it of typhus
fever, 2 of pyiemia, 3 of scarlatina, and 30 of puerperal fever;
of 41 that died, only two or three could be attributed to the
accidents of child-birth. The year’s mortality was one in 25^
births. Adverting to this, Mr. Simon reports to the Privy
Council, that—“the outbreak furnishes an example of the
well-established fact that scarlatina, typhus, and other exan¬
themata, are not only peculiarly apt to attack puerperal
women exposed to their contagious influences, but prove pecu¬
liarly fatal to them, and that these poisons constitute a fruit¬
ful source of contagious forms of the so-called puerperal
fever.” *
A remarkable instance of the havoc which puerperal fever
causes in Lying-in Hospitals, is given by one of the Rotundo
Assistant Masters in The Medical Press and Circular of
the 3rd October, I860. He states—“ During the month of
March, 117 cases were delivered and five died. In April, a
woman who had been confined the day before, died. In the
same ward with the last patient were four others, three of
whom were attacked, all died ; none of them living more than
12 hours. Thus, out of a total of 25 patients who were in the
lying-in wards at the time of the outbreak, 17 were attacked,
and 16 died. It is the custom in this hospital to have patients
Buffering from this disease in the same ward with others ; in
fact, we never remove them until we anticipate a fatal termi¬
nation.”
Dr. Brishowe and Mr. Holmes, who inspected the Rotundo,
subsequently reported that—“ though occasional cases of puer¬
peral fever are not uncommon in the Rotundo, epidemic out¬
breaks are comparatively rare.” I think if these gentlemen had
known that in each of 31 years the mortality in that hospital
was more than one in 60 births, as I have ascertained, they
would not have made that assertion, for no circumstance or
disease, except puerperal fever, would bo likely to cause so
high a mortality in a lying-in hospital.
The mortality caused by puerperal fever in the London
Lying-in hospitals has for many years induced the governors
of these institutions to limit the admissions very much, and
to depend more on extern maternities for affording midwifery
attendance to poor women, a fact which is proved by the very
small number that have died in childbirth in the London
Lying-in hospitals for several years, in which only an average
of about 20 died annually ; Mr. Simon reports to the Privy
Council that—“for the most part the lying-in hospitals in
England and Scotland are small' and insignificant insti¬
tutions,” compared with the Rotundo. Small hospitals and
their extern maternities afford a far lower death rate than we
have in the Dublin District. For instance,
In an excellent report on the Waterford Lying-in Hospital,
Dr. Elliott states that—3458 women have been confined in it
during the last 28 years, about an average of 10 each month,
and that 15 women, or one in 230, died ; 5, or one in 690, died
of puerperal fever ; and 10 of the accidents of childbirth. I
may add, in proof of the value of small hospitals, that in the
11 years, ended September, 1867, there were 28,723 births in
the Irish Workhouse hospitals, and that 206, or one in 139,
died. This, though high, contrasts favourably with the
Rotundo mortality, yet it is difficult to conceive persons more
physically or mentally depressed than most of the women that
are confined in our workhouses, or more likely to be affected
with a contagious disease, if within its atmosphere. But as
there are usually only one or two at the same time to be con¬
fined, if on rare occasions, as in the Waterford Lying-in Hospital,
puerperal fever should occur, there are few or none that are
susceptible of it, and the case is the same in respect to home
births, and it cannot spread ; but it is different when 25 or 30
women are confined at the same time in one hospital.
I beg to give two instances of the advantages of home
attendance.
During the ten years ended 1867, the medical staff of the
Coombe Lying-in Hospital attended 6539 extern labour cases,
of whom 26, or one in 252, died. In a lately printed report
by the governors and medical officers of Guy's Hospital, it is
stated, in allusion to the divisions of the out-patients, that
“ perhaps the mo9t interesting and most successful of these
divisions is the Maternity, or Lying-in charity, as the treatment
of the patients is followed up to a termination in their own
homes, and we have consequently the means of arriving at
data of Comparison with other charities of a like description.
During the last year, 1727 poor women were attended during
their confinement at their own residences by pupils of the
hospital, under the supervision of the physician accoucheur.
The deaths amounted to four, and a nearly equal success has
continued to mark the progress of the department since its
first organisation” (which occurred ten years ago). “ In this
respect, its working contrasts favourably with the experience
of public institutions where women are admitted for the pur¬
pose of being lodged during their confinements, but where
they are so liable to suffer from occasional outbreaks of puer¬
peral infection.”
Greatly to their credit, the governors of Sir Patrick Dun’s
Hospital have lately established an extern maternity charity,
and have at much cost provided a residence for an assistant to
their midwifery professor, Dr. Sinclair. Under this assistant,
the medical students of Trinity College learn practical mid¬
wifery by attending poor women in the district of St. Mark’s
parish and Ringsend. They have also appropriated some
hospital beds for the treatment of the particular diseases of
women, and have established a ladies’ committee, by which
some tea, sugar, and baby-flannels are being given to such poor
lying-in women as are found in need of them. These judicious
and humane arrangements will provide for a population of
about 23,000, and if somewhat similar arrangements were made
for the remaining population of the city, about 230,000, some
lives would be saved every year, and many poor women would
be assisted in their hour of need. I believe there are ample
means and materials to make these prolusions or arrangements,
but I must not trespass further on your space.—Yours, &c.,
Denis Phelan.
22nd August, 1868.
-♦-
/V
Cupping Glasses in the Treatment op An¬
thrax. —M. Foucher adopted the following method of treat¬
ing a case of anthrax. It was as large as an egg and situated
in the left dorsal region, on a level with the spine of the sca¬
pula. He procured a cupping glass about an inch and a-half
in diameter, and adopting to it the pump, he placed it over
the carbuncle and exhausted the air. The cup filled quickly
with sanious pus and shreds of tissue ; he left it on for some
moments, when upon taking it away the pain disappeared and
the tumour was emptied of its contents. He applied the
cup three successive days ; each time all organic detritus was
removed from the tumor, and the third time the integument
over the part came away, leaving a healthy exposed surface,
perfectly clean, and commencing to be covered with healthy
granulations. The borders of the wound were irregular,
sharp, and elevated, and suppuration was normal. The dress¬
ing consisted of poultices, and the wound proceeded to a speedy
cure.— Benchonlat's Annual Abstract.—Pacijic Med. and Surg.
Journal.
A Case of Puerperal Convulsions.— A stout
negress was taken in labour, and in an hour, without any ap¬
parent cause, was attacked with violent spasms. The mem¬
branes were unruptured, the vertex presenting, and the pelvis
was roomy. The diagnosis was made that the convulsions de¬
pended on an “ erratic distribution of nervous energy.” The
membranes were ruptured, but the uterus was not competent
to expel the foetus. The convulsions were somewhat abated
by the use of chloroform. After waiting some time, it was
decided to use hypodermic injections of morphia, and accord¬
ingly, half a grain of the sulphate was injected under the skin,
on the arm. In less than five minutes, the effect of the nar¬
cotic was plainly perceptible in its controlling influence on the
convulsive respiration, and the uterus began to work mow
vigorously, and in ten minutes the child was delivered. The
convulsions after delivery recurred only at long intervals, and
the mother and child did well.—J. C. Osborne, M.D., in Ne*
Means Journal of Medicine.
Lime Inhalations in Croup.—D r. B. B. Wilson
of Philadelphia, reports in the Bichnumd and LouisiHUe Med*-
cal Journal, the successful treatment of two cases of croup by
“ lime inhalation,” one of which he says, was undoubted “ pure
and uncomplicated membranous croup.It had existed
several days, and was in a most critical condition when fiwt
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Th# lUdteal Ptmb and Circular.
MEDICAL NEWS.
August 96,1868. 195
Been and prescribed for. The doctor claims for the inhalation
of “the vapour of lime” that in addition to being “an effi¬
cient remedy for such a desperate phase of disease . .
it can be used in addition to, and without interfering with any
other treatment. . . . There can, therefore, be no objec¬
tion to its exhibition in cases in which the prognosis is most
unfavourable, and it is in those cases particularly that I de¬
sire the profession to give it an opportunity to prove its value.
.... It can be conveniently administered by slacking in
a pitcher a lump of quick lime, as originally suggested by Dr.
A. Geiger, of Dayton, Ohio, a vapour bath being extemporized
by two or three large quilts or blankets, supported by chairs
or props, the head-board of the bed, or arm of the sofa, and in¬
cluding the entire body of the patient within its limits.
An Interesting Case of Labour.— N. Guhman,
M.D. (St. Louis Med. Reporter ) communicates the following
interesting case of labour. He was called on April 6 to a
primipara, aged 21. After a protracted labour she was deli¬
vered of a male child, after passing eight hours in gestation.
He called the next morning after delivery, and was told that
she had convulsions about four o’clock in the morning, and had
bad a paroxysm every half hour. After waiting at the bed¬
side about five minutes, the patient went into a convulsion, of
which she had a warning. The spasmodic movements always
commenced about the legs and ami3 first; the convulsion,
which was of an epileptic form, lasted about five minutes, and
then the patient fell asleep, which lasted about ten minutes;
then she roused up and remained in a semi-conscious condition
until another paroxysm returned. Pain in the frontal region
was her chief complaint.
Blood-letting was decidedly indicated, and he proceeded to
take from the arm 16 to 20 ounces of blood. The following
prescription was also ordered:—
R. Hydrarg. chloridi mitsi, gr. xvj.
Pulvis jalap, optim., gr. xxv.
M. Ft. Chart. No. 6.
Of which she took one every half hour. A few hours after¬
wards he took another medical man with him, and the patient
was found comatose, with stertorous breathing ; the bowels
had not moved. The pulse was found strong and forcible. By
the advice of Dr. Cooper, who thought that the only hope for
life was in bleeding, ten or twelve ounces more blood was
taken, which made a decided impression on her pulse. With
careful nursing, her recovery was rapid and complete.
He reports this case to draw the attention of the profession
to these cases of disease, which require prompt and efficient
treatment. He did not use opiates, anti-spasinodics, or anaes¬
thetics, as are usually recommended, because he believes that
the disease is nothing more nor less than a congested state of
the brain, and probably the spinal column.
He states in conclusion, that this case did not present very
well marked indications for the use of the lancet, but it was
well borne. She had diarrhoea up to forty-eight hours
previous, and still he gave her alterative doses of mercurials,
with strong purgatives ; no anodyne medicine was taken.
Treatment ofa Severe Case ofWhooping-cough
by Vaccination, —A very Bevere case of whooping-cough
occurred in a child sixteen months old. The paroxysms
varied from twelve to fourteen a-day. With the idea of cut¬
ting short the malady, or of modifying its severity, the child
was vaccinated. Upon the first appearance of the areola, and
before the full development of the vesicle, all convulsive
coughing had ceased. A. Aronstein, M.D.— Pacific Med. and
Surg. Journal.
Lactate of Zinc in Epilepsy. —Dr. Hart has tried
this remedy in combination with belladonna, on 240 patients
in the Western Lunatic Asylum of Kentucky, all of'whom had
been affected with epilepsy from three to six years. An im¬
provement took place in all, and in no case did he use it with¬
out effectually controlling the paroxysm in from 24 to 48 hours.
His formula was:—R. Zinci lactatis, gr. xxx.; ext. belladonna,
gr. viii. M. ft. piL x. Sig. One before each meal. It is a
question which remains still to be decided, what is in fact the
best remedy for this dreadful affection. The whole family of
zinc salts and its oxide have, as well as the lactate, been highly
recommended by different parties for curative virtues in convul¬
sive nervous diseases. The sulphate, Dr. Babington had good
success with in treating epilepsy, but the valerianate was con¬
sidered the most effective of all the zincs in doses of one-half a
grain raised gradually to three grains three times a-day. The
whtd tf beeladoima is frequently united with the zinc in pill,
and it may be supposed, from its general use, that it has some
peculiar sedative action in convulsive disease. The bromides
at present, however, seem to have the most popular and pro¬
mising position.— Med. Archie.
Hypodermic use of Morphia during Anaes¬
thesia. —In a recent clinical lecture, connected with the ope¬
ration of Lithotomy, Prof. Wm. Warren Greene, of the Maine
Medical School, said that he was thoroughly convinced that
the use of warm, instead of cold sponging, diminishes very
much the shock in this, and other severe operations, and also
the liability to inflammation. The water should be fully up to
blood heat, and the part should be kept as near it 3 natural
temperature as possible during the operation. The cases where
this indication is over-balanced by the necessity for the styptic
effect of cold are comparatively rare. A second point was the
importance of the subcutaneous injection of morphine while
the patient was under the influence of ether. The influence of
this early and speedy introduction of an anodyne into the cir¬
culation, in anticipating all pain and irritation and preventing
shock, can hardly be over-estimated, especially after severe
procedures and in feeble subjects. But another effect, of the
greatest consequence, as regards at least the comfort of the
patient and the convenience of all parties, is the decided effect
of morphine thus introduced in shortening the anaesthetic in¬
fluence and in preventing delirium and nausea. He is in the
habit of giving a full dose—usually not less than half a grain
and often a whole grain—and is quite sure that a trial of it ia
all that is necessary to secure its adoption by surgeons every¬
where .—Medical Gazette.
|ptal
The Public Health.—I n the week that ended
on Saturday, August 15, 4141 births and 3573 deaths were
registered in London and in thirteen other large towns of the
United Kingdom. The annual rate of mortality was 29 per
1000 persons living. The annual rate of mortality was 24 per
1000 ia London, 27 in Edinburgh, and 26 in Dublin, 25 in
Bristol, 36 in Birmingham, 36 in Liverpool, 44 in Manchester,
42 in Salford, 34 in Sheffield, 32 in Bradford, 36 in Leeds, 34
in Hull, 31 in Newcastle-upon-Tyne, and 29 in Glasgow. In
ten large English towns, including London, the annual death-
rate from diarrhcea last week was 7 per 1000 persons living,
against 9 and 8 in the two previous week*. In the several
towns it was 4 in London, 5 in Bristol, 6 in Newcastle, 9 in
Bradford, 10 in Sheffield, 11 in Hull, 12 in Liverpool and
Manchester, 14 in Salford and Leeds, and, again highest, 17
per 1000 in Birmingham. Although the deaths from diarrhoea
showed a considerable further decrease in London, they were
more numerous in most of the provincial towns, and the
779 deaths referred to this cause in the ten towns were only
17 below the number in the previous week. The deaths re¬
gistered in London during the week were 1462. It was the
thirty-third week, of the year, and the average number of
deaths for that week is, with a correction for increase of popula¬
tion, 1425. The deaths in the present return exceed by 37
the estimated amount, but are less by 83 than the number
recorded in the preceding week. The deaths of 223 children
and 22 adults from diarrhoea were recorded. Cholera or chole¬
raic diarrhcea proved fatal to 19 children and 10 adults. The
mortality from diarrhcea exhibits a decrease, but the number of
deaths from cholera was the same as m the preceding week.
The necessity for prompt and active treatment of these dis¬
eases in the earliest stage cannot be too generally known.
Many lives would be saved if medical aid were obtained at the
onset. The mortality from diarrhoea and choleraic diarrhoea
or cholera in the London waterfields to 100,000 living was 7 in
the New River, 8 in the Grand Junction, 11 in the Southwark
and Lambeth, 12 in the East London, and 10 in the Kent field
of supply. The deaths of 3 persons from sunstroke were re¬
corded last week ; in the three preceding weeks 11, 6, and 4
fatal cases were registered. At the Royal Observatory. Green¬
wich, the mean height of the barometer in the week was
29*630 in. The barometrical reading decreased from 30*01 in.
on Sunday, August 9, to 29*34 in. on Thursday, August 13.
The mean temperature of the air in the week was 64*3 deg.,
which is 2*4 deg. above the average of the same week in 50
years (as determined by Mr. Glaisher). The highest day tem¬
perature was 82*7 deg., on Monday, Aug 10. The lowest night
temperature was 52*0 deg., on Friday, August 14. The mean
Digitized by VjfOOv LC
196 The Medical Pre* and Circular.
MEDICAL NEWS.
August 26,1868.
degree of humidity of the air was 71, complete saturation
being represented by 100. Bain fell to the amount of 0*37
in., of which 0*13 in. fell on Tuesday, 11th August, and 0*23
on Thursday, 13th August. On Tuesday, 11th August, the
rainfall a t Hull amounted to 1*22 in., at Wakefield to 0*80
in., and at Eccles to 0*72 in. The general direction of the wind
was variable. Ozone was observed on six days during the
week.
Scottish Registrar-General’s Quarterly Re¬
turn. —The return just issued records 16,928 deaths registered
in Scotland during the second quarter of the present year,
being in the annual proportion of 21*2 per 1000 of population,
or one per 1000 below the average of the last ten years. In
the town districts the mortality was at the annual rate of 25 2
per 1000, while in the country districts it was 16*4. The
mean death-rate in the previous ten years in the former was
25*6, and in that of the latter 17*7, so that the influence of the
mild weather in Scotland during the quarter under review
was more favourable in the country than in the town districts.
The weather was unusually mild over all the lower portions of
Scotland. The rainfall was very nearly the average, though
greater than usual during April and May, and correspondingly
below the average in June. Acute pulmonary affections were
less prevalent and less fatal than in former years, and the
ordinary epidemics had not been more prevalent than usual.
Whooping-cough was the most fatal epidemic ; scarlet fever
was the next most fatal disease in the mtfst southern part of
Scotland, while measles was very prevalent in the northern
parts! Typhus and enteric fevers maintained their normal
prevalence ; the proportion of deaths from typhus was about
double that from enteric fever. The deaths from consump¬
tion were, if anything, rather higher than usual, noth with¬
standing the mildness of the season. The mean temperature
of April, with 5754 deaths, or 192 daily, was 46 deg. ; that of
May, with 5665 deaths, or 183 daily, was 51*4 deg.; and
that of June, with 5509 deaths, or 183 daily, was 556 deg. The
mean temperature of the quarter was 51*0 deg. The
mean rainfall was 6*96 inch. The births registered during the
quarter numbered 31,025, or the annual birth rate of the
season was 38*9 per 1000 of population, the average rate
being 37*8 per 1000. The marriages numbered 5660, or 7*1
marriages per 1000 persons living; the average rate being
6*9 per 1000. If a high marriage-rate may be taken as
an indication of prosperity, then in a commercial point of view
the eight principal towns of Scotland arranged themselves
during the quarter as follows:—Thus, of every 10,000 persons
in each town there married 71 in Paisley, 76 in Glasgow*, 80
in Greenock, 88 in Aberdeen, 103 in Perth, 106 in Leith, 109
in Dundee, and 118 in Edinburgh.
The Condition of the Thames.— The Field
says :—The old fishermen—“ trinkermen” as they are termed
—in the tidal way are praying devoutly for a continuance of
r&in, as they declare that if a very large bulk of water does not
fall between this and the set of the approaching spring tides a fish
of any kind will not be left in the river from Putney to Kew.
The captains of the river steamers likewise state that they do
not recollect so great a stretch of mud deposit for years past
as is now to be seen at low water from Chelsea, past Wands¬
worth on both sides, up to Bishop’s Palace at Fulham. The
low tides have disclosed the existence of many a covert pipe
ingeniously concealed and as persistently denied ; but, of course,
now their presence is manifest, these suspicious ducts will be
declared to be used only for taking the water into the works,
and not for the egress of wash and other deleterious refuse.
We shall perhaps hear more about some of these questionable
pipes. Gudgeons have shown themselves as low dow*n as
Chiswick, but unfortunately on the top of the water, from
whence they have been removed by scoop nets—now the
common implement of every little mudlark upon the banks.
It would be cheering to hear that an inspection of the several
creeks up the Thames was to take place. An investigation
faithfully carried out would reveal a good deal that is interest¬
ing. A visit to the pools in the upper reaches shows how ex¬
tremely low they can be without being perfectly dry. There
is but a mere trickle over some of them, yet it is stated that
“ the supply for London of the water companies located at
Hampton has not fallen off,” and that “ there is a resource for
double the demand if needed.” This is a statement of serious
import to London ; may it be true ! It would be, therefore,
interesting to ascertain from whence this supply is derived and
kept up ? If the pools above have ceased to send their usual
flow below, there must be some hidden springs, not hitherto
taken into the calculation of our water supply, to account for
this seeming contradiction. Should such be the case, a matter
of very considerable anxiety—not only during droughty seasons
but with an ever-increasing population to provide for—is in a
measure mitigated.
The Director-General presents his compliments
to the editor of The Medical Press and Circular, and begs
to enclose, for insertion, a list of gentlemen who competed
successfully for appointments as assistant-surgeons in H.M.
British Medical Service, at the examination *held at Chelsea
on 10th August, 1868.—Army Medical Department, August
22nd, 1868.
1. J. Cliatterton, 2210; 2. A. H. Stokes, 2160; 3. G. Cony, 2055*.
4. W. H. Snunderson, 1950 ; 5. J. J. Crean, 1915; 6. J. Scanlon, 19001
7. F. G. Adye-Curran, 1875; 8. T. Faris, 1855 ; 9. G. R. Triphouk,
1780; 10. H. Stannard, 1745; 11. J. H. Webb, 1730; 12. W. Sharpe,
1725; 13. R. D. Bennett, 1695; 14. H. E. Maunsell, 1670; 15. J. G.
Thornley, 1655; 16. A. W. Duke, 1630; 17. T. E. Carroll, 1600; 18.
F. A. Davy, 15^5; 19. H. B. White, 1560 ; 20. R. M. Bradford, 1530;
21. E. C. Maxwell, 1530.
A Royal decree in the Gazette of Madrid orders
quarantine to be enforced on arrivals from England.
Dr. Nelaton, the eminent surgeon, has been made
a senator. This is the first time that an “ operative ” repre¬
sentative of the medical profession has been promoted to a
seat in the Upper Chamber of the Luxembourg. It was Dr.
Nelaton, as your readers may remember, who extracted the
ball from Garibaldi's ankle after the Italian campaign. It is
little probable, as the A venir National slyly remarks, that this
cure had anything to do with his being raised to the dignity
•f senator.
Madame Alexandrine Bris has just passed a
brilliant examination before the Faculty of Sciences at Paris
and obtained the degree of Bachelor. Her intention is to
study medicine with a view of obtaining a physician’s diploma.
Surgical Separation of the Siamese Twixs,
Chang and Eng. —The scientific world, and especially that
portion of it who have made the study of medicine and surgery
their profession, cannot fail to be intensely interested in the
fact which has recently come to our knowledge, of the deter¬
mination of Chang and Eng, the Siamese twins, to submit to
a surgical operation for the purpose of dissevering the wonder¬
ful link that has so long bound them together. Some forty
years ago these twins were introduced to the notice of the civi¬
lized world, having been brought to England from Siam in the
year 1827 or 1828, by Captain Bunker, at present living in
New York; and for a series of years they were exhibited to the
public at all the great centres of civilisation. Having visited
America, they determined to make this land their home. They
bought a valuable tract of land in North Carolina, married
two sisters, and settled down in the ordinary routine of a
farmer’s daily life. Each of them is now the father of nine
children. The reason for their determination, at this late day,
to call in the art of surgery, to produce an entire physical sepa¬
ration, is that having reached such an advanced age (59 yean)
they are fearful that one may become the subject of disease
which may prove fatal to both. The interesting question
arises, what are the probabilities of a successful operation being
performed ? It will be remembered, in pursuing these in¬
quiries, that the twins are held together by quite a massive
link of thoroughly normal and perfectly vitalised integument,
some ten or twelve inches in circumference, situated near the
vital organs, and in close proximity to the heart and longs,
and the connection is so intimate that each seems to be tho¬
roughly an organised portion of the other, as much so as any
of the ordinary members of a naturally constituted human
body. Sensation, nervous impression, mental phenomena,
morbid, physical, and nervomental conditions, all show a most
perfect psychical unity in this wonderful dual physical exis¬
tence. The question in regard to the result of an operation is
no new one, but soon after their first appearance in London
and Paris it excited the minds of the foremost intellects in the
surgical world. If we remember rightly, the “ Twins” were
exhibited before the Academy of Physicians and Surgeons in
Paris at that time, for the purpose of ascertaining their
opinion in regard to the probabilities of a successful operation.
The disagreement in regard thereto, we believe, led to the
abandonment of the project. Has the science of surgery so
rapidly advanced that to-day successful results can be promised
when there was so [much doubt a score or two of years ago.
We understand they contemplate visiting Paris for the purpose
of having the operation performed.— Netc York Tribune.
The Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
August 26, 1863. 197
THE VICTIMS OF
THE ABERGELE CATASTROPHE.
From a medical point of view the circumstances of this most
painful occurrence leave very little for us to record. Un- j
happily there was no mitigation in the severity of the injuries; j
no medium between the utter destruction of the unfort unate
sufferers who were burned, and the contusions of slight sig¬
nificance which the other passengers received.
We believe that the most serious non-fatal casualty was a
temporary concussion of the brain, and both the driver and
guard concur in the belief that the shock of the collison
was comparatively so slight, that were it not for the fire there ■
would, probably, hare been no fatality whatever. The most
extraordinary point in the whole misfortune was, that not the
least sound or outcry was heard from the persons in the fore¬
most carriages. It is totally impossible to suppose that the
occupants were everyone rendered insensible by the shock,
though hardly any of the other passengers suffered to that
extent. It is also manifestly impossible that the victims can
have been overpowered by the fire before they had time
even to utter a cry. We believe the explanation must be
looked for in absolute and instantaneous suffocation, or anaes¬
thesia by the vapour of the petroleum, a supposition, which
we would fain hope may be correct.
Petroleum consists of various hydrocarbons of various boil¬
ing and vapourising points. The more volatile ones were
extensively used during the American war, under the name of
turpentine substitutes. The vapour of these will form explosive
mixtures with atmospheric air. After them come the portions
that are used for burning in lamps. They are not explosive
with air, but highly inflammable , particularly when they have
an absorbent material, such as dry earth, wood, &c., to bum
upon. The heavy oils are not so inflammable, and are only
used for lubricating. Keroselene—the most volatile portion,
and which only constitutes a very small percentage—has been
used successfully as an anaesthetic, and is similar to benzol or
ether in its effects.
Without attributing anaesthetic results, which the percentage
of keroselene would not justify, we may still hope that the
instantaneous volatilisation of a great quantity of this petro¬
leum may, as in the case of nitrous oxide, by simply depriving
the lungs of the air, have caused the immediate anaesthesia
which we know by experience would result from such a con¬
tingency.
The interval from perfect consciousness to total insensibility
is, as we know, almost inappreciable, and it is easily supposable
that, for the instant, the shock of the collision may have com¬
pletely incapacitated the sufferers from even a cry.
mg, upon reference to his notes, informs us that the report is strictly
correct. The wording may be somewhat different, hut the meaning
conveyed by the several speakers was unquestionably that recorded in
our columns.
Mr, J. Waring-Curran, Spalding.—Your proof'was returned through
the post, “ Insufficiently Addressed.” Please write name and address
legibly at the back of any communication intended for the printer, that
proofs may not be delayed or miscarry.
Dr. DAvev, Bristol.—'Your letter shall appear in our next.
Mr. S. B., Plymouth.—The subscription in advance, post free, is
21s. 8d. It can date from any time most convenient to yourself.
Dr. G. F. Bi rder is thanked.
The Disasteb at Abergele.— Dr. H. C. Andrews, has just issued an
appeal to the benevolent, on behalf of the widow and eight children
of the late head-guard, Smith, who was amongst the sufferers from this
fearful accident. From personal experience, we are happy to add our
testimony to that of Dr. Andrews, as to the kindness and attention
at all times shown by this poor man, especially to invalids; and we
hope the appeal now made will place his distressed family above the
pale of want.
Err ati'm.— Letter on Puerperal Fever, p. 103, twelfth line from
bottom of column, read 14 instead of 13 4-51.
-♦-
BOOKS, PAMPHLETS, &c., RECEIVED.
A Woman’s Work in Water Cure. By Mrs. Nichols. London :
Longmans, Green, and Co.
Oa the Obscure Diseases of the Brain. Fourth Edition. By Forbes
Winslow, M.D. London: John Churchill and Sons.
Bathiog, it Uses and Advantages. By G. Worthington, L.K.Q.C.P.
London : John Churchill and Sons.
The New Orleans Journal of Medicine. The American Journal of
the Medical Societies. Journal de Medicine dc Bordeaux. The Boston
Medical Journal. The London Scotsman. London Review. Rhyl
Record. Hastings Chronicle, &c.
-♦-
APPOINTMENTS.
The following have ju9t been gazetted :—
Medical Department.— Assistant-8urgeon J. W. C. N. Murphy,
from 75th Foot, to be Staff Assistant-Surgeon, vice B. Lindsay, M.B.,
appointed to 75th Foot.
Royal Hospital, Chelsea.— Field Marshal Sir A. Woodford,
G.C.B., G.C.M.G., to be Governor, vice Field Marshal the Right Hon.
Sir E. Blakeney, G.C.B., G.C.H., deceased; Field Marshall 8ir H. D.
Ross, G.C.B., to be Lieutenant-Governor, vice Field Marshal Sir A.
Woodford, G.C.B., G.C.M.G.; Brevet Colonel C. L. B. Maitland, from
Lieutenant Colonel, half pay, late of Grenadier Guards, to be Major,
vice Brevet Colonel Sir J. M. Wilson, deceased.
-+-
BIRTHS.
Gray.— On August 16th, at Armagh, the wife of Robert Gray.
: L.R.C.P.Edm., L.R.C.S.I., of a son.
Piielan.— On the 15th inst., at Chapelizod House, Co. Kilkenny, the
| wife of William B. Phelan, L.R.C.S., L.R.C.P., &c., of a son.
SIX FOUNDS FEB WEEK
- 4 -
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in England on or before Friday morning are
expected to be returned to the Editor, at the office, 20, King
William-street, Strand, W.C.,before five p.m., on Friday afternoon.
Proofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two p.m. on Saturday, which is
an early closing day. Duplicate proofs are sent to authors, in
order that they may correct and return one copy, and keep the
other for private use. Contributions should be leoibly written, on
one side of the paper only.
*ill Communications and Letters must be authenticated by Hit name of the
writer, though not necessarily fur publication.
To Costbibutors.— It would save both time and trouble if gentlemen
would write name and address at the back of their MS., to insure an
early transmission of proofs.
Papers have been received on Cannabis Indicis in Catarrhus Senilis;
Vemtnun Vjride in Pericarditis; Belladonna in Infantile Icterus.
XjOkb Ajcbirley ox OvER-poruxATioar.—A correspondent informs'us
that Lord Amberley denies the accuracy of our report of the proceedings
of the Dfateetieal Society, published in our impression of July 22nd, at
fbe tarn* time calling upon us to verify our report. To this request we
9S9 happy to comply, as the gentleman who represented us at the meet-
while laid up by injury, and
£1000 IN CASE OF DEATH
caused by accident of any kind.
May be secured by an annnal payment of from £3 to £6, 5s.
TO THE
RAILWAY PASSENGERS ASSURANCE COMPANY,
For particulars apply to the Clerks at the Railway Stations, to the
Local Agents, or at the offices,
64, CORNHILL, and 10, REGENT-8TREET,
W. J. VIAN, Secretary.
FURNISH YOUR HOUSE
WITH THE BEST ARTICLES AT
DEANE’S
Ironmongery * Furnishing
WAREHOUSES.
Catalogue with Furnishing List Post-free.
DEANE & C0.(w^8t e )L0ND0N BRIDGE
SrtablvM A.D. 1700,
Digitized by
Google
August 26,1868.
%xm and (Siwttat* gMhrcrfiftr.
DENMAN’S GREEK WINES,
GUARANTEED PURE.
Sample cases of Twelve different Wines sent in return for Post-office
Order for £1,11s. 4d., payable at Chief Office, E.C.
GREEK WINES.— 44 These Greek Wines are pure from the vine¬
yard.”—T imes.
GREEK WINES.— ‘‘Possess qualities of clearness, vinous flavour
and natural strength that we certainly look for in vain in other
wines, and their bouquet is enough to make an old man young
again.”— Once a Week.
GREEK WINES.— 44 Are particularly fitted for those who are
hardly weaned from brandied wine, and who require something
full-bodied.”— Saturday Review.
GREEK WINES.— 44 No cellar stock increases in value so rapidly
as a stock of Greek wines, of which some excellent varieties cost
16s. qj* 20s. a dozen.”— Examiner.
PAMPHLET on “WINE and its ADULTERATIONS”
post free.
“ We consider that Mr. Denman has done good service in publish¬
ing his pamphlet, in which the evils of fortifying wine and the merits
of the lighter and purer wines are so graphically portrayed.”—T he
Lancet, June 22, 1867.
J. L. DENMAN, 20, PICCADILLY, LONDON, W.
A. & R. TH WAITES & CO.,
PREPARERS AND IMPORTERS OF
MINERAL WATERS
TO HER MAJESTY,
57, UPPER SA CKV ILL E-STREET, DUBLIN.
SINGLE AND DOUBLE SODA WATERS,
Prepared in Cisterns of Granite.
HESE Waters were introduced to the notice of the Public
in the year 1800, as their invention, by the testimony of
the Professor of Chemistry (the late ROBERT PERCEVAL. lfJ>.),
in his Lectures in Trinity College, Dublin, and from that period have
continued to obtain the recommendation of the Gentlemen of the
Medical Faculty, and the approbation of the Public.
The Double and Single Soda Waters derive their names not from the
quantity of fixed air which they contain, but from the peculiar mode of
preparation employed by A. & R. T. and Co., which renders them highly
useful to the powers of digestion, improving the appetite, and stimnlat-
ingthehepatic functions.
The above kind of Soda Water is exclusively prepued by t hem , sad
is not manufactured by any other House in the Kingdom.
PURE LIGHT WINES
FOR THE SUMMER SEASON.
BEDGBS AND BUTLER
Solicit attention to their
St Julien Claret.
White Bordeaux.
Burgundy .
Chablis .
Rock and Moselle .
Champagne ...
Sherry .
Port, from first-class shippers.
Old Pale Cognac Brandy.
.18s., 20s., 24s., and 30s. per doz.
24s., 30s., and 36s. „
24s., 36s., and 42s. „
.24s., 80s., 36s., and 48s. ,,
.24s., 30s., 36s., and 48s. „
.36s., 48s., 60s., and 66s. ,,
.24s., 30s., 36s., and 42s. „
,24s., 80s., 36s., and 42s. „
.48s., 60s., 72s., and 84s. „
Claret in hhds., containing about 23 dozens.
No. 1- Good sound Claret....
Noe. 2 and 8. Good Medoc.
Nos. 4 and 6. Stout Claret..
No. 6. Dessert Claret.
Nos. 7 and 8. Superior class Wines
Noe. 9 and 10. Good Sauterne.
£12 per. hhd.
£12 and £15 „
£15 and £18 „
£25 „
£30 and £35 „
£15 and £20 „
All the above Wines are strongly recommended and guaranteed by
H. and B. Lists of all other Wines and Liqueurs on application.
HEDGES AND BUTLER,
155, REGENT-STREET, LONDON,
And 80, KING’8-ROAD, BRIGHTON.
E INAHAN’S ll whiskey.
DUBLIN EXHIBI TION, 1865.
This oelebrated Old IRISH WHISKEY gained the Dublin Prise
Medal. It is pure, mild, mellow, delicious, ana very wholesome.—Sold
in bottles at 8s. 8a., at the retail houses in London; by the Agents
in the principal towns in England; or, wholesale, at 8, Great Win dmill ,
street, London, W.—Observe the Red Seal, pink label, andoork,
branded 44 Kinahan’s LL Whiskey.”
M ost important to families.
GUINNESS’S XXX PORTER.— J. Bebe invites
attention to this Celebrated Porter in Bottle, being now specially
ordered to invalids, for its nutriment and strengthening qualities, in
fact it has been found, in great many instances, to supersede Wine in
recruiting health and strength. Each Bottle is wired and tin-foiled,
and is protected by his label and “ Trade Mark.” Prices are as
follows. Terms Cash.
Per doz.
Guinness’s Celebrated XXX Porter (small bottles) ... 2s. 4d.
Guinness's Celebrated XXX Porter (large do. ) ... 4s. 6d.
Ten Vans deliver dally in the city and suburbs, and orders sent by
Railway to all parts of Ireland.
JOHN BEBE, Rectifying Distiller, Direct Wine and Brandy Importer,
18, THOMAS-8TREET, DUBLIN.
A orated LitbiaWater.—Messrs. BLAKE,
.ll SANDFORD, and BLAKE, are prepared to supply the
HT HIA WATERS (of which they were the original manufacturers
Under Dr. Garrod’s instruction) of any strength prescribed by the Pro¬
fession for special cases. Those in constant use contain two grains and
five grains m each bottle, either by itself or combined with BICAR¬
BONATE of POTASH or PHOSPHATE of AMMONIA.—Also, Potash,
Citrate of. Potash, Soda, Seltser, Vichy, and Mineral Add Waters, as
usual.
BUks, Baadford, and Blake, FtamaoeottotlChemists, 47, Piocadilly<
OCHWEPPE’S MINERAL WATERS. By Specitl
^ Appointment to Her Majesty and H.R.H. the Prince of
Wales. Every bottle is protected by a label having name and trade¬
mark.—London, Liverpool, Derby, Bristol, Glasgow, Malvern.
THREE PRIZE MEDALS— [Paris Exhibition, 1867.]
fi&OSSE AND BLACKWELL,
vJ Purveyors in Ordinary to Her Majesty, respectfully invite
attention to their PICKLES, Sauces, Tart Fruits, and other table
delicacies, the whole of which are prepared with the most scruputoui
attention to wholesomeness and purity. The practice of colouring
pickles and t&rt fruits by artificial means has been discontinued, and
the whole of their manufactures are so prepared, that they are not
allowed to come in oontact with any deleterious ingredient. A few of
the articles most highly recommended are, Pickles, and Tart Fruit*
of every description, Royal Table Sauce, Essence of Shrimps, Sobo
Sauce, Essence of Anchovies, Jams, Jellies, Orange Marmalade.
Anchovy and Bloater Pastes, Strasbourg and other Potted Meats, and
Calf s-foot Jellies of various kinds for table use. C. and B. art Sole
Agents for M. Boyer’s Sauces, Relish, and Aromatic Mustard; and for
Carstair’s Sir Robert Peel’s Sauce, and Payne’s Royal Osborne Sauce.
The above may be obtained of most respectable Sauoe Vendors through*
out the United Kingdom; and Wholesale of
CROSSE Sc BLACKWELL, 21, Soho-bquark.
WHEAT PHOSPHATES IN CHILDREN’S POOD.
M ESSRS. CHAPMAN and CO. beg to call the atten¬
tion of the Profession to their “ PREPARED ENTIRE
WHEAT FLOUR,” which, in addition to the Starch, contains all tbs
Gluten and Phosphates of the Grain, thus rendering it far more valu¬
able than any of the ordinary foods now in use, and is equally service¬
able for Puddings, Ac.
Sold by all Chemists, at 3d., 6d., Is., and 8s.—St. James' Steam
Mills, Hatcham, S.E.
B
DIABETES.
ON TH RON’S DIABETIC BREAD AND
BISCUITS
Have been approved by the Profession and by Diabetic Patients;
contain no starchy matter, and are highly
palatable and agreeable.
Country Orders punctually attended to.
Address, J. BONTHRON, 106, Regent-street, London, W.
EFFERVESCING
COMPOUND CITBATE OF POTASH WATER.
I N a Series of Lectures on Gout, Rheumatism, Rheumatic
Gout, and Sciatica, published in the Lancet by Dr. Fullib,
attention was drawn to the extraordinary virtue of Citrate Of Pot¬
ash in neutralising the acid products of indigestion and ia ridding the
blood of the uric add and other add materials. In confirmation of
this opinion Dr. Ro bert s, of Manchester, in an admirable papsr pub¬
lished in Vol. XLVTII of the 44 Transactions of the Royal Meoieo*
Chirurg cal Sodety of London,” proves, by a series of elaborate experi¬
ments, that the solvent power of Citrate of Potash in gouty
urinary deposits exceed that of Lithia and aU other alkalies. uA
when combined with certain materials calculated to correct addtfi
proves the most valuable of antacid and gouty remedies
neutralising the add which exists in the bloody and me rs utia g ft*
being passed through the kidneys in the form of gravel. It is m7
agreeable and refreshing, ywo or three bottles may be taken difly.
Pbspabed only by W. TWINBERROW AND SON*
2, Edwurdftreet, Port®an-squ»re: and 45, Wfftbom*
London, w.
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“SALTTS POPULI SUPREMA LEX.’*
WEDNESDAY, SEPTEMBER 2, 1 868.
CONTENTS.
ORIGINAL COMMUNICATIONS.
Morbid Con di tion* of the Throat in their
Bilatkin to Pulmonary Conanznption:
their Diagnosis and Treatment. No. V.
By 8. Seott Alison, M.D. Edin.. page 199
Tho Forms of Pneumohia. By Octavius
Stingos, M.D.Cantab. 900
Case of Strangulated Femoral Hernia.
By Henry Gray Croly, F.R.C.8.I., Sur¬
geon to the City of Dublin Hospital, Ac. 909
Remarks on Ferer and Inflammation.
By B. Kelly, M.D., L.K.Q.C.P.I. 908
On the Pathology and Signifloance of
Certain Endo-Cardial Murmurs. By
Thomas Haydtn, M.D., F.R.C.&.I.,
F.K.Q.OPJ.! 906
HOSPITAL BBPOET8.
Da. STBSTsat' Hospitai/—
Case of Leucocythmmia. Under the
care of H. FWke, MJ>.„ F.K.Q.C.PL,
PAGE
M.R.I.A, Physkian to Steerens' Hos¬
pital.205
Kixo’sColliob Hospital—
Cases underthe care of Dr. Beale, F.B.8. 206
Cochty Limebicx Ixfirhary—
Circumscribed Femoro Popliteal Aneu¬
rism of Left Leg: Failure of Pressure:
Ligature of Femoral Artery in Porter’s
Space: Secondary Haemorrhage on 15th
Day: Ligature of External Iliac Artery:
Death from Pyaemia and Gangrene of
Foot and Leg. Under the care of Dr.
Thomas J. (felston. 907
LEADING ARTICLES.
“ Doctors," Civil ahd Military. 909
Lord Amberlky’s Views oe Abortioh... 210
NOTES ON CURRENT TOPICS.
Doctors in the Legislature.—The Quar¬
terly Examinations at the Royal College
of Surgeons in Ireland.—The Dublin
PAOB
City Prisons.—Reproduction Extraor¬
dinary.—The Perils of the Sea-8ide.... 211-19
FOREIGN MEDICAL LITERA¬
TURE.
On Diabetes Mellitus and Paresis of the
Right Extremities, in consequenoe of a
Tumour in the Medulla Oblongata.
Translated by W. D. Moore, M.D..
Dub. etCantab., M.R.I.A., L.K.Q.C.P.I. 218
CORRESPONDENCE.
Davey on “ The Fellowship of the Royal
College of Physicians of London". 218
MISCELLANEA.
Summary of Science. By 0. R. C. Tich-
borne, F.C.8., F.R.O.S.I., &c. 207
British Association for the Advancement
of Science.—Meeting at Norwich.. 214
Medical News, Notices to Correspondents,
Ac..7..819-20
Original (ftammairijcalraijs.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
Bt S. SCOTT ALISON, M.D. Edik.,
FELLOW OP THE BOYAL COLLEGE OP PHYSICIAHS, LOHDOW, AHD
PHYBIC1AH TO TBS HOSPITAL FOR COHSUMPTIOH AHD DISEASES OP THE
CHEST, BSOMPTOX, AHD THE SCOTTISH HOSPITAL.
No. y.
In casts of disorder of the cervical portion of the air-tube
apparatus simulating pulmonary consumption, the careful
application of the tests of physical exploration suffices to
declare with all but certainty in every case the true nature
of the malady, and the comparative safety of the patient.
In the first place, a large body of negative evidence is
procured by the examination of the chest—none, or very
few, of those signs being present which we find in pul¬
monary consumption. Except in a few examples of simu¬
lated pulmonary consumption, percussion gives the clear,
long-continued resonance of healthy, or of more than usu¬
ally air-holding lung, and it is symmetrical. The motion
is ample, and except in very exceptional cases, such as
those combined with malformation of the chest, or old !
pneumonic or pleuritic condensation, it also is symmetrical.
The humid crackle in the apices of the lung is absent, ex¬
cept in a very few cases of liquid bronchitis, the value
of which is usually to be made out by the presence of more
or less sibilus or bronchitis, and the absence of dulness
on percussion. Chamber or cavity sounds are not com¬
monly to be discovered, but it must be admitted that, in a
few exceptional cases, air-chamber sounds, with loud
p qja a and air-chamber crackling, are to be discovered in
tfqott affections, not combined with tubercle of the lung,
betttis is a very rare occurrence. When these signs are
nfcdaout, the throat affection is combined with bronchitis
aodMjfeysema, and with dilatation of one or more of the
<*W<f Ironchi, in these cases the percussion being
clear, over dear, and sibilant and sonorous rhonchi, or
whsseiQg. being present throughout the chest, generally
with Comparatively little emaciation of the body, the bron-
drial oharsoter of the malady is indicated. The presence
of dis e as ed heart supports the non-tubercular view—
cqpoio disease of the neart is meant.
It is also to be admitted that throat affections, simu¬
lating phthisis, or tubercle of the lung, are met with, but as
extreme rarities, iu which the throat affection is combined
with consolidation of the lung, the result of pneumonia, a
cirrhose state in which the voice becomes very loud above*
and simulative of the cavernous character, in consequence of
the contracted and pressed-upon air-tubes below refusing
to disperse the voice as usual throughout the lung struc¬
ture, causing reverberation above. The heart is often dis¬
placed more or less, especially at its base, in consequence
of the traction of the contracting lung giving rise to undue
loudness, and to undue impulse at unwonted parts of the
chest.
In examples of throat disorders simulating pulmonary
consumption, I regard as a very valuable piece of negative
evidence of the non-pulmonary tuberoular character of the
malady, the absence of an auscultatory sign I have very
frequently discovered in cases of the early and yet scanty
deposition of tubercle in the apices. I refer to an inter¬
rupted or divided friction-like sound or rhonchus. The
sound is coarse, and three or four or five divisions, well-
marked, are made out in a single inspiration. It resembles
the sound of two pieces of coarse cloth slowly rubbed upon
each other in contrary directions. The motion not being
continuous, the sound is interrupted. Its locale is usually
one shoulder; it is sometimes found at both. It is heard
best above, between the scapula and the clavicle; at the
scapular region; and it is sometimes most audible at the
head of the humerus. It does not proceed from pleural
friction, but from the repeated obstructions to the passage
of the inspired air-column through the finest bronchial
tubes, from the pressure of tubercular material
This sound, to which little attention has been paid, is
sometimes mixed with the well-known click and fine, humid,
distinct crackle of early phthisis. This sign is very incon¬
stant: heard now, it may be inaudible in a few minutes.
It may continue for days, then stop for hours, but to return
with certainty, and remain with sight intervals until the
tubercular deposit shall be absorbed or become softened,
and give rise to cavernules and cavities. The presence of
this auscultatory sign, and its amount, are a good deal
affected by the quantity of the secretion of the mucous
membrane of the fine bronchial tubes, and in consequence
the sound under consideration varies considerably with the
state of the weather, and with the varying amount of
watery vapour in the atmosphere. I have found this inter¬
rupted, coarse, friction-like sound to become mm marked
STURGES ON PNEUMONIA.
September ft, 1868.
200 The Medieal Press and Circular.
during the prevalence of cold, dry winds. When this sound
has disappeared in the breaking-down lung, it is often
heard in tne apex of the opposite one, usually regarded as
healthy, but now really becoming the seat of tubercu¬
lar deposit. For some years I have called attention
to this important sign, at the Consumption Hospi¬
tal. I regard the absence of it in throat affections
simulating pulmonary tubercle as a very important piece
of negative absence. Its presence I hold as very suspicious
in respect of the lung, and its permanent absence as a very
material fact in support of the disorder of the patient
being one chiefly of the throat or its adjacent parts. It is
for these reasons I have thus dilated upon it in this place.
I do not mean to say that this sign is necessarily associ¬
ated with tubercle, but it is almost always so associated.
In examples of throat disorder simulating pulmonary con¬
sumption, while auscultation applied to'the chest affords
most valuable evidence of the absence of signs observed in
tubercle of the lung, with the exceptions already stated,
and more particularly of the coarse tube blowing inspira¬
tion and expiration likewise unduly prolonged. Applied
to the neck it gives positive and readily appreciable testi¬
mony of the presence of disease in the upper part of the
air-tube apparatus, in the forms of altered respiration
Bounds, adventitious sounds, and of alterations of the
voice.
The most common form of alteration of the respiration in
the upper part of the air-tube apparatus is a high-pitched
constrictive quality very easily recognised, and seated, ac¬
cording to the locality of the disease, at the glottis, at the
larynx, or the narrows of the trachea, immediately above
its bifurcation. The constriction sound pervades all parts,
but it is most intense where the disease is immediately
located, and the greatest intensity is, as respects locality,
aaoertained with perfect ease by the use, simultaneous or
successive, of the two limbs of my differential- stetho¬
scope. The most intense constriction is heard in that ear
connected with the immediate seat of disease. In cases of
severe constriction sound of the trachea some degree of
constriction sound is also heard at the upper part of the
sternum and under the clavicles ; but the origin of the
sound is proved to be in the throat, and not in the lung or
chest by the ear connected with the limb of the differential
stethoscope, again connected with the throat having the
constriction sound in its louder degree.
This constrictive condition of respiration sound is heard
all over the neck, from the hyoid bone above to the upper
border of the sternum below in front, from the inferior
angle of the jaw down to the scapular extremity of the
clavicle at the side, and from the lower part of the occiput
down to the second dorsal vertebra—the level of the bifur¬
cation of the trachea, behind. In some examples of constric¬
tive respiration dependent upon enlarged tonsils and some
thickening of the mucous membrane of the glottis and larynx,
the great extent to which the sound exists at the nape of
the neck is remarkable, and its abatement and final disap¬
pearance, as the stethoscope is made to travel down the
neck into the interscapular regions, are highly striking and
instructive, suggesting that the disorder Is located in the
neck, and not m the chest, a point of the greatest patholo¬
gical and therapeutical importance.
The duration of the inspiration and of the expiration in
cases of throat disorder simulating tubercle of the lung is
increased, and in some cases scarcely any pause between
the sounds of inspiration and expiration and those of ex¬
piration and inspiration can be made out.
Large, moist, bubble-bursting sounds in the neck are in
many examples of throat disease made out by placing the
stethoscope upon the larynx or in the course of the trachea.
This occura, of course, where the secretions are in abun¬
dance, and these may be pus or mucus, with or without ex-
travasated blood. These sounds may be heard in any part
of the neck, back or front, but they are loudest at the par¬
ticular seat of the disease most deeply implicated.
Small bubble-bursting sounds are also not unfrequently
heard in the same parts, and these occur when the secre¬
tion is more scanty. These sounds are sometimes called
crepitations, large and small. When they are heard in the
course of the neck, and when they are absent in the
chest, and when the respiration, the voice, and the per¬
cussion sounds are normal throughout the chest, no doubt
need be felt in regarding the upper part of the air-tube
apparatus as the seat of the main disease, and the local dis¬
order there situated as the cause, for the most part, of the
deteriorated general health of the patient.
In some of the more severe throat affections simulating
pulmonary consumption, the respiration at the apices ac¬
quires a rough and constrictive character, and the expir¬
ation becomes long, and thus a simulation of lung disease
is set up, even in respect of the auscultatory test. This
occurs chiefly in cases marked by the narrowed condition
of the lower part of the trachea, already fully described.
Full and symmetrical expansion of the chest, long con¬
tinued and symmetrical resonance on percussion, absence of
humid crackling, of air-chamber signs, and of the divided
friction-like rhonchus, combined with high constrictive
respiration in the trachea, serve to justify the location
of the disease in that part or the adjoining structures.
The stethoscope applied over the front of the neck, in
many cases of disorder simulating pulmonary consump¬
tion, conveys to the ear a husky voice. Sometimes
the voice is unduly resonant and loud, and this seems to
arise from a moderate amount of narrowing at the glottis,
and sometimes from a moderate amount of undue narrow¬
ing of the trachea, above the bifurcation.
The mechanism seems to be that reverberation of sound
which obtains in moderately shut-in cavities or tubes, the
same as we discover in narrow lanes and passages. A
brazen or metallic voice is sometimes heard through the
stethoscope, and tfiis arises from a dry condition of the
tube.
The cough, in many cases, heard through the stetho¬
scope is extremely loud and explosive. Sometimes it is
brazen or metallic, and this, like the voice, Beems to de¬
pend upon a dry condition of the air-tube, associated with
a spasmodic state. The explosion, hissing, and abrupt
barking sounds, already referred to, are conveyed to the
ear in remarkable force, through the stethoscope placed
upon the throat.
THE FORMS OF PNEUMONIA.
By OCTAVIUS STURGES, M.D.Cantab.
Some short time since, in a paper contributed to the St
George’s Hospital Reports, I ventured to suggest that for
clinical purposes pneumonia may usefully be divided into
four classes. I adopted the view, or rather endeavoured to
illustrate and enforce it by examples—t hat between purely
hypostatic consolidation and purely inflammatory consoli¬
dation, are to be found the great majority of cases of so-
called pneumonia; in other words, that consolidation of
the lung was due in most instances to the joint operation
of a mechanical and a vital cause, either of these prepon¬
derating in any particular instance. It might even be pos¬
sible, I nave thought, by arrangement of a mass of cases,
to place, in their order, the modifications in clinical respects
to which the varying combinations of these two causes
would successively give rise. Such a series would compre¬
hend a complete history of the several phenomena whieh
have been included under this common name. It would
review in turn—First. That purely hypostatic consolida¬
tion, whose site is mainly determined by the posture of
the patient. Secondly. The consolidation, in part mecha¬
nical, which, with a certain favouring condition of the
blood, a material impediment iD the course of the circu¬
lation will suffice to produce. Thirdly. The consolidation
wholly due, as we suppose, to the presence of a materie$
morbi; and lastly. That inflammatory consolidation which
is wont to arise in the healthy and robust under the in¬
fluence of climate changes, or in response to some direct
irritation.
So considered, pneumonia in some of its commonest
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STURGES ON PNEUMONIA.
September 2,1868. 201
forms becomes a mere exponent of the general state of the
system, and the varying degrees of solidity which the lung
exhibits under the operation chiefly of mechanical causes
—now airless only, and laden with serum; and now com¬
pact, swollen, and incompressible, from a new material
filling its cells, may be looked upon as conditions of the
pulmonary circulation, which have their analogy in the
systemic. In this view, the serous and the fibrinous
dropsy which Vogel long ago described may, in the lungs, be
represented by engorgement and consolidation respectively,
and the two appearances, instead of being regarded as suc¬
cessive steps in one process, or else as arising from totally
dissimilar and even opposite causes, may often be more
fitly described as strictly analogous conditions, either of
which may occur in any given case.
Accepting then the word pneumonia in its widest sense,
I proceed to speak of the four forms of it in the order
in which I have just mentioned them. As regards the
first, it deserves notice, that writers who have been the
most peremptory in demanding for pneumonia its -true
etymological meaning, do not overlook the influence of
posture as determining its situation. Thus it has been
sought to account for the greater frequency of right pneu¬
monia by reference to the anatomical arrangement of the
right pulmonary vessels, and even by the fact that the
majority of people repose habitually on the right side.
There are, indeed, some remarkable facts quoted by
Grisolle, which would seem to prove that with children at
least this preference of pneumonia for the right side may
be at once and at will, transferred to the left by takin g
care that the patients lie continually on that side. In
this connection must be mentioned the remarkable prepon¬
derance of double pneumonias in weakly children, and in
old people ; “ all authors,” say Rilliet and Barhez, “ have
recognised that prolonged decubitus on the back, inspira¬
tion of bad air, bad food, &c., have a real influence in the
development of secondary pneumonia.” Such patients are
spoken of as having a “ susceptibility for pneumonia.”
Now, if it be granted that pneumonia is apt to occur
owing to any cause which tends to lower vitality, and that
when so occurring, its place of attack is always the most
depending portion of the lung, we may either adopt the
explanation of Grisolle, if it be one that “ the stagnant
blood sooner or later provokes a true inflammation of the
pulmonary parenchyma,” or we may say, more simply, that
exudation into the air-cells, of one kind or another, is
sufficiently accounted for by the circumstances of the case,
and that the nature of it, in particular instances, will be
determined by conditions of pressure and resistance, which
we have no means of measuring. It is of no practical
importance. It is to be observed, however, that this form of
consolidation is rarely accompanied by pleurisy, and hardly
ever by pericarditis, it thus differs remarkably from the
pneumonia, which certain blood diseases excite in a known
order of frequency. As occurring at the end of life, its
only necessary condition seems to be slow dying, ‘‘the
gradual withdrawal of the vital force permitting physical
laws little by little to resume their sway.”
Allied to these cases of purely hypostatic consolidation,
which it is impossible to refer to any common cause except
general failure of the powers of life, other recorded instances
of hepatization are met with which seem to be due, some
to a definite obstruction as in valvular disease, and others
to an impediment not less real, which is offered by the
altered constituiion of the blood itself. But while each of
these agencies plays its part in the production of hepatiza¬
tion, each, too, has a well-known tendency to pro¬
duce the other. On the one hand, actual mechanical ob¬
stacles to the passage of the blood prevents its due arterial-
ization, and thus render it liable to become the source of
local irritation and disturbance; on the other, a hyperinotic
state of the same fluid leads to the deposition of fibrin on
the valves, and so in the most direct way becomes the
some of permanent valvular disease. These two condi¬
tions, then, will be apt to occur together, and, so occurring,
they may prodace a result which either alone is insufficient
to effect. Valvular disease, therefore, is not itself the cause
of pneumonia. It is only the condition which determines
that phenomenon in the presence of other favouring in¬
fluences, themselves insufficient alone to produce it. The
subjects of valvular disease may, therefore, very properly be
said to have a proclivity to such attacks, just as they may
be said to have a proclivity to anasarca. Consolidation of
the lung iu such persons may not differ intimately from
that which accompanies lingering death or from that asso¬
ciated with blood-poisoning—either of these may have
furnished its remote cause—only, here, a new source of
embarrassment being superadded suffices to precipitate a
result which otherwise would have been delayed, or, per¬
haps, by timely measures, altogether escaped.
Thus we may conceive an explanation for some of those
cardiac cases in which the consolidation, though evidently
depending upon blood-poisoning, yet, instead of resembling
in its position th^ true inflammatory hepatization, occurs
symmetrically at the lower and depending portions of both
lungs, differing only from hypostatic consolidation in
being associated with pleurisy, and often with pericarditis.
In such instances the immediate cause of the exudation I
conceive to be due to the condition of the blood. Its site
is determined, in obedience to physical laws, where the im¬
pediments are greatest and the propelling force the least.
Similarly, in cases where this rule of symmetry is
not exactly preserved, we often find that hepatization in
one lung is represented by extravasation in a corresponding
portion of the other. In instances, especially of mitral
narrowing, where the effect upon the lungs of a definite
obstruction can be best studied, such extravasation occurs
frequently in this association, the one appearance being
about as common as the other. Thus, while it is necessary
here to invoke the agency of a blood-poison, since, without
it, we know that the extremest valvular contraction may
go on for years, yet the lungs remain efficient, it is im¬
possible to overlook the manner in which that agency is
modified by others which are purely mechanical.
To illustrate these remarks, by reference to collected
cases, it appears that in association with valvular obstruc¬
tion we get hepatization of three kinds. First,i and most
commonly, it occurs along with congestion, and resembles,
pathologically, the simple hypostatic consolidation of
which I have before spoken. Such cases, however, are
distinguished, clinically, from these by their more rapid
course, and usually by the presence of active cardiac symp¬
toms. In some, indeed, the surrounding circumstances
render it probable that the condition of the lungs is the
result of the mechanical hindrance alone. Secondly, we
find it—in situation again like the purely hypostatic, but
now often in company with inflamed serous membranes—
in cases where, together with valvular contraction, there is
either a strongly-marked rheumatic diathesis, rheumatism
probably being present at the time, or evidence of uraemic
poisoning, or such like ground for believing that the
initial cause is an altered condition of the blood. Here,
too, hepatization in one lung may be represented by extra¬
vasation or congestion in the othen or the three may be
mixed up together. Thirdly, and I think exceptionally,
we find cases where valvular contraction and blood contami¬
nation co-existing, the latter condition overrides the other,
and hepatization is met with at some defined and limited
spot, as we are accustomed to see it where the valves of
the heart are unaffected.
(To be continued.)
Physicians v. Surgeons.— At the Venereal Hos-
pital of Paris one of the surgeoncies is to be abolished, and %
physician is to take the appointment. Venereal diseases lie
in some degree between physio and surgery. The former
seems in the ascendant in the French capital. At the Lying-
in Hospital a similar alteration has taken place.
1 The three kinds of hepatization here alluded to I suppose to find
illustrations chiefly in Class HI. of my Tables in the 8t. George’s Hos¬
pital Reports. Thus the first kind occurs in oases 1,2, 4, 8,18,15,17,
22, and 33; the second in 6, 9, 11,13, and 80; and the third in 14, 16,
19, 21.
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202 The Hadical Prea and Circular.
CROLY ON HERNIA.
Septembers, 1806.
CASE OF STRANGULATED FEMORAL HERNIA:
EARLY OPERATION : STRICTURE UNUSUALLY TIGHT I SAC
OPENED : INTESTINE VERY DARKLY CONGESTED : IN¬
TESTINAL FISTULA RESULTING : NATURAL CLOSURE OF
FISTULA : COMPLETE RECOVERY.
By HENRY GRAY CROLY, F.R.C.S.I.,
SURGEON TO THE CITY OP DUBLIN HOSRITAL, BTC.
On Saturday, the 11th of July last, Mr.-called upon
me to visit his wife, who was suffering from hernia. The
following is the history of the case as related by the patient
on my visit:—She was 68 years of age, the mother of
eleven children, and had enjoyed excellent health. Six
years ago, in walking, she accidentally slipped and nearly
fell, and on her return home she felt a small kernel in her
right groin. She resided in the country at the time, and,
on consulting her medical attendant, was advised to wear
a truss, which was accordingly procured, and constantly
worn during the day. The patient also stated that the
greater portion of the tumour was reducible, but a small
swelling always remained in the region of the hernia.
Four days previously to my visit, she observed a blueness
about the hernia, her bowels were constipated for several
dayB, and on the night of the 10th of July at nine o’clock
(the truss being off) she vomited. The hernia came down
and became very painful. She did not attempt reduction,
and says she felt unwilling to do so lest it should burst.
She passed a restless night, with pain in the groin, and a
burning sensation at the navel. She vomited sour fluid on
several occasions during the night, and also at half-past
ten o’clock that morning, half an hour before I saw her.
Symptoms at my visit .—Face slightly congested ; coun¬
tenance a little anxious; pulse quick; patient complains of
colicky pain in the umbilical region. On examining the
groin, I observed a tumour occupying the region of the fe¬
moral ring at the right side, oval in shape, and about the size
of a small-sized hen’s egg, situated obliquely, with the’smaller
end upwards and outwards, in the direction of the anterior
superior spine of the ilium, and the larger end downwards
and inwards, towards the saphenic opening. At first glance
the tumour looked like an oblique inguinal hernia, but on
eareful examination, I was enabled to trace Poupart’s liga¬
ment, upon which the smaller end of the tumour had
ascended. The patient informed me that the hernia came
down originally at the upper part of her thigh, and placed
her Anger exactly on the femoral ring.
The hernia was extremely tense, and very painful to the
touch.
Treatment before Operation .—I introduced the long
enema-tube (O’Beime’s) almost its entire length, and ad¬
ministered a purgative injection, which was retained for
some minutes. The bowels then acted, the discharge, con¬
sisting of feculent matter, afforded some relief. A grain
of opium was given at once, and ordered to be repeated
every hour. I informed the patient and her husband of
the true nature of the case, and the necessity for early ope¬
rative interference, if the symptoms were not relieved.
By 3 o’clock p.m., at which nour I again saw the patient
and ascertained that she had two evacuations from the
bowels since my morning visit, the vomiting had ceased,
and her countenance was placid. The hernial tumour, how¬
ever, was just as tense and painful to the touch as in the
morning.
I accordingly decided upon immediate operation, and
extemporized an operation-table, on which I placed a mat¬
tress. My friend Mr. Stokes administered chloroform most
carefully (which was subsequently kept up by Mr. Florence
M‘Carthy), and ably assisted me in the operation, which I
proceeded with in the following manner:—
The integument over the tumour having been pinched
up, was divided by transfixion; the incision thus made
extended from above downwards, at right angles with
Poupart’s ligament. Layer after layer of fascia was raised
with a fine-pointed dissecting forceps, and divided on a
director with a scalpel. The coverings were found to be
thin, in consequence of the position of the hernia. The sac
was soon reached, and a knuckle of very dark-coloured
intestine appeared. A piece of omentum was observed
lying to the right side of the gut, and the sac contained
* irk fluid.
I raised the sac cautiously with a tenaculum, and opened
it, holding the scalpel flatwise. A director was then intro¬
duced, and the sac freely opened upwards and downwards.
A considerable quantity of dark serous fluid escaped, which
was removed by the application of a warm sponge over the
wound.
A knuckle of darkly congested intestine was thus fully
exposed (the size of a large walnut). A piece of omentum
of pinkish hue lay to its right side. I passed my finger
carefully around the gut, and detached a few slight adhe¬
sions. I next felt for the constriction, which I did with the
utmost caution, lest I should injure the gut, which was
unusually tense. By gently drawing the hernia downwards
I was enabled to feel a tight band at the upper part of the
saphenic opening (Hey’s ligament). I tried to introduce
the tip of my index-finder beneath the stricture, but could
not do so. I according bent the director near its point,
and succeeded in passing it under the stricture, which I
inwards. I was then enabled to introduce the end of the
little finger of my right hand, and on it the hernia-knife,
and further divide the stricture. The omentum was re¬
duced first. It passed up, beneath, and to the outerside of
the intestine,* which I reduced by very gentle and steady
pressure. It went up with a gurgling sound. The tip of
the forefinger was introduced into the abdomen, and the
hernia was found to be fully reduced. One vessel, which
bled at this stage of the operation, was ligatured. The
wound was sponged, and the edges were approximated by
the interrupted iron-wire sutures. A large compress of
lint was applied, and retained by the figure of 8 bandage.
The patient was lifted into bed, and her thigh flexed upon
a pillow. She soon recovered from the chloroform. A
grain of opium was placed on her tongue, and ordered to
be repeated every second hour. She was directed to take
ice and chicken broth, and to have a linseed poultice ap¬
plied to the abdomen.
II o’clock p.m. —I visited the patient, and found that
she slept well since the operation, and there was no return
of the vomiting, but she complained of a flatulent pain in
the abdomen. Tongue clean and moist. Pulse 80 in the
minute, soft and regular. Shortly after I entered the bed¬
room she became pale, and vomited a small quantity of
sour-smelling fluid. Ordered iced milk with lime water
as drink, and small quantities of brandy in iced water.
Poultice to be renewed, and a dry turpentine fomentation
to be applied to the abdomen. The grain of opium to be
continued every second hour.
July 12th.—10 o’clock a.m. —Countenance natural
Pulse 72 in the minute. Patient was restless during the early
part of the night, and complained of a colicky pain in the
abdomen, which was relieved by a repetition of the tur¬
pentine fomentation. She slept well afterwards until seven
o’clock a.m., when she vomited several times, sour-smelling
fluid. She passed water during the night. A sinapism
was applied over the epigastrium, and teaspoonfuls of
brandy with ice were frequently given. The following
mixture was prescribed :—
R Acid hydrocyanic, dil., H^viij.
Bi-oarb. potassse, 3ij.
Tinct. opii.,3i.
— Card! co., 3y.
Aquae ad., §viij. M.
Sumat cochl: duo amplacum uno succi limon : in effer¬
vescent : tertiis horis.
11 o’clock p.m. —Pulse 80. Countenance natural. -Ab¬
domen not tender. Patient vomited four times since
morning. Took brandy, ice, chicken broth, and effervesc¬
ing mixture; also the opium.
13th.—Patient vomited four times during the night.
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The Medical Press and Circular.
KELLY ON FEVER.
September 2, 1868. 203
Dressings removed. Wound looks very healthy ; pulse
72.
10 p.m. —Stomach has not been sick since morniDg ; no
pain or uneasiness complained of. Continue treatment.
14th.—Pulse 72 ; stomach quite settled ; two-thirds
of the central portion of the wound have united by “ the
first intention ; ” slight red blush around the wound ;
lower suture removed ; slight discharge from lower angle,
of a sanguineous fluid; linseed poultice applied.
9 p.m. —Warm water dressing.
15th.—Pulse 80; tongue covered with a white fur; patient
passed a restless night; had pain in region of umbilicus;
discharge from wound foetid, thin, and bloody ; “ Condy’s
fluid” applied with warm water dressing; ordered,
Calomel, gr. vj.
Pulv. opii. gr. iij.
in pulv. xij. equal; i. tertiis horis suniend.
Turpentine fomentation to abdomen, and linseed
poultice.
11 p.m. —Pulse 80; abdomen full, but not tender on
pressure.
16th.—Discharge from wound copious and bloody ; car¬
bolic acid lotion applied; omit powders.
17th.—Discharge from wound feculent , and very copi¬
ous.
18th.—Patient looks well; discharge from wound like
half-boiled egg ; it comes out with a sudden gush, and
scalds the wound and surrounding integument, which is
reddened.
28th.—The fecal fistula has closed naturally, the dis¬
charge lessened each day ; the bowels were acted upon by
enemata, administered with O’Beime’s tube.
August 8.—The fecal fistula opened again, and dis¬
charged for a few days ; a bright papilla (with small orifice
in its centre) appeared in the funnel-shaped orifice at the
lower angle of the wound ; an occasional touch of solid
nitrate of silver assisted nature in closing the fistula, and
the patient is now in the enjoyment of excellent health,
and has no tendency to protrusion of bowel, the operation
having performed a radical cure.
Observations. —On reviewing the progress, treatment,
and termination of the foregoing interesting case, the fol¬
lowing practical facts may be summarized, viz.:—
The snape of the hernia (which was femoral) resembled
the obliaue inguinal form, in consequence of the direction
which the tumour assumed by passing over Poupart’s
ligament, and extending in the direction of the anterior
superior spine of the ilium ; on close examination, how¬
ever, the diagnosis was not difficult, as the neck of the
tumour was traceable beneath Poupart’s ligament, in the
direction of the femoral ring.
Before deciding upon operation, I tried the effect
of purgative injections, administered by means of O’Beirne’s
long tube (passed fully up into the bowel), and the
internal use of opium. Notwithstanding the bowels
having acted freely, and vomiting having ceased, the
hernia remained unaltered ; the taxis was not tried in con¬
sequence of the tenderness and unusual tension of the
hernia, and the result of the case showed the propriety of
this practice. The sac was opened in consequence of the
dark appearance of the intestine, as seen through it.
The stricture was very tight and was caused, as usual,
by the upper margin of the saphenic opening (Hey’s liga¬
ment), and required much care to divide it without injury
to the gut, which was tense and very darkly congested.
The patient was kept under the influence of opium for
many’ days, to allay the peristaltic action of the bowel.
An intestinal or fecal fistula formed on the 7th day ; the
neck of the sac and the adjoining peritoneum became ad¬
herent, and prevented extravasation of the contents of the
intestine into the cavity of the abdomen, and in due time,
these newly adhered parts became cicatrized, and a natural
core of the fistula was effected.
Die case proves, in my judgment, the importance of
early operation and avoidance of the mischievous taxis;
had the former been delayed (though the constitu- j
tional symptoms did not appear to be urgent), and the
latter resorted to, death from gangrene of the intestine
must, I believe, have been the result.
REMARKS ON FEVER AND INFLAMMATION.
Br B. KELLY, M.D., L.KQ.C.P.I.
The aphorism, “Ubi irritatio ibi fluxus,” is scarcely more
applicable to the blood than to the nervous fluid. Nor is
it alone in morbid conditions of the system we see the
force of this truth exemplified. In concentration of
thought, as in deep meditation and study, the senses are so
far blunted and kept in abeyance that powerful external
impressions often fail to arouse them. The state of mind
produced by moral emotions also sufficiently prove the in¬
fluence exercised upon the nervous system, and, through
it, on the circulation by subjective impressions alone. Thus,
chagrin and jealousy induce jactitation and feverish ex¬
citement ; pleasure and hilarity, on the contrary, are at¬
tended by an equable temperature.
It is thus, doubtless, that in phthisis, pneumonia, pleu-
ritis, &e., during their inflammatory stage or acme, so
great is the accumulation of nervous energy in the diseased
organs that, all other portions of the body being in a great
measure deprived of it, a condition analogous to section or
paralysis of the organic nervous system ensues ; and hence
the sympathetic fever which always accompanies the dis¬
eases in question. Why the vasomotor system should suffer
more than the cerebro-spinal by this abstraction and local
congestion of the nervous fluid may possibly be owing to
the fact that the former presides more especially over the
functions of circulation and nutrition, and is thereby more
generally and intimately diffused throughout the economy.
The exacerbations and remissions which occur in the course
of acute disease, and which correspond to the ebb and flow
of the nervous fluid, may thus serve as a faithful guide to in¬
dicate the amount of irritation centred in the inflamed part.
Although the organic nervous system is not directly
under the voluntary control of the cerebro-spinal, it by no
means follows that its nervous power does not emanate
from it. Impressions made upon the peripheral portions
of the sympathetic, whether located in the intestines or in
other abdominal or thoracic viscera, must necessarily tra¬
verse the corresponding ganglia in order to be felt by the
nervous centres. In like manner the excitations—the re¬
sult of these impressions—produced in the central organs,
and carried by the efferent branches, slowly repeat the
same circuitous process ere they can reach the muscles and
other tissues to which these nerves are distributed. We
thus can easily account for the tardy manner in which non-
stripe d muscular fibre contracts under the influence of a
stimulus ; but its energy is not the less powerful or per¬
sistent for its slowness.
All acute inflammations and most fevers are ushered in
or preceded by a chill, which usually lasts for a period
commensurate with the severity of the disease of which it
is the harbinger. In a simple phlegmasia it is generally
single, but in fever it is invariably multiple, and consists
of a quick succession or series of horripilations. This
rigor, as it is called, is characterised by a shrivelled state
of the skin, by contraction of the capillaries, and, as a con¬
sequence, by a notable decrease of temperature. The first
action of the morbific cause, whatever it may be, whether
fibrile or inflammatory, seems to expend itself upon the
organic nervous system, and to stimulate it to its utmost
capacity. We know that excitation of the sympathetic is
followed by contraction of the arterial capillaries, slowness
of the circulation, and diminution of the animal heat of the
body. These phenomena tally in a remarkable manner
with the premonitory symptoms of febrile and inflamma¬
tory diseases. Following the chill there next appear suf¬
fused redness of the whole surface, turgidity of the vessels,
and elevation of temperature. The same, it is unnecessary
to say, is observed in section or paralysis of the great sym¬
pathetic, But how are we to account for such a striking
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204 The Medical Press and Circular.
KELLY ON FEVEK.
September 2,1868.
similarity of effects in conditions so apparently opposite ?
The old-school pathologists explained away the phenomena
of the first stage of inflammation in a very off-hand and,
to themselves, a very satisfactory manner.
The capillaries, said they, at first contract, because they
possess the inherent power of contraction; and secondly, they
dilate, because they possess the power of dilatation ! This,
certainly, was very accommodating of the capillaries. But
why do the capillaries in inflammation at first contract, and
soon afterwards dilate ? These vessels, being under the
control of the sympathetic, remain contracted so long as
sufficient nervous fluid is conveyed to them; but, as the
result of over-stimulation of any portion of the nervous
system is exhaustion, or paresis, the vessels soon dilate
from sheer pressure of the blood, and not from any dynamic
activity inherent in themselves. In a word, the stage of
contraction coincides with nervous irritation, and that of
dilatation with exhaustion of nervous energy; and as all
muscular fibre, whether organic or striated, is incapable of
contraction independently of nervous fluid, or some agent
analogous to it, so does its extension depend upon mecha¬
nical force. And as a state of contraction of the capillaries
is attended bv depletion of the tissues, so does the opposite
condition, or that of dilatation, induce hyperaemia, stasis,
and congestion.
In a simple phlegmasia, the irritation which disturbs the
nervous system, and, through the latter, the circulation, is
peripheric, and is located in the organ or tissue inflamed,
in fever, on the contrary, the irritation is central, and de¬
pends upon a general specific intoxication of the system;
and hence the treatment best adapted to the former will
prove utterly worthless, or even destructive, to the latter,
and vice versa. It may, however, be here objected that il
the irritation which gives rise to a phlegmasiae be peri¬
pheric, and confined solely to the part inflamed, how comes
it to pass that the temperature of the whole body is exalted
as in common continued fever. That the heat of the in¬
flamed tissue is greatly increased, there can be no doubt,
as is easily witnessed in anthrax or furuncle; but this in¬
crease is only relative as regards the entire system. Owing,
as already remarked, to the abstraction of the nervous fluid,
and its concentration within a narrow focus, a condition of
the sympathetic ensues somewhat similar to what follows
its section or paralysis. The heat, moreover, in inflamma¬
tion, is more subjective and imaginary than positive or
objective. In continued fever the contrary of this obtains.
The patient invariably complains of coldness; whereas, if
the hand of the physician, or a thermometer, be applied to
any part of his body, a notable elevation of temperature
will be found to exist. The state of the circulation is also
diametrically different in both cases. In inflammation the
pulse is generally increased in frequency and force, the
focal and partial paralysis of the great sympathetic being
more than counterbalanced by a morbid erethism of the
cerebro-spinal system. The arteries throughout the body,
•and more especially those leading to the point inflamed,
pulsate vehemently, as though some great obstacle, the
removal of which they had undertaken to accomplish, had
lain direct in their course. In fever, on the other hand,
the circulation is apparently quickened, but diminished in
force; the pulse, consequently, is rapid and fluttering, but
weak and compressible; hence the great tendency to pas¬
sive haemorrhages and hypostatic congestions shown by the
disease. The blood also retains more or less of its arterial
character after having traversed the tissues of the body,
proving conclusively that nutrition, normal and physio¬
logical, is not only impaired, but in a great measure sus¬
pended; the fibrine is diminished, and a state of the mus¬
cular system resembling at first fatty degeneration, and
finally atrophy, ensues.
The decrease of fibrine may be owing to some yet un¬
known change (probably of a catalytic type) in the albumen,
as a highly fermentible substance, by the zymotic poison,
or the fibrine itself may be primarily attacked by the same
subtle and septic agent.
We agree with Lyons, that the increased circulation in
fever is more apparent than real. This authority states:—
“ Indeed so imperfect are these contractions (ventricular)
sometimes found to be, that the mass of the blood, instead
of moving with increased velocity, is retarded, and flows
more slowly than usual.”
In inflammation the blood, especially the veinous, is
surcharged with fibrine and carbonic acid ; and although
the muscles are wasted when the disease has continued a
considerable time, nothing approaching fatty or waxy
metamorphosis of their fibres is ever noticed.
Another remarkable difference between fever and in¬
flammation is shown by the manner in which congestions,
as they occur in both, usually comport themselves. In
fever a pneumonia, for instance, will persist nearly during
the whole course of the.disease without effecting any
change of a fatal or destructive nature in the lung tissue—
neither purulent nor plastic infiltration taking place—the
parenchyma of the organs becoming only somewhat more
friable than normal, owing to lesions of a necrobiotic order
induced in all the solids and liquids of the body. Pus
formation is as much a natural and common consequence
of an acute, unchecked, phlegmasia, as the absence of sup¬
puration is characteristic of simple idiopathic fever. The
ulceration of Peyer’s patches, which sometimes ensues in
the course of typhoid, forms no exception to the truth of
this proposition. These bodies, like all other conglobate
glands, become hypertrophied in fever ; the nucleated
vesicles in the interior of their stroma undergo cheesy or
fatty degeneration, as the result of modified and impaired
nutrition, and finally softening and sphacelus supervene.
Their superficial location on the surface of the small intes¬
tine, where they are continually exposed to friction from
the passage of faecal matter, is highly favourable to their
disintegration, and accounts, at the same time, for the com¬
parative immunity enjoyed by the mesenteric and other
ductless glands of the system. The ulceration of the
larynx, pnarynx, and oesophagus; the bed sores on the
hips, nates, and other parts exposed to pressure or friction,
afford additional proof of the fatal facility with which in¬
flammation and sloughing arise from slight causes of irrita¬
tion in the course of continued fever.
The eliminating function bestowed upon Peyeris patches
in typhoid by many pathologists, is as erroneous as the one
generally attributed to the kidneys in scarlatina, or to the
stomach and bowels in cholera. The only stage at which
expulsion of the putrid poison can well be said to take
place is, when the glands are simply enlarged, and before
ulceration has set in ; but we have no presumptive evi¬
dence, much less positive proof, that such is the case.
Nature, we are sure, never blindly destroys on organ which
she had previously intended should subserve the office of
an emunctory. And as the term “elimination” neces¬
sarily implies a physiological act, it would be repugnant in
the highest degree to connect it with a morbid process like
that of ulceration. The changes wrought in the economy,
and especially in the glandular system, by the zymotic ele¬
ment of fever, are as material and fundamental in them¬
selves as the lesions induced by corrosive and irritant
poisons. It expends its virulence, so to speak, in operat¬
ing these changes, much in the same way as the chemical
quality of an acid is lost in neutralizing an alkaline base.
There is, consequently, great wasting of the tissues—the
poison being thus thrown off, not, indeed, such as it entered
the system, pure and active, but modified and combined
with effete organic matter. “ Muscle, gland tissue, bone
itself,” as remarked by Lyons, “ undergo manifest diminu¬
tion in volume and density in the course of febrile diseases,
often to an excessive degree.” In this way, also, we ean
account for the remarkable fact of fever scarcely
ever attacking the same individual a second time-
all the organic liquids and solids of the body having
undergone such profound modification from the poison
while permeating the system, that even, when restored to
health, they still retain the impress of its morbific action
to so great an extent as to become impervious to all subse¬
quent contagion of a similar kind.
The Medical £rea and Circular
HOSPITAL REPORTS.
September 2,1868. 205
Great stress is often laid upon deafness when it arises as
a symptom in typhoid ; and physicians, not unfrequently,
endeavour to draw an unfavourable prognosis from its pre¬
sence. But the reason, we think, why deafness is thus
invested with greater importance than any other physical
or rational sign of the disease, is due to the fact that we
commune more generally with patients through their hear¬
ing than any, or all, of their other senses.
Indeed, so far as we have observed, the sight, smell,
taste, and even touch of fever patients are as often im¬
paired and blunted, as is the auditive faculty. Occasion¬
ally there is undue sensitiveness of the acoustic and optic
nerves, but such an accident is comparatively rare, and,
when it exists, should make us rather suspect the presence
of a disease simulating typhoid. The sordes on the teeth,
lips, and gums ; the thick, clammy film, often veiling the
cornea and conjunctiva ; the desquamated, dust-like parti¬
cles obstructing the nares and covering the alae nasi, with¬
out exciting any sense of discomfort, prove conclusively
the degree of intellectual hebetude and nervous torpor in
which the individual is plunged. These accidents are in
themselves as significant as the temporary and partial loss
of hearing, but they fail to impress us as vividly as the
latter for the reason already adduced.
An unfavourable prognosis may be safely drawn from
contraction of the pupils, especially when well-marked
and persistent. This symptom constitutes, per the
strongest evidence of the complete paralysis of the organic
nervous system by the typhic poison. The general hyper-
sesthesia of the surface of the body, so common in con¬
tinued fever, would also seem to indicate that the ereth¬
ism of the sensory nerves is in a great measure vicarious
of the nervous energy withheld from the sympathetic.
The pulse in these cases is remarkably quick, small, and
fluttering, which clearly indicates the employment of neu¬
rasthenic agents, and which nearly always ushers in a fatal
termination.
A correct prognosis, whether favourable, or otherwise,
can also be often determined from the condition of the
tongne, and intellect of the patient. When the former
remains moist and comparatively clean throughout the
coarse of the disease ; when the reason is unimpaired, or
only subject to slight paroxysms of stupor and delirium ;
ana when, withal, there is a keen appetite for the more
substantial kinds of food—approaching a true boulimia,
the case becomes one of extreme gravity, and will require
all the vigilance and skill of the physician to prevent a
fetal issue. The most deceptive, and, at the same time,
the most formidable cases of typhoid fever that have ever
fallen under our observation, were those in which the
tongue was moist and uncoated, the mental faculties un¬
clouded, or slightly impaired, and the appetite ravenous.
ON THE PATHOLOGY AND SIGNIFICANCE OF
CERTAIN ENDO-CARDIAL MURMURS.
By THOMAS HAYDEN, MJ)., F.R.C.S.I., F.K.Q.C.P.I.
[Abstract of Paper read before Section A (Medicine) of the British
Association at Oxford, August 7, 1868.]
Dr. Hayden commenced by classifying murmurs originat¬
ing within the heart under two heads—namely, those
occurring simultaneously with the sounds, and usually
designated “systolic” and “diastolic” respectively; and
those which occur during the intervals of silence or so-
called periods of repose between the sounds. These periods
of silence are two in number, and distinguished as the
Short or “ systolic” pause, occurring between the first and
second sound; and the long or “ diastolic” pause between
tlie second and succeeding first sound. The designations,
“systolic” and “ diastolic,” he has applied to these periods
by pseference, because they imply the corresponding §tatc
of'tbs ventricles in regard to contraction and relaxation,
bad thereby assist the mind of the student in interpreting
o ott hsnpgr — sous murmur* -
Systolic murmurs are of two kinds—viz., those which
accompany, and those which supersede the first, sound.
Diastolic murmurs were similarly classified.
The relative significance of these two kinds of murmur,
in association with the first and second sound of the heart
respectively, was next pointed out. as was likewise the
condition of the valves to be met with in each case.
Murmurs occurring within the time of the short pause
are theoretically of two kinds—viz., “ post-svstolic,” which
immediately follow, and are in direct continuity with, the
first sound, extending to a variable length, into the short
pause, but in most instances falling short of the second sound.
Such murmurs, he showed, were confined to the apex of
the heart, of mitral origin, and due to simple valvular in¬
competence, without organic valvular disease.
The second kind of murmur falling within this period—
viz., towards its close, and immediately preceding, and
continuous with, the second sound, he designates “ pre¬
diastolic.” Practically, the latter kind of murmur is exo-
cardial; he has not met with a single example of such a mur¬
mur due to an endo-cardial cause. A case was given, in which
it was represented by a circumscribed pericarditic friction-
sound, and another in which the murmur of an abdominal
aneurism, synchronous with the pulsation of the abdominal
aorta, and occasionally audible by transmission at the apex
of the heart, corresponded in time with the period imme¬
diately preceding the second sound, and was, therefore,
a veritable pre-diastolic murmur.
Murmurs developed within the period of the long or
diastolic pause are of two kinds—namely, “ post-diastolic,”
which are continuous with, and, as it were, appended to, the
the second sound, but falling short of the first. These
murmurs are basic, usually aortic in origin, and expressive
of imperfect closure of the aortic valves, the consequence of
incipient, and as yet very partial structural change confined
to the edges of the valvular segments.
Fiually, the murmurs which occupy the terminal portion
of the long pause, he designates “ pre-systolic” m pre¬
ference to the title “ auricular systolic” given to them by
Dr. Gairdner.
These latter murmurs are by no means uncommon, are
usually confined to the area of the apex, and pathogno¬
monic of mitral constriction.
Numerous examples were given of the several species of
murmur mentioned, with detailed history of cases, and the
classification of murmurs, with their relationship to the
several phenomena constituting the cycle of cardiac action,
was illustrated by diagrams.
fosjjM g^prfss.
DR. STEEVENS’ HOSPITAL.
CASE OF LKUCOCYTH.EMIA.
Under the care of
H. FREKE, M.D., F.K.Q.C.P.I., M.R.I.A,
PHYSICIAH TO STBKVEN8* HOSPITAL.
(Reported by S. Flood, M.B., F.R.C.S.I., Clinical Clerk.)
J. M., aged 51, a constable in the Royal Irish Consta¬
bulary, was admitted into Steevens* Hospital, on the
15th of June last, complaining of palpitation, general
debility, loss of appetite, and inability to perform his
duties.
lie states that lie always enjoyed good health until
January, 1867, when he began to suffer from dyspepsia
and weakness, which have continued up to the present
time.
His symptoms were dyspnoea; palpitation increased by
exercise, or goiDg up stairs ; vertigo ; dimness of vision ;
general debility ; anorexia constipation ; pyrosis ; oc¬
casional lancinating pain in the region of the spleen and
left shoulder ; emaciation. Tho mucous membrane of the
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206 The Medical Press and Circular.
HOSPITAL REPORTS.
September 2,1668.
conjunctive and mouth was pale and almost bloodless.
Legs cedematous ; skin sallow and dry ; tongue clean and
pointed; abdomen tumid; appetite very capricious; bowels
constipated. No pain on pressure over any portion of the
abdomen ; liver enlarged one fmger’s-breadth below the
false ribs. Respirations 18, lungs apparently healthy ;
pulse 96, weak ; temperature 99°. Area of precordial
dulness slightly increased ; heart’s sounds heard more dis¬
tinctly than normal, and over an increased space ; no
bruit. Urine acid, sp. gr. 1030, depositing a copious
brick-dust sediment of lithates ; no sugar ; spleen not
perceptibly enlarged ; thyroid body of natural size ; great
depression of spirits. Cervical, axillary, inguinal and iliac
glands enlarged (many of them to the size of a chesnut),
and distinctly indurated. A loud and harsh bruit is heard
on placing the stethoscope over the enlarged glands at the
root of the neck on the left side. Never had haemorrhage
of any sort. The patient attributes his illness to ex¬
posure to cold and wet.
In the absence of any history of haemorrhage, malarious
or malignant disease, it was difficult to arrive at an exact
diagnosis, until that form of leucocythcemia, described by
Dr. Hughes Bennett and Virchow as affecting the glan¬
dular system without splenic enlargement, suggested itself.
A microscopic examination of the blood on several oc¬
casions verified this opinion. The number of red and
white corpuscles in the field of the microscope was about
equal. Several of the red globules appeared irregular in
shape.
The treatment consisted in the administration of
various salts of iron in full doses ; strychnia, quinine,
iodine, and liberal diet; and all without the slightest
beneficial effect ; the patient presenting the same strik¬
ingly anaemic look which was so conspicuous on his admis¬
sion.
He was discharged on the 1st of August, and again re¬
admitted on the 3rd, suffering from severe diarrhoea, which
has continued up to the present time quite unchecked by
acetate of lead and opium (Graves’ pills); katechu, kino,
logwood, opium, chalk, sulphate of copper, and nitrate of
silver, &c., &c.
KING’S COLLEGE HOSPITAL.
Casbs under the care of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Pneumonia. —Arthur R., aet. 14, no occupation. Admitted
April 1 ; discharged May 11. In hospital 40 days. Re¬
covery. While sweating drank 2 pints of cold water ;
shivering soon afterwards. On 2nd day, pain in left
side; cough and feverishness. On admission face flushed ;
drowsiness; tongue coated ; pulse 120; respiration 36 ;
left lung slightly dull in front, completely dull below spine
of scapula behind ; fine crepitation and bronchial breath¬
ing over dull space ; sibilus elsewhere ; 6 days later less
bronchial breathing and bronchophony; scanty white
frothy expectoration ; 12 days later lower one-third of left
lung dull ; distant vesicular breathing ; crepitation at
right base ; rhonchus and sibilus at upper part of lungs ;
6 days later breathing everywhere vesicular; lower one-
third of left lung still slightly dull.
Liquor ammon. acetatis, aromatic spts. of ammonia, and
spt. eth. nitrici (17 days). Then bark, muriatic acid and
squills. Brandy to 9 oz. Turpentine stupes.
Tubercular Pneumonia.— J. M‘D., vet. 23, potman.
Admitted April 14. Died on April 22. In hospital 8
days. Three brothers died of phthisis. Profuse haemop¬
tysis 18 months ago ; slight cough previously. Out of
work, and “ worried” of late ; has lost flesh much ; very
weak and feverish 1 week. On admission emaciated ;
tremulous ; delirious ; dulness diminished ; expansion
and cracked pot sound under right clavicle ; gurgling cre¬
pitation ; tubular breathing and pectoriloquy below ; dul¬
ness and coarse crepitation over whole back of right lung;
breathing bronchial over lower third ; purulent expectora¬
tion streaked with blood ; tongue red and glazed; pulse
130 ; respiration 60. Gradually became weaker and died
on 22nd.
Post-mortem .—Old adhesions of and recent lymph on
right lung ; right lung and apex of left studded with mili¬
ary* tubercles, and completely hepatized by pneumonia;
cavity in each apex ; ulceration of back of true vocal cords;
ulcers in ileum.
Liquor ammon. acetatis, aromatic spts. of ammonia,
chloric ether, and squills ; quinine and opium. Brandy
12 oz. Turpentine stupes.
Chronic Peritonitis—Disease of Ovaries and
Bladder. —A. C., ait. 19, housemaid. Admitted Decem¬
ber 26; died on May 7. In hospital 72 days. Amenor-
rhoea 9 months. Pain, tenderness, and swelling in hypo¬
gastric and left inguinal regions; vomiting, loss of flesh
and strength, and occasional severe headache, 6 months;
jaundice 4 months ago, and again 1 week ago; diarrhoea
3 months. On admission skin dark and sallow. Tender
tumour just above pubes; dull on percussion; as large as
two fists. Appetite pretty good; often capricious. Tongue
clean. Much diarrhoea throughout. Occasional vomiting.
Progressive emaciation and weakness. Death on March 7.
Post-mortem. —A few tubercles at apices of lungs; liver
fatty. The tumour was formed of some coils of small in¬
testine matted together by lymph. Old abscess between
uterus and bladder. Superficial ulceration of os uteri. Cyst
of each ovary. Black fungoid excrescences on posterior wall
of bladder. Intestinal mucous membrane healthy.
Bark and hydrochloric acid. Glycerine and syrup of
iodide of iron. Chloric ether and sp. ammon. arom. As¬
tringents for diarrhoea. Wine 4 oz.
Ulcer of Stomach — H^ematemesis. —J. G., tek 38,
labourer. Admitted November 4; discharged November
19. In hospital 15 days. Recovery. Had cholera 11 years
ago. Pain at epigastrium, 2 months; increased by food,
which is vomited soon after it is taken. Sour risings. Pro¬
fuse haematemesis on day of admission. Motions dark and
loose since. Epigastrium tender. No dorsal pain. Is very
anaemic.
Tannic acid (1 day). Then sulphate of magnesia and
dilute sulphuric acid.
Ulcer of Stomach — Haematemesis. —J. G., 21,
barmaid. Admitted May 18; discharged July 1. In hos¬
pital 44 days. Very much relieved. Pain in chest and
between shoulders 2 years. Vomited a dot of dark blood
three weeks ago. Slight haematemesis twice or thrice daily
since. Bowels confined. Appetite bad. Nausea after
food. Tongue brown. Pain at epigastrium on 2nd day
after admission (23 days). Vomited about half an ounce
of blood o.m. Discharged because unwilling to follow treat¬
ment.
Hydrocyanic acid and bicarbonate of soda (25 days).
Then quinine and iron. Hydrochloric acid lotion.
Ulcer of Stomach (?)—Caroline D., aet. 32, married.
Admitted April 21 ; discharged May 7. In hospital 16
days. Recovery. Typhus 16 years ago ; confined 16
months ago; dyspeptic since. Suckled child for 12
months. Weakness, flatulence, epigastric pain, worse after
food, sour risings, evening vomiting, occasional diarriwa,
motions dark, appetite bad, pulse feeble.
Aromatic spts. of ammonia, and mixt. camph. (7 days)-
Sulphate of iron and quinine.
Vomiting. —John R., ret. 41, street fruit-seller. Ad¬
mitted July 8 ; discharged July 13. In hospital 5 days.
Recovery. Vomiting and epigastric pain 1 month ; pi°
over whole abdomen, 4 days ; sour risings ; constipation ;
tongue coated ; pulse 76 ; constant vomiting of dark green
fluid.
Hydrocyanic acid, chloric ether, and bicarbonate of soda.
Dyspepsia. —A. F., net. 28, housemaid. Admitted No¬
vember 3; discharged November 23. In hospital 20 days*
Recovery. Family phthisical ; catamenia irregular 3§
years; loss of flesh; vomiting and epigastric pain 6 months;
four attacks of haemoptysis in last 4 months, the last 14
days ago ; cough 2 months; much tenderness of abdomen;
the Medical Press and Circular.
SUMMARY OP SCIENCE.
September 3,1868. 207
slight dulness, harsh bronchia, and increased vocal reson¬
ance at left apex; no vomiting after admission.
Pepsine, bismuth and hydrocyanic acid, bicarbonate of
potass. Aperients.
Dyspepsia. —Clara C., set. 36, perfumer’s assistant. Ad¬
mitted September 29; discharged October 27. In hos¬
pital 28 days. Recovery. Catamenia absent 7 months;
and waterbrash 7 months; pain at epigastrium, at first
slight and occasional; appetite bad ; epigastrium tender ;
constant vomiting ; pulse feeble.
Hydrocyanic acid and bicarbonate of soda, pepsine, and
dilute hydrochloric acid, sesquichloride of iron and
quassia.
COUNTY LIMERICK INFIRMARY.
CIRCUMSCRIBED FEMORO POPLITEAL ANEURISM OF LEFT LEG:
FAILURE OF PRE88URK I LIGATURE OF FEMORAL ARTERY
IN PORTER’S SrACE : SECONDARY HAEMORRHAGE ON 15th
DAY : LIGATURE OF EXTERNAL ILIAC ARTERY : DEATH
FROM PYaEMIA AND GANGRENE OF FOOT AND LEG.
Under the care of Db. THOMAS J. GELSTON.
James O’Dba, ast. 46, seen by me as a dispensary patient
on 27th June, 1868, when I at once baa him removed
to the County Infirmary, where I saw him in consultation
with Dr. Wilkinson at three o’clock p.m. Is a sawyer by
trade. He received no injury ; had venereal; drinks freely,
and suffers from rheumatism. The enlargement begins at
the angle of Scarpa’s space, and extends to the lower margin
of the popliteal space. The sound limb measures above the
knee 12* inches, whereas the diseased one . at the same
point 15$ inches. Visible pulsation; great oedema of leg
and foot. He has been blistering and poulticing the
tumour on bis own responsibility. No medical man saw
him. Heart sounds healthy. Patient very irritable and
nervous. Commenced compression at once, and applied
ice to the tumour. All pulsation ceases on pressure being
applied to the femoral above the tumour ; but the sac can¬
not be entirely emptied. Says he never remarked any¬
thing wrong till about a month since. Glands in groin
enlarged, and distinct fremisseunent along entire course of
artery of diseased limb, and slightly so in sound one.
July 1st.—Compression kept up since the 27th of June.
The aneurism measures this morning 17£ inches. He now
cannot bear any pressure in the groin, and the clamp which
was applied in the thigh has produced a slough ; great
CBdema of entire limb up to groin ; so we decided on tying
the femoral artery, whichT did on the morning of July
2nd, by Porter’s operation, by a transverse incision
half-an-inch below roupart’s ligament; the vessel was
easily secured, and pulsation immediately ceased. Applied
a flannel bandage up to one knee, and hot jar to foot. To
have his meat ; no porter or ale. Scarcely a drop of
blood was lost during the operation. Six p.m. —Going on
very well; had some pain in his knee during the day, which
is now quite gone. Temperature of foot and leg good ; no
pulsation in tumour. To have 40 drops tinct. opii at bed¬
time. From this time he went on well. Tumour daily
getting more solid, and measured on the 10th July 15$
inches, when on July 17th, at 11 a.m., secondary haemor¬
rhage took place, pressure was applied in groin, and when
my father and I arrived, I at once cut down and tied the
external iliac artery by the usual operation. Scarcely a
drop of blood was lost, and the haemorrhage was com¬
pletely arrested. To have 40 drops tinct. opii at once.
All went on well till the 19th July, when fresh bleeding
took place from the old wound from the distal end of the
femoral ; when I arrived all had ceased, so I applied a gra¬
duated compress. Patient very weak. Circulation feeble,
but temperature of leg and foot good. Went on very well
till July 21st, when the bleeding again took place. We
enlarged wound, but could not get at any vessel ; all the
parte sloughy, plugged wound with sponge and a saturated
solution of perichloride of iron in glycerine, and to keep
Up pressure over all with the hands, which was done by all
the patients in the hospital by turns, night and day (till his
death).
24th.—Bled again ; plugged wound as before.
28th.—Bled again, tried in vain to secure some vessel,
but failed. All parts sloughy, and full of pus ; would
not hold a tenaculum or needle.
30th.—No bleeding since, but gangrene is setting-in in
the foot. To be kept warm.
31st.—Gangrene spreading ; no return of haemorrhage ;
patient very weak, and sinking rapidly. Died at two p.m.
of the morning of August 1st, 1868.
Ten hours after death the femoral artery was found ex¬
tensively diseased, and the haemorrhage took place from
the distal end of the femoral ; all parts sloughy and full
of pus. The ligature on the external iliac came away
when touched, but the artery was impervious. We did not
open the sack, which was quite soft, not wishing to dis¬
figure the remains too much.
The failure of the ligature on the common femoral in
this case I attribute to the diseased condition of the vessel*
-» - ■■■
(Specially edited and Compil'd /or the Medical Press and Circular.)
By C. R. C. TICHBORNE, F.C.S., F.R.G.S.I., Etc.
[The Editor of this Summary wishes it to be understood that he is
not responsible for the ideas, theories, or the correctness of statements
made in any of the papers quoted in the compilation.]
OCCLUSION OF HYDROGEN-GAS BY METALS.
The master of the mint has applied this term to the absorption
of gases by what he terms colloid metals.
A new method of charging the metals with hydrogen at low
temperatures has lately been discovered by him.
When a plate of zinc is placed in diluted sulphuric acid
hydrogen-gas is freely evolved from the surface of the metal ;
but no hydrogen is occluded and retained. A negative result
was, indeed, to be expected from the crystalline structure
of zinc. But a thin plate of palladium in the same acid,
and brought into contact with the zinc, soon becomes largely
charged with the hydrogen, which is transferred to its surface.
The charge taken up in an hour by a palladium, plate amounted
to 173 times its volume.
A1 though the hydrogen enters the palladium, and no doubt
pervades the whole mass of the metal, it exhibits no disposi¬
tion to leave that substance even in a vacuum at the tempera¬
ture of its absorption. Occluded hydrogen is therefore no
longer a gas, whatever may be thought of its physical condi¬
tion. When palladium charged with hydrogen is left exposed
to the atmosphere, the metal is apt to become suddenly hot, and
to lose its gas entirely by spontaneous oxidation.
The condition of hydrogen, as occluded by a colloid metal,
may be studied with most advantage in its union with palla¬
dium, where the proportion of gas held is considerable. The
largest absorption of hydrogen observed was in the case of
palladium thrown down upon a thin platinum wire by electric
deposition. Such a specimen of metal occluded 982 times its
volume of hydrogen, or by weight—
Palladium, 99*277
*723
100 *
or an approximation to the compound Pd H.
Professor Graham thinks that the passage of hydrogen
through metals is always preceded by the condensation, or
occlusion of the gas. The “ solution affinity” of metals
appears to be nearly confined to hydrogen and carbonic oxide;
metals are not sensibly penetrated by other gases than these.
TIIE COMPOSITION OF COMETS.
Mr. W. Huggins describes the appearance of the comet seen
in the telescope on June 22nd. He found the light of this
comet when examined with a spectroscope furnished with two
prisms, to be resolved into three broad, bright bands. The author
gives a measure of these bands, and a diagram of their appear¬
ances. This spectrum of the comet agrees exactly with a
form of the spectrum of carbon , which he observed and mea¬
sured in 1864 —viz., the spectrum of the induction spark taken
Digitized by VjiOO^lC
20& The Medical Press and Circular.
SUMMARY OF SCIENCE.
Septembers, 1868.
in a current of olefiant gas. The remarkable close resem¬
blance of the spectrum of the comet with that of carbon neces¬
sarily suggests the identity of the substances by which the
light is emitted in both cases. Phosphorescent substances
give discontinuous spectra, but we cannot consider cometary
light to be of a phosphorescent character.
ADULTERATION OF SUBNITRATE OF BISMUTH.
Dr. Redwood has met with two samples of adulterated sub¬
nitrate. The new sophistication seems to be phosphate of lime.
M. Roussin had previously found a sample containing 28 per
cent, of phosphate of lime; and we are glad to find, for the
credit of the British manufacturers, that the two samples exa¬
mined by Dr. Redwood were of foreign make.
This fraud is detected in the following manner:—Equal
quantities of the subnitrate and tartaric acid are dissolved in
water, acidulated with nitric acid. To this is added a strong
solution of carbonate in excess. The subnitrate of bismuth will
remain clear, even after boiling; if it contains one or two per
cent, of phosphate of lime a white precipitate will fall on boil¬
ing.
ON PHOSPHORIZED OIL.
M. C. Mdhu writes upon the above subject in the Journal do
Pharmacie et de Chime. The oil is used in paralysis and other
diseases. M. Mdhu says that the preparation of the French
codex (Iluile Phosphoric) is a bad preparation; both uncertain
in its composition and changeable.
One of the causes of this instability is the impurities in the
almond oil. He therefore heats the oil in a porcelain capsule
during one-fourth of an hour to a temperature of 150°, and
finally to a temperature of 200 to 2b0 9 for six minutes.
It gives off the vapour of water and certain organic sub¬
stances easily alterable; at the same time the oil becomes com¬
pletely blanched. It is only necessary to filter it.
One centigramme of phosphorus is then placed in a flask,
and a gramme of oil, prepared as above, is added.
The phosphorus must be quite transparent, and free from
red or opaque phosphorus. The flask is placed upon a salt¬
water bath, and the mouth opened once or twice, to allow the
heated air to escape, and finally the temperature is raised to 80
or 90° C. without shaking ; the flask is then closed and shaken
violently, until all the phosphorus is dissolved. The phosphorus
is not deposited again on cooling.
The oil at 1-100 is phosphorescent when the flask is open;
the space filled with air exhibits a magnificent phosphorescent
cloud, and the vapour of phosphorous acid is formed.
An oil which does not contain more than two grammes of
phosphorus for 1000 does not shine in the dark, and the vessel
is no longer filled with white clouds of phosphorous acid.
Such an oil is preferable for daily use to one which is under¬
going a partial alteration each time it is opened.
The phosphorescence of any oil is a sign of its alteration in
the air. If, however, a few drops of ether are added to the
oil, the faculty of shining in the dark is instantly stopped. Sul¬
phide of carbon and turpentine possess this property, but
essences of thyme, rosemary, and mint, and alcohol do not pos¬
sess it. The vapour of ether alone is quite sufficient
to stop the phosphorescence.
DETECTION OF NITBO-GLTCEBINE.
A. Weber gives us the following method for detecting nitro¬
glycerine in case of poisoning. The organic material or sub-
stance is comminuted ana then extracted with ether or
chloroform. The tincture is mixed with two or three drops of
pure aniline and evaporated on a water-bath.
To the residue a few drops of concentrateds ulphuric-aci
re then added, when, if nitro-glycerine is present, a purpled
colouration appears, which changes to a dark green on dilution
with water. As little as *001 grain of nitro-glycerine may
thus be identified .—Foreign Correspondent of the Chemical
News.
SPECTRA OF POTASSIUM AND BARIUM.
Mr. J. Freeman fChemical Neves) recommends the use of a
mixture of the chlorates instead of the nitrates for viewing
the spectra of their metals, and there is no doubt that his re¬
marks are applicable to other metals. The increased tempera¬
ture produced from the combustion of a chlorate with char¬
coal, compared to a nitrate, renders visible, in the case of pot¬
ash, all the lines with the exception of one, in the blue, many
of which are invisible when only viewed from the combustion
of nitre. The &me remarks apply to barium.
PERSULPHIDE OF HYDROGEN A TE3T FOB STRYCHNINE.
Under the heading of “ A Contribution to the Knowledge
of Persulphide of Hydrogen,” Dr. Hofmann has forwarded to
the Royal Society an account of a most curious reaction, which
promises to be of considerable practical value. The composi¬
tion and even the existence of persulphide of hydrogen has
remained so far an open question, although examined by Schule,
Berthollet, and Thenard. It remained for Dr. Hofmann, with
his usual facility, to decide this point, and to give the account
of some experiments which promise to have a practical bear¬
ing. On adding a cold saturated solution of strychnine in
strong alcohol to an alcoholic solution of polysulphide of am¬
monium, brilliant crystalline spangles soon begin to appear
in the liquid, and after twelve hours the vessel is filled with
beautiful orange-red needles, frequently attaining the length
of a centimetre. After the removal of the mother liquor it is
only necessary to wash these crystals once or twice with alcohol
to render them quite pure. They are insoluble in water,
alcohol, and ether, and also in bisulphide of carbon. The
crystals are composed of one molecule of strychnine with one
mol. of persulphide of hydrogen. This compound C * 1 H**N*
02, H2 S 8 goes far to prove the existence of a persulphide of
hydrogen.
Quinia, cinchonine, brucine, and several other vegetable
bases were respectively submitted to the action of an alcoholic
solution of polysulphide of ammonium, but (in no case was a
similar phenomenon observed. It therefore becomes evident
that not only does Dr. Hofmann’s experiments bear a more
than ordinary scientific interest, but that a mode of preparing
strychnine and also a test for that important alkaloid is thus
shown.
SILICI-IODOFORM AND IODIDE OF SILICUM.
Iodide of silicum is formed by passing iodine over red-hot
silica, the iodine vapour must be passed with perfectly dry
carbonic acid—as thus obtained it is in white cubic crystals. It
decomposes water with the formation of silica, and hydriodic
acid, with the liberation of hydrogen, and the precipitation of
iodine. By causing bydriodic acid to act upon silicum in the
presence of hydrogen, a liquid product was obtained by M.
Friedel, which was found to have the composition Si H I s .
Its density is 3*360. It does not, however, seem to be i
stable compound. When decomposed by water, it yields s
white substance, which liberates hydrogen, which M. Friedel
supposes to be siliciformic anhydride.
PURE CARBONATE OF LIME.
Dr. Grasger’s process (given in the July number of the
American Journal of Pharmacy) may be found useful in the
arts, as pure lime is not easily procured economically.
Burned lime, recently slacled t is digested with a solution of
nitrate of ammonia, leaving the lime somewhat in excess.
The liquid contains nitrate of lime and ammonia, none of the
impurities found in lime being dissolved. Carbonic acid gas
passed through this solution precipitates pure carbonate of
lime as a dense crystalline powder. It is admissable to add to
the liquid a little carbonate of ammonia before filtering it
The filtrate is neutralized with nitric acid, and serves again
for dissolving burned lime. The only expense, therefore, is in
generating the carbonic acid ,—Journal de Chemie .
DETECTION OF ERGOT IN FLOUR.
In same journal we have an account of a method of detect¬
ing ergot in flour, a matter of some importance in many conn-
tries. M. Berlandt’s process is based upon the decomposition
of propylamin into marsh gas and hydrocyanic acid (C 6 H 9 N=
2 C, H 4 + C a N H). One part of the flour, 1 of caustic
potassm, and 6 water, are introduced into a small flask, which
is connected, first, with a chloride of calcium tube, and then
with a combustion tube of 5 mm. diameter placed in a com*
bustion furnace; this tube is connected with a Liebig’s potash
apparattis containing distilled water. The combustion tube is
heated to redness, and then the flask is heated for half-an-
hour, while the potash apparatus is kept in ice. This liquid is
afterwards mixed with sulphide of ammonia, evaporated to
dryness, and dissolved in a little water. A few drops of
diluted Besquichloride of iron produce a blood-red colour, in
consequence of the formation of sulphocyanide of iron.
COLOURLESS IODINE.
Under this name a solution containing iodine, carbolic ac id,
Digitized by vJiOO^lC
September 2, 1868. 209
The Medical Press and Circuit. DOCTORS,” CIVIL AND MILITARY.
and glycerine, has been introduced to the American profession.
It is made by mixing—
Compound tinct. of iodine, *lxl v.
Carlx>lic acid cry., tilvj. (fused).
Glycerine, 3viii.
Water, 3 V -
The colour of the iodine gradually disappears, and the solu¬
tion eventually becomes colourless; this change is completed at
60° Fahra., in eight or ten days, but if exposed in a water bath
to a temperature of 90° to 100°, the change will be effected
in eight or ten hours. The change is due to the carbolic acid,
not to the glycerine. The character of the change is the pro¬
bable transformation of iodine into iodoform .—A merican Jour¬
nal of Pharmacy.
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it aitir Similar.
“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 2, 1868.
“DOCTORS,” CIVIL AND MILITARY.
The late Mr. Guthrie made the remark that there is
hardly a great functionary, a member of Parliament, or a
clerk in any of the public offices which may have directly
or indirectly to do with doctoring, who does not consider
himself by virtue of his station or office better qualified
to judge of all matters in physic and surgery than any
doctor in the empire. In civil life, the medical man finds
his views and professional action often combated and embar¬
rassed by venerable people of either sex, who would not
dare to question the opinion of their lawyer on a point of
law, or their clergyman on one of controversial theology ;
but who hesitate not to evolve, out of their inner con¬
sciousness, any number of theories to hurl against the
experience and science of the doctor. The latter, if he be
a discreet man, learns to accommodate himself to circum¬
stances—knowing that while bread and butter are not to
be quarrelled with on slight pretences, the tendency of
nature is, in most instances, to effect a cure ; and that in
the few exceptions, or where the case is really complicated
or severe, he is pretty sure to be left in the full enjoyment
of all the responsibility connected therewith, but also of all
the odium, should unhappily the laws of mortality prove,
as they are sure to do some time or another, more potent
than his art.
As an example of what occurs in the public services, let us
take the Army. According to theory, and the regulations , the
medical officers are responsible in regard to all matters that
bear upon the health of the troops, and it is perfectly right
that they should be so. But what is the case in practice?
There is hardly an officer of or above Field rank who now*
a-days does not consider himself quite as capable as any
doctor to form an opinion upon any sanitary question that
may arise,—a belief in which they are encouraged by the
higher authorities, who make a point of constituting sani¬
tary boards of military officers, with a surgeon merely to
give his opinion upon any matter regarding which it may
be required. Men, not of the medical profession, have, as
a rule, a very imperfect idea of what are called sanitary
requirements, beyond what can be effected by the scaven¬
ger. They, therefore, consider that any proposal which
does not include the use of the broom is not in its nature
worthy of attention, while to a suggestion that does in¬
clude the employment of that very useful, if not particu¬
larly scientific instrument, they reply that their noses and
eyes enable them to form as correct an opinion as any
medical man could in the existing conditions. But let us
suppose that the report or representation of an army medi¬
cal officer with regard to a question, say of barrack or
hospital construction, has, after being duly commented
upon, been forwarded to its destination, the chances are
that it there subsides ; Or, should any reply be vouchsafed
to the proposals, it is only an intimation that they shall be
considered, or, perchance, included in the estimates for
improvements to be effected at some distant future date.
With this the Military Medical Officer will, if he has
tact and discretion, be satisfied ; only be knows, probably
from past experience, that he had better take a note of the
circumstance. Should, unfortunately, illness occur among
the troops under his charge, or defects be discovered by
any of the many Inspecting Officers who from time
to time go their rounds, woe betide the unlucky
Surgeon who is unable to show that he has already
brought the subject to notice! Thus, he finds himself
in this happy position, that if he does suggest neces¬
sary improvements, the chances are much against their
being carried into effect; whereas, if this knowledge
deters him from doing so, and any circumstance should
arise to direct special attention to the existence of defects,
his prospects, as regards advancement in his department,
are floored from that moment. A pleasant position truly !
And yet, how can circumstances be altered ? The publio
cares little by what precise means desired ends are attained*
but it does care that the army for which it is made to pay
exorbitantly shall be maintained in the highest possible
degree of health and efficiency. Let, therefore, medical
officers have, in reality, as they now have only in name, the
entire superintendence of all matters bearing upon the
health of the soldier. Let the cobbler stick to his last;
the military officer to matters military ; the medical officer
having control and responsibility in regard to those that
come within his proper sphere.
Doubtless, there are times, as for example in active ser¬
vice, when military requirements supersede all other con¬
siderations ; but under ordinary circumstances, both at
home and abroad, there appears to exist no actual reason
why the principal medical officer in the command should
not, through his subordinate officers, be held as supreme
in sanitary questions, as the commanding Royal Engineer
is with reference to his branch of the service ; he being in
turn responsible to the Director-General, who, in order
that he might exert his proper functions, should be directly
in communication with the Secretary of State for War ?
towards whom his standing ought to be in all respects
equal to that of an Under Secretary.
There exist certain questions of sanitation that concern
Digitized by vJiOO^lC
210 The Medical Press and Circular. LORD AMBERLEY ON ABORTION.
September 1, 18&
the military in common with the civil portion of the com¬
munity. They ought really to be considered by a Board
or Committee, consisting of representatives of each; the
views arrived at, in so far as they concern the troops,
being submitted through the Army Medical Department.
As matters at present are, that department, in regard to
the larger questions affecting the health of the soldier,
holds little, if at all, better position, than it did at the
end of last century. It is time that this anomaly should
cease.
LORD AMBERLEY’S VIEWS ON ABORTION.
As we anticipated, the report of the discussion on Mr.
Lawrie’s communication to the Dialectical Society “ On the
Happiness of the Community as Affected by Large Fa¬
milies,” has excited very justifiable indignation against the
doctrines to which some of the speakers gave expression.
On that occasion Lord Amberley, son of the leader of the
Radical party in the House of Peers, the pet lordling of
the Reform League, and the Liberal candidate for the re¬
presentation of South Devon in the new Parliament, oc¬
cupied the chair, and the assembly was greyed by the pre¬
sence of several females, whose views on morality appear
to be very advanced indeed.
The author quoted Scripture to show that all the ills
the world ever suffered under were due to the over produc¬
tion of the human race. He wound up the disquisition
with the opinion that emigration, colonization, or any of
the existent means of getting rid of the surplus population
are oqly inefficient make-shifts, and that the only panacea
is the small family system prevailing in France. So far
Mr. Lawrie’s paper was innocuous, for even if his argu¬
ments were not unsupported by practical experience,
there could still be no great objection to persons restricting
the number of their children by enforced self-denial. So far
from the author’s premises being true, it would seem evi¬
dent that the high and increasing rates of wages even in
the most over-populous places, and the existence on the face
of the globe of whole continents of barren and uninhabited
soil, indicate that increased rather than diminished popula¬
tion is what the world requires to attain the highest degree
of happiness and civilization. It is simple nonsense for an
author who desires to legislate for the whole world, to argue
from individual grievances ; and the absurdity was capped
by a subsequent speaker, who said that an agricultural
labourer of his acquaintance had only 8s. a-week, and three
children, “ owing to the fact that the people are landless,
and that large tracts of ground were taken up by the
hunting grounds of the aristocracy.”
It is not, however, to Mr. Lawrie’s proposal of small fa¬
milies that we object, but to the means openly and unblush-
ingly proposed to remedy the difficulty, and the utter
disregard by the speakers of the principle of right
and wrong which conscientious persons derive from the
teachings of religion. Feeling the hopelessness of incul¬
cating universal self-denial as a remedy for their alleged
grievance of over-production, they at once discard it, the
only natural or right means of controlling over-population,
and they look around them for means, holy or unholy, by
which the world may be permitted to give full licence to
its sensuality without incurring the penalty (as the Dialec¬
tics would call it) which nature and a just Providence pro¬
vides. Before considerations of what they call expediency
all conscientious or scriptural restrictions vanish, and they
do not hesitate when a moral difficulty arises in their path
to elbow it aside at once to make room for a feasible, if not
very righteous plan of their own. We believe we have
not misrepresented the opinions of those who took partin
the debate.
Mr. Levy said—As to the way in which the limitation
of families should take place, he did not think, with many,
that each family should only have two or three children
Delicate persons would be better without any children, and
the robust and capable ought to have the privilege of en¬
gendering a larger number than the average.
Dr. Chapman accepted the law of Malthus as a scientific
truth. The tendency to procreation helped us to keep
down the inferior races, and thus, with the palliative of
emigration, he thought that the “struggle for existence”
was, on the whole, beneficial to mankind. Probably, as
civilization advanced, the mere animal propensities would
become more easily kept in abeyance, and poverty, arising
from our over-population, would cease.
Lord Amberley said the subject brought forward by
Mr. Lawrie was of first-rate importance. There was no
doubt that prevention of over-population was by far the
most satisfactory method of attacking the eviL How was
this idea to be best spread among the poorer classes ? He was
glad to hear from Mr. Bradlaugh that the working classes
were beginning to debate this vital point. Unfortunately
the influence of the clergy in common with that of society,
and the natural passions of mankind, were opposed to the
prevention of over-population. He ventured to think that
the propositions of Mr. McSweeny, that the evils of over¬
population could be remedied by taking the hunting-
grounds of the nobility, were erroneous. If it would do
so, he, for one, did he possess such a park, would gladly
part with it to do away with poverty ; out, in fact, popula¬
tion would swallow up such small gifts in a few years, and
leave only fewer open spaces for all to enjoy. Emigration
was good, but not rapid enough to relieve the pressure
caused by rapid multiplication. The practical conclusion
from all of which seemed to him to be, that Mr. Malthus
was correct, and that, if ever we are to escape, as a nation,
from poverty, it must be by the limitation of the size of
our families. He (Lord Amberley) objected to celibacy;
we all naturally objected to war and famine. Well, then,
the only remaining alternative seemed to him to be small
families ; and after all it turned out to be a medical ques¬
tion how this could be best accomplished without injury to
the health. He wished much he could hear the proposals
of the medical men in the room as to the best means of
limiting numbers. In America ladies were in the habit of
keeping back their families, but the methods they em-
K seemed to him to be dangerous to health. Hence
uld much like to hear a discussion as to whether some
innocuous measure might not be discovered. It was remark¬
able that the subject should have first been taken up in
America, where it was not so much required as it was here-
Mr. Rigby Smith believed that the existence of large
families was an immense evil. He would add that, at
present, it was by no means the best portion of the race
which increased and multiplied too fast; it was precisely
the opposite of this. Witness the celibacy of the bar¬
risters and of the upper and educated classes, and the
rapid multiplication of the uneducated classes.
Dr. Charles Drysdale said he would not assume that
all in the room agreed with the law of population,
according to Malthus. He believed it was but proved by
the following facts :—During the years from 1790 up to
1810, there was scarcely any emigration into the United
States of America, and yet the population there nearly
doubled itself in these twenty years. Now, in Great
Britain the greatest rapidity of multiplication ever known
—t.e., from 1800 to 1853, had caused the population to
double only in 53 years. In France the rate of increase
of late was almost null. In Turkey it was calculated that
it would require 555 years for the population, at its present
rate of increase, to double itself. Now, it was evident that
Digitized by V J °°8 le
The Medical Frees and Circular.
NOTES ON CURRENT TOPICS.
September 2,1868. 211
if in France, for example, the population did not double
itself so fast as in the United States from 1790 to 1810, it
must be because it was checked in various ways. And, on
inquiry, it would be found that in France, as in England
—(1). Marriages were contracted later than in America.
(2). Wages were far lower in France than in the United
States. (3). There were far more prostitutes in France than
in the United States. (4). There were fewer chil¬
dren to a family in France than in England, or a fortiori,
in the United States. Lastly, a vast number of children
died from privations and poverty. He, therefore, ad¬
mitted witn Lord Amberley that the question was
mainly a medical one—viz., how could married persons
limit the number of their offspring without injuring their
health ? He thought this question reqnired much calm
thought and discnssion, and meanwhile would only state
that in France, a few years ago, he had in one hotel met
with two young couples both married about five years, and
both without children. On interrogation the same answer
was returned by both husbands, that they were not rich
enough yet to afford children. This was one solution of
the difficulty of over-population, if not the best.
Mr. Nasmyth contended that the over production of
children was, in a great measure, dependent on fashion. It
was the present fashion in England to have large families,
whilst in France, as everybody knew; a great number of
persons thought it absolutely wrong to have more than two
or three.
Mr. Davis contended that the cause of the poverty of the
poorer classes in this country was not that they had too
many children, but that the land laws were bad and re¬
quired alteration.
We have reprinted above the most important portions
of the debate, as it appeared in our issue of July 22nd. We
understand that Lord Amberley, feeling that the view's
attributed to him are not likely to meet with favour with
his friends in South Devon whom he desires to conciliate,
denies the accuracy of the report.
We have only to say that we have entire confidence in
the source from which we have received it; that it was re¬
vised by a gentleman who was present at the meeting; that
Lord Amberley’s official presence at the society, and the
adoption by a subsequent speaker of the views which he
now repudiates—should be some guarantee that his views
were accurately represented; and that we believe our re¬
port embodies, if not his Lordship’s ipsissima verba , at least
the plain significance of his words.
We are not surprised that his Lordship should consider
the obvious bent of the discussion such as to demand his
repudiation. We take from it an unpleasant estimate of
the prevailing morality of the age in which “ advanced”
politicians officiate at a discussion which, if it means any¬
thing, means abortion and prostitution as an expedient
alternative for persons of easy conscience and unbridled
appetite.
- 4 -
lories on (ftarmit ftfljjics.
Doctors in the Legislature.
We hope we may accept the advancement of M. Nelaton
and the rumoured intention of the Emperor to promote M.
Claude Bernard to the Senate of France, together with the
mcreased and increasing number of medical candidates for
Parliamentary seats under the New Reform Act, as evi¬
dence of an awakening on the part of governments and
the doctors themselves to the claims of the profession to
legislative rank. The list of our existing medical members
(if indeed they can be called medical representatives, in
whom their professional connection is apparently forgotten)
—Sir John Gray, Dr. Brady, and Dr. Clement—are nume¬
rously and energetically reinforced for the forthcoming
contest by several other candidates. We have for the
Universities of St. Andrews and Edinburgh, Dr. Prosser
James and Dr. Richardson ; for Manchester, Mr. Mitchell
Henry, who at last election contested Woodstock ; for
Bridgewater, Mr. Vanderbyl ; for Marylebone, Dr. Hum¬
phry Sandwith ; for Colchester, Dr. Brewer; for Roches¬
ter, Dr. Alfred Smee, and we trust we may add Sir Domi¬
nic Corrigan to the list.
Whether any or many of these gentlemen succeed in ob¬
taining a seat or not, we think their candidature is a matter
for congratulation. Our profession owes its subordinate
position, as we believe, mainly to the fact that its members
are regarded by the public as “ only mere doctors,” simple
earners of fees—Helots who have their task to do, and
perform it and no mere, and accordingly deserve little
thanks for their services. It is satisfactory to see that the
aspirations of our brethren are not limited, nor their am¬
bition narrowed by the pursuit of their profession, and
that even men who have practice to leave behind and fees
to lose, are moved to some greater pursuit than medical
money-getting.
The Quarterly Examinations at the Royal
College of Surgeons in Ireland.
The second or Surgical Examination of the Royal College
of Surgeons has just terminated, and it affords every reason
for satisfaction to the College and the Profession.
The number of candidates was large—forty-eight appli¬
cants having appeared in the Hall. The answering was
excellent, and in every respect bears favourable comparison
with that elicited at the last quarterly examination. Of
the entire number only two were rejected, and forty-six
passed on much higher averages than have usually pre¬
vailed. We attribute this desirable condition of things to
the justly severe measure meted out to the bad candidates
on former occasions.
The Dublin City Prisons.
We rejoice to observe that the attempt to make the public
appointments under the patronage of the Dublin Corpora¬
tion subservient to family and religious considerations, to
which we have more than once adverted, has been at last
finally overthrown. The medical officer elected and re¬
elected by the Town Council under the circumstances
which we have narrated, has been replaced by the officer
elected by the Grand Jury, who formally entered on his
duties last week. Wc cannot congratulate the public on
the fact that they have achieved absolute purity of election
in the new appointment, for the savour of a family political
job is not much less offensive in the one case than in the
other. Either gentleman is personally and professionally
a perfectly unobjectionable occupant of the office; yet, were
it not for the satisfaction that the attempted job of the
Town Council, which was peculiarly flagrant in its charac¬
ter, has been defeated, we hardly think there is much
choice of motives between the selection of a son-in-law for
his father-in-law’s, or a son for his father’s politics.
Reproduction Extraordinary.
Ocr readers will call to recollection the fact that a young
man who suffered under a repulsive deformity, exhibited
himself some years since in tdi# bp^eat towns of Great
Sl2 The Medic*! Press and Circular. FOREIGN MEDICAL LITERATURE.
September 2, 1862.
Britain and Ireland, not only to the profession,’ but to the
general public. He presented the extraordinary monstro¬
sity Of a third leg, and a double penis, and at the time a
disgusting picture and a minute description of the ap¬
pearances appeared in the columns of a leading medical
periodical, and were so highly appreciated by a certain
class that copies of the journal in question were sold at
half-a-crown each. The only point of any scientific in¬
terest in the case was the influence of the monstrosity on
the generative function, and we learn that [some time
since the young man was married at Cardiff, and that his
wife has lately given birth to a fully formed and perfect
child, which has since enjoyed uninterrupted health.
an example. Palpitation may be a symptom that would
disappear with fresh air and exercise, but suppose disease
of one of the valves of the heart to exist—is there any
medical man who could forget that the mode of life we
have mentioned above would certainly aggravate it, and
might rapidly prove fatal? Yet, we have known such
patients exposed to such perils, and urged or dragged on
in the mad career by friends and relatives, recklessly bent
on making the most of the time. Sometimes the excess
does not stop here, but balls and parties add ill-spent
nights to over-wrought days. It is a great error. Let
those who have committed it try a short time the effect
of rest, and they will thank us for the hint.
The Perils of the Sea-Side.
At a season when so many escape from the ordinary toils
of life to spend a little time at the sea-side, a medical
journal may well remind its readers of some of the perils
that may be encountered, and are easily avoided. We are
not about to dilate on the dangers of boating to those who
cannot swim, although during this season four deaths have
come under our personal notice caused by this careless¬
ness. Nor do we propose to warn against the danger of
entering apartments lately vacated by patients suffering
from small-pox or other infectious disease ; the recent Act
of Parliament will, it is to be hoped, afford more protec¬
tion from such perils than has heretofore been attainable.
We have lately given some advice to bathers, and there¬
fore need not dwell further on that subject, than to remark
that during the past week we have met with a case rapidly
ending fatally, induced by injudicious bathing.
Patients who so recklessly resort to such treatment with¬
out professional advice are just now so numerous that we
can scarcely expect other than that some sad consequences
should be occasionally met with.
We desire, however, to warn against perils more easily
overlooked. There are many patients who, under the best
advice, go to the sea-side and would obtain great benefit,
but for their own imprudence. To say nothing of their
diet, which, in many instances, is anything but suitable for
them, they abandon every caution, and make demands on
their slender strength which only the robust can endure.
Ladies who at home assert that a drive in the park fatigues
them, that a northerly or easterly wind gives them cold, and
that a drop of dew or rain might lay them up for weeks when
they reach a fashionable watering-place, enter on a course of
life that makes men wonder how they get through the toil-
If a hurricane blow it is a “sea breeze,” or a mere “land
zephyr.” If towards evening the seats on [the parade
should be dripping, it is “not pernicious dew or fog,” but
only the “ sea moisture of the air settling.” Should the
sands be the fashion at the place selected, saturated shoes,
stockings, and petticoats are of no consequence, as “ sea¬
water never gives cold.” Then excursions up precipitous
hills, clambering up the cliffs, or jumping from rock to :
rock in the insane pursuit of all the hideous “ wonders of
the shore,” that are demanded by the insatiable aquarium
of an Englishwoman at the sea-side; these, and more than
these, are the freaks constantly to be seen. For strong
and hearty people, well and good ! For those whose ail¬
ments are imaginary, better still a little roughing, it may
do much to restore the tone of the over-wrought creature
of civilisation, and give an appetite to the fastidious and
dainty. But where there is real physical disease or defect,
such freaks cannot be too sternly forbidden. Let us give
-♦-
Jump $p&kal gikrato.
ON DIABETES MELLITUS AND PARESIS OF
THE RIGHT EXTREMITIES, IN CONSEQUENCE OF
A TUMOUR IN THE MEDULLA OBLONGATA
(Reported by Dr. J. B. Dompeliko.)
Translated from the Nedkrlandsck Archie/ voor Genets m NatuurkumU ,
IVe Deel, Ie Aflevering, 1868,, p. 179, by
W. D. MOORE, M.D.Dub.etCantab., M.R.I.A, L.K.Q.C.P.L
HONORARY FELLOW OF THE SWEDISH SOCIETY OP FHTBICIAXS J OP
THE NORWEGIAN MEDICAL SOCIETY; AMD OP THE ROYAL MEDICAL
SOCIETY OF COPENHAGEN; SECRETARY FOR SWEDEN, XOBWAT AED
DENMARK, TO THE EPIDEMIOLOOICAL SOCIETY OP LONDON.
The following case, already brought some weeks ago before
the Medical Society of Utrecht, appears to me sufficiently
important to be made known to a wider circle. From the ex¬
planation of the morbid phenomena in their details, in con¬
nection with the affection of the medulla oblongata, I refrain,
confining myself rather to an accurate statement of the his¬
tory of the case.
Heer v. L., bora of a phthisical mother, had always enjoyed
good, though not strong, health, and by observing a very re¬
gular course of life, and abstinence from Bacchus and Venus,
he was never ill. He remembered having fallen, when at
Zevenaar in his fifteenth year (1858), without any assignable
reason or cause, upon his occiput, against a sharp angle of a
wall. This was attended with no external injury, but with
momentary loss of consciousness, and with the occurrence of
a peculiar sensation in the right hand, while he felt a diffi¬
culty in walking. He afterwards suffered much from head¬
ache, commencing in front, and ending in the nape of the
neck.
In his twenty-first year, he went as officer of health to India,
having fpreviously, though formerly thin, become, within a
few months, rather corpulent. He arrived in good health in
India, but thinks that he soon after found his gait to be
tottering, and his vision double. In the course of six months
he was, in July, 1865, transferred to Telok Be tang, in the
Lampongs, south coast of Sumatra. He there felt that the
tottering in his gait increased, and that writing became diffi¬
cult, as he could not guide the pen properly. On a certain
morning he was attacked with fever, violent pain in the ood-
put, vertigo, and hiccough. These symptoms having been
subdued after the lapse of 44 days, he was directed to Katim-
bang, situated at the foot of Ratjabassa (highest mountain), a
cooler place. The improvement which had set in did not,
however, continue, so that he sailed for Batavia.
From the report of his state there made, the following
appears:—
The patient has a suffering aspect. His face, especially on
the right side, is of a dark red colour, the oonjunctivw are in¬
jected. The whole right side is somewhat paralysed. In the
dark, or with his eyes closed, he cannot stand or walk without
tottering considerably. In these respects he is better in the
morning than in the evening. In the light he can better con¬
trol his movements. The right, upper, and lower extremities
are considerably emaciated, the muscles are flaccid. The dif¬
ference in circumference between the right and the corns*
ponding left side amounts to three Netherlands inches.
The sense of touch in the right hand is almost lost, the send*
bility to temperature on this side is, however, exalted
Digitized by
Google
The Medical Pren and Circular.
FOREIGN MEDICAL LITERATURE.
September 2, 1868. 213
As to the right lower limb, the feeling in the sole of the
foot is normal, yet the patient complains of defect in guiding
the foot, of difficulty in drawing on his stockings, of crackling
in the right knee, of periodical spasms in the right foot and
hand, while lying he can execute all movements with the right
extremities. Under the action of the induction*current the
irritability of the muscles of the right side seems to be
diminished.
The patient complains moreover of giddiness when he lies
low and when the temperature is high, of singing in both
ears and double vision when he looks to a distance with his
head raised, at which time the right eyeball is directed too much
inward. When the head is bent forward, or looking at near
objects, vision is normal. Ophthalmoscopic investigation pre¬
sents nothing irregular, with the exception of slight hyper-
amis of the retina.
His sleep is calm, without troublesome dreams. He has
almost always pain in the occiput. Respiration is normal.
The pulse is quick, more than 100 beats in the minute. The
action of the heart is otherwise as it ought to be. Swal¬
lowing takes place almost invariably with the aid of fluids.
His speech is undisturbed. So are the digestion, the sexual
power, and the urinary apparatus. The patient complains
only of considerable thirst, which constantly induces him to
drink.
As to the psychical functions, he complains of weakness of
memory, especially for the retention of names, while his temper
is characterised by indifference and depression.
As he had expressed a wish for a cooler climate, he was
removed to Sindanglaya, above Buitenzorg.
When there, he began to be more feverish in the evening ;
his pulse did not fall below 100 beats in the minute. On
moving, his speech was affected with quivering of the lips,
swallowing was very difficult. His left leg about the knee
was insensible to pain and temperature. The right leg was
paralysed. After a derivative treatment the congestive symp¬
toms improved, but diarrhoea continued. At the end of a
fortnight he returned to Batavia, used much laudanum for the
diarrhoea (the cholera was then raging at Batavia), and ten
days later embarked for Holland.
On the voyage home his condition became remarkably im¬
proved. He retained, however, a great appetite, particularly
for sweets, and much thirst. He Buffered a great annoyance
from dryness of the eyes, labouring, in consequence, on two
occasions, under conjunctivitis, and during the last weeks of his
voyage he passed joints of a tapeworm. On the 21st December,
1866, he arrived here very happy at having, after so much
wandering, reached a sure haven.
I saw the patient in the evening of the same day (21st
of December, 1866). He was scarcely recognisable by those
who had known him before his departure. He was decrepit,
emaciated, I should almost say that he had become smaller.
His unquenchable thirst for water struck me ; I therefore had
his urine examined the following morning, and it appeared
that his disease, which in India had been diagnosed as pro¬
gressive atrophic muscular paralysis, or progressive locomotor
ataxy, was a considerable diabetes. The reaction of the urine
was strongly acid. Its density was about 1*044 = 6°. With
the copper-test fluid, one drop of urine in 60 of distilled water
gave a very strong reaction. With the potash test, 10 drops of
urine in two drachms of distilled water and half a drachm of
liquor of caustic potash gave a brown reaction.
The weight of the body is 55 kilogrammes, or 110 pounds.
The intellectual faculties are normal, both the imagination and
the memory. Hearing on both sides is good, even acute.
There is no tinnitus aurium,
Opthalmoscopical investigation, performed by Dr. Snellen,
gave : paresis of all the muscles of the eye on the right side,
especially of the abducent, thence double vision in all strong
peripheral movements of the eyes, especially in looking out¬
wards to the right- Slight nystagmus. Pupils easily movable,
apparently somewhat less so towards the left. Emmetropia.
Nothing else abnormal.
Smell and taste are good. The tongue does not deviate.
The right half of the body, both arm and leg, and also in some
degree the trunk, atrophied. The sense of touch is lessened. In
the hand two sharp points of the compass could be distinguished
at ft distance of about three Netherlands inches. 'The
—faihilitY to temperature exalted. The whole left side better
■owidieSy tolerably muscular and strong (the patient was
from infancy left-handed). The sense of touch is normal, if
not exalted, sensibility to pain and temperature diminished.
Bespfraiion normal, often treubled with hiccough, pul¬
monary capacity ample. The voice masked. Neither abdomen
nor hepatic region swollen or sensitive. Bowels rather confined,
each evacuation accompanied with proglottides of a tapeworm.
The patient was now ordered os much as possible animal
food, the use of Carlsbad water ; subsequently he took also
Vichy. The treatment of the tape- worm with Kousso was tried,
whereupon a medio-cannellata of about three yards in length,
without the head, appeared. Subsequently the treatment was
repeated in Friesland, in vain, until later it completely suc¬
ceeded with decoction of pomegranate, and the head also was
expelled. Afterwards he used cod-liver oil, and had a seton
placed in the back of the neck.
The patient now went to Zaandam, and some weeks later to
Friesland, where he much enjoyed the country air. He sent
me from time to time his urine, with statements. For example,
January 19, 1867, took 110 ounces of fluid, while the quantity
of urine was 152 medicinal ounces in the twenty-four hours.
2nd February, used 124, excreted 196 ounces, density 1*040,
When diluted 450 times it still gives a very evident reaction
with the copper test.
Beginning of March used 131, excreted 129 medicinal ounces.
Reaction very strongly acid ; density 1*042 = 5} °/ 8
Returning on ttie 27th May from Friesland, I saw him
again. His appearance was much improved ; his weight was
118 pounds, he had therefore increased 8 pounds. He had now
always written letters with the left hand, but the last, although
very badly, again with the right. He stands more firmly on
his legs, and totters only in the dark. His thirst is not so ex¬
cessive. The eyes are still somewhat dry, only in the evening;
but the urine still contains very much sugar, and its specific
gravity is 1*045. He set out this day for Carlsbad ; he got
tired here and fancied the change might be of use to him.
Though I did not expect a cure I thought it might improve his
condition. After remaining there six weeks, under the treat¬
ment of Professor Seegen, he returned. He had first drunk
of the Marcbrunnen, which caused diarrhoea, then of the
Felsenquellen and Miihlbrunnen, subsequently of the Sprudel
cold spring.
The urine at first contained 7°/„ of sugar.
The quantity in the 24 hours was 14 cups.
The following week the sugar was 4°/o in 6 cups.
At the end of the treatment it was 24%> in 6 cups, which
may be called a small quantity.
The weight of the body is now 112 pounds, that is a falling
off of 6 pounds ; all the symptoms are better.
The strength, especially on the left side, is increased. The
eyes are no longer so dry in the evening ; the thirst is less.
The double vision (images next one another) is very variable,
at one time better and again worse.
The specific gravity of the urine is 1*035.
Within the last few days the cough has increased, with some
tightness in the right side of the chest, and rusty-coloured
sputa, especially in the morning.
The cough now began to get gradually worse. After the
lapse of a couple of months haemoptysis came on, and the
patient became phthisical. In November the urine was once
more examined by Dr. Brondgeest with Soleil’s saccharometer.
It contained then nearly 7°/ 0 of sugar, its specific gravity
being 1*0195. The patient suffered much from fever, became
very weak, and his life ended on the 2nd February, 1868. He
had sat up that day for some hours, went to bed, fell asleep,
and with a single gasp life was extinguished.
We have thus had to do, in this instance, with a very inte¬
resting case of diabetes. That this affection had a central
origin, may almost certainly be stated, on account of the
simultaneous occurrence of very serious cerebral phenomena. In¬
deed, I may say, that the diabetes was only one of the symptoms
presented by the affection of the brain. It was at the same
time the leading string to determine where this cerebral affec¬
tion had its seat, which in fact could not be otherwise than on a
level with the fourth ventricle. Disease, however, of this
part of the brain, is attended with this form of diabetes, which
Eulenberg and Landois have described as the angio-neurotic
form of diabetes. I borrow the following from their important
communications, to be found recapitulated in a aeries in the
Wiener Wockenschrift for the 80th November,-1867 :—
“ As is well-known, Claude Bernard made the important
discovery, that an injury of the floor of the fourth ventricle of
the brain is followed by the excretion of sugar through the
urine, which in mammalia commences one and a half hours
after the operation, and for the most part terminates in six
hours. The place on the floor is tolerably extensive, and on
opposite sides of the median line. If the lesion touches the
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214 The Medical Press and Circular. BRITISH ASSOCIATION MEETING.
September 2,1868.
spot between the origins of the vagi and auditory nerves, we
observe with the excretion of sugar increased secretion of
urine ; if it be higher, the excretion of urine, and also the
quantity of sugar, is more moderate, but there is at the same
time albumen in the urine. Through the operation, the so-called
sugar puncture, the centre of the vascular nerves of the
liver becomes injured, and there arises in fact an angio-neurotic
form of diabetes.
“ According to Schiff, the paths of these vasomotor nerves
of the liver run from the floor of the fourth ventricle in the
medulla oblongata, and further in the anterior columns of the
cervical and dorsal medulla, to the fourth or fifth dorsal verte¬
bra. Here they leave the medulla and repair through the
Communicating branches in the path of the sympathetic, run
with them downwards, and finally accompany the vessels of
the liver in the hepatic plexus, into the interior of the paren¬
chyma.
“ Some of these nerves seem to take their course in the path
of the splanchnic nerve, at least, von Graefe and others saw
diabetes occur after division of this nerve. In general lesion
of the vasomotor hepatic nerves has, in whatever part of their
course, the same result as the sugar puncture. There always
arises, as immediate result, paralytic vascular dilatation of the
liver with stasis.
“ In the interior of the hepatic cells the so-called hepatic
starch or glycogen is found, a non-nitrogenous substance which
is by ferments, and also by saliva, metamorphosed into sugar,
which, however, does not take place in the normal state.
“ The sugar formed by fermentation is diffused through the
blood-vessels in the blood. A portion of the sugar is in the
lungs burned through respiration into carbonic acid, so soon,
however, as the quantity of sugar in the blood amounts to
one-half per cent, the combustion no longer takes place com¬
pletely, and sugar appears in the urine.
“ This sort of diabetes may now be traumatic : diabetes
angio-neuroticus traumaticus, or toxical.
“ The first runs mostly an acute course, after a fall on the
occiput, wounds of the head, contusion of the neck ; but also
mental affections. &c., may act injuriously on the centre of
the hepatic vascular nerves.”
What was the nature of the cerebral affection in the above
case, and what cause had giveu rise thereto ? There was as
little reason for assigning the first as the second. On the other
hand, there were many reasons for believing that in this in¬
stance pressure had taken place, from some tumour or other,
in the neighbourhood of the fourth ventricle.
As to the cause, two presented themselves as having pos¬
sibly given rise to the disease. In the first place, the fall on
his head in the patient’s fifteenth year, which, as we have seen,
is frequently the cause of this form of diabetes. But if we
assume this cause, the results thereof were very insidiously
and slowly developed; for from that time until the patient
went to India no trace of any cerebral affection manifested
itself. All that time I saw the patient daily, and went about
with him. His intellectual faculties, his vegetative and animal
functions were perfect.
Another question which might come under consideration was
whether there was any connection between the occurrence of
the taenia and the cerebral lesion; and I must acknowledge
that at first at least I attached some value to it.
The possibility of so-called self-infection is, however, ren¬
dered probable by many observations. Not long since I met
with in “Schmidt’s Jahrbiicher,” 1S67, No. 3, a case described
by R. Wagner, in which cvsticerci in the brain and a taenia in
the jejunum co-existed. Among the eighty-eight cases of cys-
ticerci in the brain collected by Kiichenmeister, however, I
found not one in which they were located in the fourth ven¬
tricle. Meanwhile, this appeared to me to be no great diffi¬
culty, as there was, a priori, no conceivable reason why evsti-
cerci should not occur in that place. Though, if in our patient
self-infection had taken place, we should assume that cvsticerci
of tsenia mediocanellata may occur in the brain, which, so far
as I know, has not yet been met with. 1
But enough of conjectures. The post mortem examination,
at least of the skull, was permitted. A tumour was found j
occupying the whole right half of the medulla oblongata, and '
passing into this without any defined line of demarcation. I
Above and on the under surface of the tumour were situated |
two vesicles filled with fluid, in which, however, nothing of I
qystioeroi was met with j
1 Since this article was iiiU es I met wish a rs—frown nidi il by ;
Dr. Arnu .-mb. ZnUdbiA fmr /ir/diitric aaicr dkr He-
rf a cl ioa rwa HtmrickL*chr, JBd a— BBC I
Otherwise the brain was normal; only some turbid fluid was
found between the pia mater and arachnoid.
The tumour, further examined by Prof. Koster, is a sarcoma
fuso-cellulare, with great capillary vascular developments;
while in some places nothing but fibrillar connective tissue
with blood-vessels is met with. Nowhere is any carcinomatous
structure to be found.
The tumour, which is of the si ze of a small walnut, was
evidently formed beneath the pia mater. This membrane can
be traced from its circumference into the neighbourhood of the
tumour, after which it passes into the surface of the same,
without being capable of being further separated.
On longitudinal incision made through the tumour we can
find absolutely no boundary between the nerve-tissue of the
medulla and the sarcoma. Each passes undistinguishably into
the other; yet, evidently, rather displacement of the mass of
the medulla has occurred than a taking-up of this latter into
the tumour, as nowhere in this is nerve-tissue met with, ex¬
cept in the depth of the incision, where it is doubtful whether
we have the tumour or the medulla before ns.
[Representations of the tumour are given in the original,
from which it appears] that the tumour has strongly pushed
to the left the sulcus longitudinalis from the floor of the fourth
ventricle; that the roots of the accessory nerve of Willis, and
the inferior root of the nervns vagus of the right side, highly
atrophic from the tumour itself come outwards, and that the
fibres of origin of the auditory and facial nerves were unin¬
jured.
In conclusion, I must add that just as I was writing out this
case I found one nearly precisely similar communicated in
Virchow’s Archiv, 1 and described as a great peculiarity, almost
as a curiosity. The tumour examined by Virchow was also in
that case a sarcoma fuso-cellulare.
-♦-
BRITISH ASSOCIATION FOR THE ADVANCEMENT
OF SCIENCE.
Meeting at Norwich, August, 1868.
The 1S68 meeting will rank second to none of its predeces¬
sors for the interest and importance of its numerous addresses
and papers. A detailed report of the proceedings would
occupy many numbers of our journal. We propose, therefore,
with a view of economising space, to give mere extracts from,
or abstracts of, a few of those we judge may be acceptable to
our readers.
PROFESSOR TYNDALL'S ADDRESS.
The section devoted to Mathematical and Physical
Science was opened by an address from Professor Tyndall,
who presided over this section. The learned successor of
Faraday at the Royal Institution, after an introduction of
great length, proceeded as follows:—“ There have been
writers who affirmed that the pyramids of Egypt were the
productions of nature ; and in his early youth Alexander Von
Humboldt wrote an essay with the express object of refuting
this notion. We now regard the pyramids as the work of
men's hands, aided probably by machinery of which no record
remains. We picture to ourselves the swarming workers toil¬
ing at those vast erections, lifting the inert stones, and, guided
by the volition, the skill, and possibly at times by the whip of
the architect, placing the stones in their proper positions. The
blocks in this case were moved by a power external to them¬
selves, and the final form of the pyramid expressed the thought
of its human builder. Let us pass from this illustration of
building power to another of a different kind. When a solu¬
tion of common salt is slowly evaporated, the water which
holds the salt in solution disappears, but the salt itself remains
behind. At a certain stage of concentration the salt can no
longer retain the liquid form ; its particles, or molecules, as
they are called, begin to deposit themselves as minute solids,
so minute, indeed, as to defy all microscopic power. As evapo¬
ration continues solidification goes on, and we finally obtain,
through the clustering together of innumerable molecules, a
finite mass of salt of a definite form. What is this form ? It
sometimes seems a mimicry of the architecture of Egypt. We
have little pyramids built by the salt, terrace above terrace
from base to apex, forming thus a series of steps resembling
those up which the Egyptian traveller is dragged by his guides.
The human mind is as little disposed to look at these pyra*
1 Zur Casuist ik <Ur Himtumoreu rom Prof. Ft. Hosier in GrtiffWald,
in Yircbow*s Archiv, Bd. xlhi. Hit 2.
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The Medical Press and Circular.
BRITISH ASSOCIATION MEETING.
September 2,1988. 215
midal salt-crystals without further question, as to look at the
pyramids of Egypt without inquiring whence they came.
How, then, are those salt-pyramids built up ? Guided by ana¬
logy you may suppose that, swarming among the constituent
molecules of the salt, there is an invisible population, guided
and coerced by some invisible master, and placing the atomic
blocks in their positions. This, however, is not the scientific
idea, nor do I think your good sense will accept it as a likely
one. The scientific idea is that the molecules act upon each
other without the intervention of slave labour ; that they
attract each other and repel each other at certain definite
points, and in certain definite directions; and that the
pyramidal form is the result of this play of attraction and
repulsion. While, then, the blocks of Egypt were laid down
by a power external to themselves, these molecular blocks of
salt are self-posited, being fixed in their places by the forces
with which they act upon each other. But passing from what
we are accustomed to regard as a dead mineral to a living
grain of corn. When it is examined by polarised light chromatic
phenomena similar to those noticed in crystals are observed.
And why ? Because the architecture of the grain resembles
in some degree the architecture of the. crystal. Iu the corn
the molecules are also set in definite positions, from which
they act upon the light. But what has built together the
molecules of the corn ? I have already said regarding crystal¬
line architecture that you may, if you please, consider the
atoms and molecules to be placed in position by a power ex¬
ternal to themselves. The same hypothesis is open to you now.
Bat if in the case of crystals you have rejected this notion of
an external architect, I think you are bound to reject it now,
and to conclude that the molecules of the corn are self-posited
by the forces with which they act upon each other. It would
be poor philosophy to invoke an external agent in the one
case and to reject it in the other. Instead of cutting our grain
of com into thin slices and subjecting it to the action of
polarised light, let us place it in the earth and subject it to a
certain degree of warmth. In other words, let the molecules,
both of the com and of the surrounding earth, be kept in a
•late of agitation ; for warmth, as mo3t of you know, is, in the
eye of science, tremulous molecular motion. Under these cir¬
cumstances, the grain and the substances which surround it
interact, and a molecular architecture is the result of this inter¬
action. A bud is formed ; this bud reaches the surface, where
it is exposed to the sun’s rays, which are also to be regarded
as a kind of vibratory motion. And as the common motion of
heat with which the grain and the substances surrounding it
were first endowed enabled the grain and these substances to
coalesce, so the specific motion of the sun’s rayo now enables
the green bud to feed upon the carbonic acid and the aqueous
rapour of the air, appropriating those constituents of both for
which the blade has an elective attraction, and permitting the
other constituent to resume its place in the air. Thus forces are
active at the root, forces are active in the blade, the matter of
the earth and the matter of the atmosphere are drawn towards
the plant, and the plant augments in size. We have in suc¬
cession the bud, the stalk, the ear, the full corn in the ear.
For the forces here at play act in a cycle which is completed
by the production of grains similar to that with which the
Process began. Now, there is nothing in this process which
necessarily eludes the power of mind as we know it. An in¬
tellect the same in kind as our own would, if only sufficiently
expanded, he able to follow the whole process from beginning
to end. No entirely new intellectual faculty would be needed
for this purpose. The duly expanded mind would see in the
process and its consummation an instance of the play of mole¬
cular force. It would see every molecule placed in
its position by the specific attractions and repulsions
exerted between it and other molecules. Nay, given
the grain and its environment, an intellect the same in
®nd as our own, but sufficiently expanded, might trace out a
Priori every step of the process, and by the application of
mechanical principles would be able to demonstrate that the
cy®ie of action must end, as it is seen to end, in the reproduc¬
tion of forms like that with which the operation began. A
similar necessity rules here to that which rules the planets in
their circuits round the sun. You will notice that I am stat-
my truth strongly, as at the beginning we agreed it should
he stated. But I must go still further, and affirm that in the
^of science the animal body is just os much the product of
molecular force as the stalk and ear of corn, or as the crystal
or salt of sugar. Many of its parts are obviously mechanical.
Take the human heart for,example, with its exquisite system of
Ttlvea, or take the eye, or the hand. Animal heat, moreover,
is the same in kind as the heat of a fire, being produced by
the same chemical process. Animal motion, too, is as directly
derived from the food of the animal, as the motion of Treve-
thyck's walking-engine from the-fuel in its furnace. As re¬
gards matter the animal body creates nothing ; as regards
force it creates nothing. Which of you by taking thought
can add one cubit to his stature ? All that has been said re¬
garding the plant may be re stated with regard to the animal.
Every particle that enters into the composition of a muscle,
a nerve, or a bone, has been placed in its position by mole¬
cular force. And unless the existence of law in these matters
be denied, and the element of caprice introduced, we must
conclude that, given the relation of any molecule of the body
to its environment, its position in the body might be predicted.
Our difficulty is not with the quality of the problem, but with
its complexity ; and this difficulty might be met by the simple
expansion of the faculties which man now possesses. Given
this expansion, and given the necessary molecular data, and
the chick might be deduced a9 rigorously and as logically from
the egg as the existence of Neptune was deduced from the
disturbances of Uranus, or as conical refraction was deduced
from ^the undulatory theory of light. You see I am not
mincing matters, but avowing nakedly what many scientific
thinkers more or less distinctly believe. The formation of a
crystal, a plant, or an animal, is in their eyes a purely
mechanical problem, which differs from the problems of
ordinary mechanics in the smallness of the masses and the
complexity of the processes involved. Here you have one-
half of our dual truth ; let us now glance at the other half.
Associated with this wonderful mechanism of the animal body
we have phenomena no less certain than those of physics, but
between which and the mechanism we discern no necessary
connection. A man, for example, can say, I feel, I think, I
love; but how does consciousness infuse itself into the problem?
The human brain is said to be the organ of thought and feel¬
ing ; when we are hurt the brain feels it, when we ponder it
is the brain that thinks, when our passions or affections are
excited it is through the instrumentality of the brain. Let
us endeavour to be a little more precise here. I hardly ima¬
gine that any profound scientific thinker who has reflected
upon the subject exists who would not admit the extreme
probability of the hypothesis, that for every fact of conscious¬
ness, whether in the domain of sense, of thought, or of emotion,
a certain definite molecular condition is set up in the brain;
that this relation of physics to consciousness is invariable, so
that, given the state of the brain, the corresponding thought
or feeling might be inferred; or, given the thought or feeling,
the corresponding state of the brain might be inferred. But
how inferred? It is at bottom not a case of logical inference
at all, but of empirical association. You may reply that many
of the inferences of science are of this character; the inference,
for example, that an electric current of a given direction will
deflect a magnetic needle in a definite way; but the cases differ
in this, that the passage from the current to the needle, if not
demonstrable, is thinkable, and that we entertain no doubt aa
to the final mechanical solution of the problem; but the pas¬
sage from the physics of the brain to the corresponding facts of
consciousness is unthinkable. Granted that a definite thought
and a definite molecular action in the brain occur simulta¬
neously; we do not possess the intellectual organ, nor appa-*
rently any rudiment of the organ, which would enable us to
pass by a process of reasoning from the one phenomenon to the
other/ They appear together, but we do not know why.
Were our minds and senses so expanded, strengthened, and
illuminated as to enable us to see and feel the very molecules
of the brain; were we capable of following all their motions,
all their groupings, all their electric discharges, if suck there
be; and were we intimately acquainted with the corresponding
states of thought and feeling, we should be as far as ever from
the solution of the problem, “How are these physical processes
connected with the facts of consciousness ?” The chasm be¬
tween the two classes of phenomena would still remain intel¬
lectually impassable. Let the consciousness of love, for
example, be associated with a right-handed spiral motion of
the molecules of the brain, and the consciousness of hate with
a left-handed spiral motion. We should then know when we
love that the motion is in one direction, and when we hate
that the motion is in the other; but the “ why?” would still
remain unanswered. In affirming that the growth of the body
is mechanical, and that thought, as exercised by us, has its
correlative in the physics of the brain, I think the position of
the im materialist’ ’ is stated as far as that position is a tenable
one. I think the materialist will be able filially to maintain
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216 The Medical Press and Circular. BRITISH ASSOCIATION MEETING.
Septembers, 18&
this position against all attacks; but I do not think, as the
human mind is at present constituted, that he can pass beyond
it. I do not think he is entitled to say that his molecular
groupings and his molecular motions explain everything. In
reality they explain nothing. The utmost he can affirm is the
association of two classes of phenomena, of whose real bond of
union he is in absolute ignorance. The problem of the con¬
nection of body and soul is as insoluble in its modem form as
it was in the prescieutific ages. Phosphorus is known to enter
into the composition of the human brain, and a courageous
writer has exclaimed, in his trenchant German, “Ohne phos¬
phor kein Gedanke.” That may or may not be the case; but
even if we knew it to be the case, the knowledge would not
lighten our darkness. On both sides of the zone here assigned
to the materialist he is equally helpless. If you ask him whence
is this “matter” of which we have been discoursing, who or
what divided it into molecules, who or what impressed upon
them this necessity of running into organic forms, he has no
answer. Science also is mute in reply to these questions. But
if the materialist is confounded and science rendered dumb,
who else is entitled to answer ? To whom has the secret been
revealed ? Let us lower our heads and acknowledge our igno¬
rance one and all. Perhaps the mystery may resolve itself into
knowledge at some future day. The process of things upon
this earth has been one of amelioration. It is a long way from
the Iguanodon and his contemporaries to the president and
members of the British Association. And whether we regard
the improvement from the scientific or from the theological
point of view, as the result of progressive development, or as
the result of successive exhibitions of creative energy, neither
view entitles us to assume that man’s present faculties end the
Beries—that the process of amelioration stops at him. A time
may, therefore, come when this ultra-scientific region by which
we are now enfolded may offer itself to terrestrial, if not to
human investigation. Two-thirds of the rays emitted by the
sun fail to arouse in the eye the sense ofwision. The rays
exist, but the visual organ requisite for their translation into
light does not exist. And so from this region of darkness and
mystery which surrounds us, rays may now be darting which
require but the development of the proper intellectual organs
to translate them into knowledge as far surpassing ours as ours
does that of the wallowing reptiles which once held possession
of this planet. Meanwhile the mystery is not without its uses.
It certainly may be made a power in the human soul; but it is
a power which has feeling, not knowledge, for its base. It may
be and will be, and we hope is, turned to account, both in
steadying and strengthening the intellect, and in rescuing man
from that littleness to which, in the struggle for existence, or
for precedence in the world, he is continually prone.
MR. BROWN’S ADDRESS.
The section of Economic Science and Statistics was presided
over by S. Brown, Esq., President of the Institute of Actuaries.
In his address he referred to the subject of technical educa¬
tion, to which he considered a strong impulse had been given
by the comparisons of the world’s industry occasioned by the
various exhibitions held of late years. It was clearly neces¬
sary that a higher standard of general education should be
established among our people, and a conference called together
by the Society of Arts had brought together a large number of
statesmen and men of science on the subject. It appeared to
be desirable that scientific instruction should be followed by
technical education in workshops; and a great advance would
be made if employers required more proofs of practical know¬
ledge. It was proposed that children should attend longer at
school. The question arose whether this would affect the
labour market, or whether a compensation would be found in
the increased skill attained. The recent munificent gift of
Mr. Whitworth deserved the hearty thanks of the nation, and
might be expected to give a great impulse to the movement
generally. That there was already a large number of skilled
workmen in this country might be seen in the interesting
volume recently published by the men sent to the Paris Exhi¬
bition by the Society of Arts. Upon the whole, it would seem
as if the action of the government would be best exerted by
extending grants in aid of local subscriptions, by appointing
lecturers, or by aiding new school buildings, while a system of
nents would probably produce satisfactory results.
i question of labour and capital, it really appeared as
i.s had been made during the last year in the
| difficult question. It would seem that a better
2 principles of political economy and the laws
production and distribution of wealth
would be beneficial to all parties. It was earnestly to be
hoped that strikes, which occasioned so much ill-feeling and
loss of wages, would be more and more avoided. The system
of co nseUs dcs prudkommes and courts of conciliation had been
attended with beneficial results. Some system of industrial
partnerships appeared likely to unite both workmen and em¬
ployers, and would enable the former to inquire into the state
of markets and foreign competition. The president traced
with satisfaction the progress of insurance—life, fire, and
marine. With regard to life insurance, vital statistics had now
assumed a form which enabled the most complicated problems
of human life to be dealt with; but life insurance business ap¬
peared to be making greater progress in the United States
than in Great Britain. The progress of the Post-Office in this
country might be regarded as a proof of the growth of educa¬
tion; and the enlightened readiness with which every improve¬
ment was adopted by the Post-Office gave us reason to hope
that what many regarded as an unwarrantable interference
with private enterprise—viz., the purchase by the State of
telegraph property, would prove a public benefit. It seemed
probable that a uniform charge of 6d. per message would be
established, and the consequence would be advantageously felt
in the internal trade of the country and in the promotion of
private convenience. As it might be assumed that telegraphic
business expanded at the rate of 10 per cent, per annum, he
believed that the interest of the capital to be paid for the pur¬
chase of the telegraphs would gradually be more than covered.
The president next touched on the desirability of establishing
a uniform system of weights and measures, and on the equally
difficult question of monetary unity. As regards the latter
subject he remarked that Austria and the Papal government
hafl expressed a readiness to take up the subject, and it
seemed strange that when the Papal government was ready to
act in the matter the English government did nothing.
Finally, the president alluded to the international statistical
conference, and he remarked that the effect of this congress
was seen in the great importance now attached to the collec¬
tion of government statistics of all kinds which would throw
light on the many unsolved problems of the age.
MR. BIDDER’S ADDRESS.
In the Mechanical Science section, Mr. G. P. Bidder, C.E.,
occupied the chair. In opening the section, he said they had
to consider the operations of the laws of mechanics with a view
to benefit the world in general, and this country in particular.
The laws they applied were certain and sure, and there was no
doubt that in their application they would conduce to the happi¬
ness of mankind in general. He referred to some of the principal
topics engrossing public attention in the present day, and, noticing
first the great water question, he congratulated the committee on
having present some of the greatest and most eminent authori¬
ties upon that subject, who would, doubtless, give information
that the association would diffuse for the benefit of the public
in general with reference to the supply and utilisation of water
in various ways, and preserving rivers from pollution by sewage
and the refuse from manufactories. A more beautiful and in¬
teresting subject than the habits of rivers could not engage
the attention of engineers ; and whether they looked at the
circumstances of the constitution of the great rivers of India
and America, or came down to those in their own neighbour¬
hood, they would find that the same general laws pervaded all.
It was well-known that the greatest rain-fall took place at the
highest levels. At the top of the Himalayas the rain fall was
not less than 400 inches per annum, while on some of the
mountains of Cumberland it was 200 inches, but in Norfolk
only about 20 inches. He suggested that the quantity of water
that fell on the whole course of a river should be gauged, and
that observations should be taken to show the meteorological
conditions of the atmosphere under which it fell. If that
course were pursued, a body of facts would be brought together
which he thought might be applied for the benefit of the
country to a very great extent. He next referred to the pecu¬
liar characteristics of the rivers in the neighbourhood—viz •
the Wensum, the Yare, the Waveney, and the Bure, and spoke
of the influence these were supposed to have in maintaining
the bar at Yarmouth. He regretted that tidal observations
which could easily have been obtained from Yarmouth and
Lowestoft, had not been laid before the Association ; and ex¬
pressed his belief that a thorough investigation and careful
collection of facts would show that the land-water gave little,
if, indeed, any advantage to the port of Yarmouth, and that
a large extent of land now rendered almost unproductive by
flood waters might be utilised without damage to that port.
k
The Medical Frees and Circular.
BRITISH ASSOCIATION MEETING.
September 2, 1868. 217
Speaking of the Suez Canal, which was now approaching com¬
pletion, he referred to the fact that it would be necessary to
fill certain lakes in the vicinity of the canal (which were now
dry) from the Bed Sea, which was distant eighteen miles ; and
as these lakes covered an area estimated by some at 300 square
miles, and evaporation went on in Egypt at the rote of one
inch per diem, the evaporation from the lakes would be equal
to 8,600,000,000 cubic feet per diem, or 250,000 cubic feet per
minute. As soon as this canal was opened he thought the
association should be put in possession of all the phenomena
attendant upon its opening, for he could not help thinking
that it must exercise some influence upon the atmosphere of
the adjoining district, which would be worthy the attention
of the association. He next approached a question which, he
said, had excited a great deal of public attention—viz., the
state of the British navy ; and he might begin by saying that
however satisfactory that state might be to some departments
it was not satisfactory to the country in general. He would
endeavour to point out in what way public opinion might be
brought beneficially to bear upon this important subject. They
would, no doubt, all agree with him that they had all but one
desire—viz., that this country—whatever might be the cost—
should have the best ships that the ocean could carry and that
machinery could propel. With regard to the ships, he thought
the great source of the present unsatisfactory state of things
was the total absence of any system upon which their con¬
struction was conducted. Before building their ironclad navy
it should have been considered what they were to be filled with,
according to the plan adopted in the merchant service. They
should also determine before a vessel was built what its speed
would be, and no ship should be considered a success that did
not accomplish a sea-going speed ; while all should be as nearly
as possible of the same speed, in order to enable them to act
efficiently. He did not purpose entering into the relative
merits of broadside guns and turret guns, but he would say
that whatever difficulty there might be in getting fine lines with
broadside guns that difficulty did not exist in the case of turret
ships. Another point was that at present they did not know
until they sent a ship to sea to what extent she was going to
roll; but the mechanical principles upon which this depended
under ordinary circumstances were so well known, that the
extent to which a Bhip would roll should be known before a
quarter of a million of money was spent upon her. The trials,
of ships in Stokes Bay he characterised as a sheer delusion
and said that trials to be of any value, should be oonducted at
sea, by men independent of any department, or of any other
influence whatever; and until that was done they would not
be able to bring to bear such a check upon the Admiralty
department as the country had a right to demand. With
regard to the armour of ships, be contended that this was a
subject that should be subordinate to the considerations he
had mentioned, for it was of no use to have a ship so over¬
weighted that she became useless as a movable fort. He con¬
cluded his address by some remarks on technical education
(contending that it should comprise a sound knowledge of the
laws of mechanics, and be specially directed to the
position the student was to fill in life), and on the application
of machinery to the economical working and ventilation of
mines.
CAPTAIN RICHARDS’S ADDRESS.
The chair was taken in the Geographical Section by Cap¬
tain Richards, R.N., who in the course of his interesting ad¬
dress said:—It cannot be long before a cable is laid through
the centre of the Mediterranean Sea, connecting Gibraltar
with Malta with Alexandria, and Alexandria by the
Bed Sea with India. Then, again, I think the time is not far
distant when the connection between India and China, and
between India and Australia will be completed. These great
undertakings require accurate knowledge and an amount of
skill, patience, and perseverance on the part of both the en¬
gineer And the seaman which those who are not thoroughly
acquainted with the subject but little understand. Our ener-
efforts, therefore, have been directed lately to this
Wu^ 9 ^; Ai^d by the aid of science and the modern mechani-
«a^ 4 g>plupce 8 which science has produced, instead of the
>ra gnp au4 imperfect knowledge which we possessed up to a
^comparatively recent period, we are now intimately acquainted
depths of almost all the oceans on the globe. For
J y mm4der that these great results are second to none
- have * been obtained in geographical research during
the jqy years : perhaps 1 may say that they are of
^importance, To follow up the progress of
geographical discovery from the earliest times, over the whole
of Europe and the greater part of North and South America,
geography has comparatively little left to learn. In Asia,
too, over the great empires of China and Japan, there is no
reason to doubt that geography has been well understood and
cultivated, although from the peculiar institutions and cus¬
toms of those countries, and from the jealousy of rulers and
other causes they have been shut out to a great extent from
the observation and enterprise of Europeans. Then on that
great neutral ground in Central Asia, between the northern
boundaries of India, and the southern parts of Russia, and in
Western China and Tartary, which has been attracting a great
deal of attention lately, we have yet a great deal to learn.
At the same time, owing to the zeal and enterprize of our
Indian officers, on the one side, and of the Russian armies of
exploration—some call them encroachments—on the other, we
are learning something every year. It is only a few weeks
since that a traveller left these shores under the auspices
of the Geographical Society in search of further discovery
in these regions. Again, with the geography of those great
groups of islands which are spread over the Pacific and the
Indian Oceans, we are tolerably well acquainted, owing
to maritime discovery, aided by the labours of the Church
missions, which have invariably taken a very important
part in all such matters. But now we must turn to another
side of the subject, and it must be confessed that it is
the darker side. If we turn to Africa, to Australia, New
Guinea, Borneo, or to the Arctic regions, there the mind
almost fails to comprehend the great problems that*geography
has yet to solve; and it is almost sickening to refleot how
comparatively little we have learnt from all the great efforts
and sacrifices that have been made by individual explorers both
in our own time and in past times. Let us look at Australia.
Here a great English nation has grown up within the present cen¬
tury, and yet there is scarcely more than a corner of that conti¬
nent which can be said to be fairly occupied. With its sea coasts
alone, and not even with all those are we thoroughly acquainted.
Of the greater portion of its vast interior, it is scarcely an
exaggeration to say that we know little more than we did
when Cook first visited its shores a hundred years a^o. The
question seems to arise, to what cause are we to attribute the
small success which has hitherto attended the labours of the
explorers in that region, many of whom have given up their
lives to the cause ? Certainly, there has been no want of zeal,
or enterprize, or devotedness on their part. It may be that
their undertakings are too great for individual enterprise, or,
indeed, for any enterprise not under the direct auspices of
Government; perhaps means and resources may have been
wanting, or organisation, or combination; but, be the cause
what it may, it is certain that no efforts have yet been made
at all commensurate with the importance of the undertaking,
or the importance of the results which are to be expected from
them. It does seem to me that the time has come when some
combined effort should be made to wipe away what almost
appears a reproach to geography. Indeed, lately a proposal
has been made for an organised exploration of the interior of
Australia, which probably is known to many here. This pro¬
posal emanated from Dr. Neumeyer, who has become an Aus¬
tralian, and who is well-known in the scientific world. It has
received the support and approbation and countenance of the
Geographical Society. But I am afraid the Geographical
Society has not much more than its sympathy to give. It is
to be hoped that if the attempt is ever undertaken, it will be
done under Government auspices; with such an organization
as to leave failure almost out of the question. There is another
terra incognita , New Guinea, which is almost within sight of
the northern shores of Australia. The coasts of that great
island have scarcely been correctly laid down on our maps.
Navigators of various countries have landed upon them, but
I am afraid the time is still distant when this very inte¬
resting country has any chance of being opened up and civi¬
lized. Its very extent, and the hostility of native tribes and
various other causes, place it entirely without the limit of any
individual enterprise, and no country seems yet disposed to
put its mark upon it. I should not like to leave these
southern regions without saying a few words on one of the
latest and most flourishing acquisitions of the British Crown
—I mean New Zealand. As an instance of rapid geogra¬
phical discovery and of colonization almost coincident with it,
this is, perhaps, the most remarkable instance in the history
of the whole world. Scarcely thirty years ago almost the
i sole occupants of New Zealand were a few English mis¬
sionaries, who have generally been the pioneers of civilization
Digitized by vJiOO^lC
218 The Medical Press and Circular.
CORRESPONDENCE.
September 3,18&
in those distant countries. Some ten years later, Lord
Auckland, then at the head of the navy, foresaw that the
easiest and shortest mode of success in New Zealand was a
complete exploration of all its shores. This was undertaken
under his auspices, and completed within seven years. Dur¬
ing this period colonization advanced very rapidly; and at the
present time, in spite of many difficulties from native wars,
the islands of New Zealand are inhabited throughout their
length and breadth by Englishmen and Englishwomen, in
possession of all the comforts and prosperity of an old and long
settled country. There is one incident connected with New
Zealand which is, perhaps, not generally known. It is this—
that but for the accidental presence, of a little brig of war
there in 1839 or 1840, commanded by the late Captain Owen
Stanley, the greater part of New Zealand, certainly the fairest
part of it, would now have been under the flag of another
country, and we should have had the spectacle, probably, of a
second British Channel at the antipodes, with our neighbours
looking at us across Cook’s Straits. I will now turn very
briefly to Africa, fruitful certainly, if in nothing else hitherto,
in geographical adventure and daring. It is a mighty subject,
too vast almost to be discussed on this occasion, and the few
words that I shall have to say about Africa will be confined
to an object of great interest to all Englishmen—that is, the
fate of Livingstone, whose life has been so intimately asso¬
ciated with Africa, and who for the last two years and a-half
has been wandering almost single-handed through that great
continent in pursuit of the object to which his life has been
mainly devoted. With regard to having work to do, Living¬
stone’s absence may be most satisfactorily accounted for.
But the least hopeful part of the question to me is that we
have heard nothing from him at Tanganyika. This may be
accounted for by the non-arrival of caravans; still his silence
is matter of great anxiety. If he should be spared to return
to this country, I believe he will return by the way he went.
At any rate, I do not see that anything can be done in the
way of searching for him until something more is heard from
him. The only thing, indeed, that can be done would be to
ascertain beyond a doubt whether he has ever reached the
eastern side of Tanganyika lake ; this might probably be done
from Zanzibar, and I think it ought to be done. In the
course of a few further observations, Captain Richards called
attention to the proposed exploration of the peninsula of
Sinai, and then urged the importance of carrying out an over¬
land communication between Canada and British Columbia,
in view of the great exertions being made by the United States
to cross the entire continent from the Atlantic to the Pacific
by railway.
THE SOIREE.
The grand soiree was held in St. Andrew's Hall, a very
spacious building, having the appearance of a church ; it has
within the last few years been restored and decorated at con¬
siderable expense, and around it are hung a fine collection of
portraits of Norfolk and Norwich worthies, besides a few
paintings of historical interest. Near the orchestra, all the
costly and beautiful corporate regalia of the city of Norwich,
formed a gorgeous display ; on another table near, Dr. Graham,
Master of the Mint, exhibited a voltameter, the negative elec¬
trode of which is formed by a bar of palladium. When con¬
tact is made with a battery oxygen gas is freely evolved from
the positive pole, but some seconds elapse before hydrogen
rises from the palladium or negative electrode. This non¬
evolution of gas proves that it is absorbed by the metal, and
the absorption is made evident by the expansion of the rod to
the same extent as if it had been heated to redness, and the
elongation of the bar, acting on a lever, causes an electric bell
to ring. On reversing the poles of the battery oxygen was
evolved from the palladium bar, removing the hydrogen pre¬
viously absorbed by the metal, which then returned to its
former dimensions. Dr. Graham’s previous experiments have
proved that palladium absorbs nearly 900 times its volume
of hydrogen, which may be extracted by heating in vacuo.
In the centre of the hall was placed a very interesting collec¬
tion of war material, shown by Her Majesty's War Depart¬
ment. It comprised many of the novelties recently brought
into operation in Abyssinia, including a specimen of a 7-pounder
mountain-gun ; also a model of an Armstrong gun, and of
Captain Moncrieff’s projecting barbette carriage ; specimens
of the Palliser and other shells, Boxer’s parachute shell-
rocket, rocket tubes, sectional models of guns, &c. In one of
the aute-rooms in the same department was exhibited a fine
collection of photographs connected with gunnery, the most
interesting being those showing the effect of shots upon armour-
plating. Mr. W. Ladd, of London, exhibited a new magnetic
machine of great power, and some magnificent specimens of
Iceland spar. On a table near the orchestra were cases con¬
taining extensive and beautiful geological specimens, British
land and freshwater shells, fossils from the chalk and gravel
beds in the vicinity of Norwich, a volume of beautifully
coloured sketches of African scenery, and a model of the Vic¬
toria falls on the Zambesi river, South Africa, which in extent
completely eclipse the celebrated Niagara, being 1900 yards
wide, and 400 feet deep, the width of the Niagara being only
1000 yardB and their depth 150 feet. Mr. Frank Buckland, the
eminent naturalist, exhibited a number of piscatorial specimens,
including a plaster-cast of a monster pike, weighing 28 lb., which
was caught in the Thames a short timesince. At intervals around
the hall ten members of the Norwich Microscopical Society gaveto
the public an opportunity of examining the wonders revealed by
the microscope. The objects exhibited included a n at omio sl
preparations (sections of tongue, skin, lungs, and brain), the
cell circulation of plants, the water flea, specimens of insect
anatomy, wings and wing cases, diatomacia, for&minifera, vege¬
table alkalides, &c. Mr. J. Huggins, of Norwich, showed a
polarising kaleidoscope, invented by himself, giving colours ao
gorgeous as to be quite unapproachable by any known process
of artificial colouring. There was likewise a very interesting
collection of drawings of fossil Crustacea, and a series of
beautiful photographs of buildings and other objects of inte¬
rest in Norwich and the neighbourhood, shown by Mr. Sawyer,
of that city.
-♦-
“ THE FELLOWSHIP OF THE
ROYAL COLLEGE OF PHYSICIANS OF LONDON”
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —Your “Notes on Current Topics** in No. 8 of your
Journal are before me. The second of these, headed “The
Fellowship of the Royal College of Physicians,'’ suggests to
the reformer the propriety of “ giving the body of Fellows st
large the opportunity of proposing names" (of Members) “for
promotion." Without doubt this would be a very important
and material advance on the present plan, which, as you ire
well aware, permits the “ Council" to “ be adbpowrfd t»
promoting its friends'' If, however, it be true that the time
has now “ come for a change in the mode of selection M of Mem¬
bers of the College in Pall Mall to the Fellowship, it is essen¬
tial that the kind or character of such change should not be
determined prematurely. Furthermore, if toe acceptance by
the Profession of large and liberal views—and the very evident
necessity of a sure and abiding adaptation of such views to the
governments of our several Colleges of Physicians and Sur¬
geons, &c., are no idle chimeras—then is there good reason
why some of us “ outsiders ” should be allowed the utterance
of a few words in regard to the question herein raised.
Now, there appear to my mind three modes of action open
to the reformer, or, if you please, to the law-givers of the Lon¬
don College of Physicians. These are—
s^jlst. The adoption of a bye-law, whereby any individual Fel¬
low may be permitted, in some defined and approved way, to
name to the Council, through the Registrar, any Member whom
he may consider eligible for the Fellowship; such Member, so
named, taking his chance of election (to the Fellowship) by
the FcUoics in Comitia in the same way as, and in common with,
those other Members duly nominated by the Council at “ those
secret meetings" concerning which “ there are suck ugly rumours
afloat” But the above “mode" is directly seen to be a mere
apology for 44 reform' ’; a poor piece of expediency held up (as
it is) for the acceptance and admiration of the readers of the
Journal of the British Medical Association, the writer of which
does not seem so free from the nervous debility and hysteric
tendencies named by him, as to throw off those very much too
active conservative tendencies, chaining him, as these evidently
do, to the rude and misshapen past. 1
This first mode of action, then, being untenable and out of
harmony with the day and its requirements, we must pass
it by.
2nd. The 44 movement ” alluded to in your “N°tos^ Jhj
has much higher claims on our attention than the last specified
1 See BritM M'iical Journal tot June 18,1S&
Digitized by Lv.
September 2,1868. 2 id
The Media*! Freas And Clrtukr. MEDICAL NEWS.
220 The Medical Press and Circular. NOTICES TO CORRESPONDENTS.
September 2,1886.
we long since sought to “point,” at.a time when we stood almost
alone amongst the journals. Not very long since we had the
Abyssinian Expedition lauded as one of the greatest of our
military achievements, and now we find it sneered at by a great
“ public instructor” as a campaign in which the only “ killed in
action” were “two non-combatant mules.”— United Service
Gazette,
NOTICES TO CORRESPONDENTS.
Mr. G. T. Domvibthorpe, Exeter, is thanked for his note and en¬
closure.
Mr. L. A.—Your application for reprints arrived after the type was
distributed. When copies of any particular article or communication
are required, it is absolutely necessary that the request should reach us
not later than the Tuesday preceding each publication.
H. W. O.—The colour is somewhat against the general adoption of
the article you mention in the preparation of milk foods for invalids ;
but from samples of the flour tested by us, we can add our testimony
to the genuineness of the production.
BOOKS, PAMPHLETS, &o., RECEIVED.
On the Treatment of Aneurism by Iodide of Pota s s i u m . By G. W.
Balfour, M.D. Edinburgh : Oliver and Boyd.
Asthma: its Pathology and Treatment. 2nd Edition. By Hyde
Salter.M.D., F.R.8. London : John Churchill and Sons.
The Pharmacopoeia of India. London : Allen and Co.
The New! York Medical Journal. Nos. 39 and 40. Hardwicke’s
Science Gossip. Bible Animals: Part IX. The Boston Medical
Journal.
APPOINTMENTS.
Dr. Frederick Royston Fairbaxk, M.D., Heidelb., L.R.C.P., Lond.,
has been appointed medical officer and public vaccinator for the
Lynton District of the Barnstaple Union, vice Mr. Thomas
Andrew Roberts, M.R.C.8. Eng., resigned.
Mr. Frederick Morgan, M.R.C.S. Eng., has been appointed medical
officer and public vaccinator for District No. 8 of the Welling¬
ton Union, Somersetshire, vice Mr. Francis D. W. Wheaton,
M.R.C.S. Eng., deceased.
BIRTH.
Gelston.— August 25th, at 62, George-street, Limerick, the wife of
Dr. Gelston of a son.
THE LONDON SURGICAL HOME,
Y7V3R Diseases and Accidents of Women; for the Re-
Jl ception of Gentlewomen and Females of respectability)
‘upon a weekly payment, under the management of Mr. Baker Brown.
The Private Medical Attendants of the patients are invited to visit
them, and to meet in consultation before treatment.
Full particulars can be obtained on application to the Ladt Super¬
intendent, 18, Stanley-terrace, Notting-hill, London, W.
80th November, 1867.
LONDON NURSES’ INSTITUTE,
118, New Bond-street, London, W.
(Removed from 42, South Audley-street.)
fFBAINED NURSES (Medical, Surgical, Mental, and
JL Monthly), can at all times be obtained from this Institute.
Hospital Appointments by special arrangement.
Letters ana Telegrams should convey the nature of the case to be
attended.
Apply to the Manager or Matron. T. HAMILTON, Manager.
TO DISPENSARY OR WORKHOUSE MEDICAL OFFICERS.
A Highly Qualified Physician, Surgeon, and Midwifery
Practitioner is anxious to obtain temporary employment
as Locum Tenens for a short period. Address to A. B., Apothecary,
Meath Hospital, Dublin.
I N consequence of the intended retirement of a medical
gentleman from an old and valuable Practice, a peculiarly
advantageous opportunity is afforded for a successor possessing first-
rate qualifications.
Address M.D., Medical Press and Circular Office, 3, Lincoln-
place, Dublin.
fTHE Friends of a Gentleman who is in good bodily
-L health, but subject to delusions, are anxious to place him
m i. r ti; . ire of a Pbysieian or Clergyman, where he would be treated
s a member of the family. England would be preferred.
uoal Paxes and Circular Office, 3, Liu-
Established 1848.
PROFESSIONAL AGENCY AND MEDICAL TRANSFER OFFICE.
50, Lincoln*s-inn-flelds, W.O.
TUTE. J. BAXTEE LANGLEY, M.E.C.S., P.L.S.,
&c. (Kino’s Coll.), has always upon his books a large
number of desirable investments and available openings for Medical
Men commencing their professional career. Gentlemen wishing to re¬
linquish practice can be introduced without delay to competent succes¬
sors with means at their disposal.
Mr. Langley devotes his prompt personal attention to the negotiation!
entrusted to him, and treats confidentially and with care all matters re¬
lating to professional business. The strictest reserve will be practised in
all the preliminary arrangements and no expense incurred (except in
special cases) unless a negotiation be completed.
The business of the Professional Agency is based upon the general
principle that no chaige is made unless work has been done and services
rendered.
A prompt and just system secured a large measure of success to the
General Partnership and Commercial Agency Business formerly con¬
ducted by him at his City offices ; this has for some years been trans¬
ferred to Lincoln’s-inn-fields, and he has invariably adopted the same
equitable policy in the more professional matters placed in his hands.
Tnus his experience in the management of large commercial under¬
takings, oombined with his medical, scientific, and literary acquire¬
ments, enable Mr. Langley to guarantee that all matters of business
placed in his hands will be carried out without delay, and with an equi¬
table regard to the interests of all the parties concerned. As an
arbitrator on matters of dispute between professional men, Mr. Langley
has had great experience, and he can refer to numerous cases in which
he has been the means of preventing expensive and tedious litigation,
and in which his awards have been made rules of her Majesty’s Courts
at Westminster.
Mr. Langley can also refer to the Professors of his College, Member!
of Parliament, Clergy, Merchants, Bankers and others, as a guarantee
of his integrity and honour in all negotiations entrusted to him.
Full information as to terms, &c., sent free on application.
Office Hours from 11 till 4; Saturdays from 11 till 2.
M IDLAND—PARTNERSHIP.— There is an opening for
a Junior Partner in an old-established Practice in a good town.
The successor must be a Gentleman of superior education. Income
£1400 a-year—capable of great increase. A Third Share to be nego¬
tiated upon the basis of two years’ purchase. There is no dispensing,
and the fees are good. Excellent residence; rent £50. Address X.866,
care of Mr. Langley, as above.
O PEN SURGERIES and RETAILS.— Mr. Lanqliy
has at present on his Books several eligible investments of this
kind, at very moderate prices.
D URHAM.—For immediate Transfer, the Vendor having
accepted an Appointment elsewhere, an old-established Practice,
realising £500 a-year. Very moderate terms would be accepted, and a
portion of the premium could be paid by instalments. Address X. 963,
care of Mr. Langley, as above.
ONDON.—In a good suburb, a Partnership for Transfer.
nd c
S
_ Present income upwards of £2000 a-year, and capable of still
eater increase. The house is well situate; rent £100 a-year. Ad-
ess X. 361, Mr. Langley, as above.
I N a pleasant country town, a Practice for Transfer. Re¬
ceipts £450, appointments £260. House very convenient, with
garden and stabling. A year’s introduction given if required. Addreai
X. 360, Mr. Langley,fas above.
S OUTHERN COUNTIES.—For Transfer an old estab¬
lished Practice, in an improving district, within easy access of
London. Receipts £1000 a-year; appointments £80. Population 2000,
and only one opponent within three miles. .House, with garden,
stabling, &c., at a very moderate rent. As the vendor has the offer of
a desirable appointment, a moderate premium would be accepted.
Address X. 859, Mr. Langley, as above.
COMPETENT ASSISTANTS Provided
^ without delay, free of expense to the principal. No gentleman
recommended whose antecedents have not been inquired into. Apply
to Mr. Langley as above.
T OCUM TENENS can be despatched by
an early train after receipt of letter or telegram stating terms,
duties, and qualifications required. Fee 10s. 6d. Address Mr.
Langley as above.
Now ready. Second Edition, with considerable additions.
A DVICE on Buying or Selling Medical Practices,
Partnerships, &c. By J. BAXTER LANGLEY,
M.R.C.S., F.L.S., &c. Free by post for seven stamps, from the
Author, 50, Lincoln’s-Inn-Fields.
Y
IA MEDICA. Second Edition. 3s.
“ Essential to every Principal and. Assistanti’lv f r>
Digitized by VjivJvJVLV^ .
SALU3 POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 9, 1 868.
CONTENTS.
ORIGINAL. COMMUNICATIONS.
Morbid Conditions of the Throat in their
Relation to Pulmonary Consumption:
their Diagnosis and Treatment. No. VI.
By S. 8cott Alison, M.D. Edin.
(Illustrated) .....page 221
Cannabis Indicus in Catarrhus Senilis—
Veratrum Viride in Pericarditis—Bella¬
donna in Infantile Icterus. By J.
Waring-Curran, L.K.Q.C.P.I., &c. 222
Amputation of the Penis for Cancer:
Reoovery. By Henry Gray Croly,
F.R.C.S.T., Burgeon to the City of
Dublin Hospital, &c. 224
A Case of Ileus Successfully Treated by
Electricity. Under the care of T. A.
Vesey, A.B., M.B. T.C.D. 224
The Physiology of Language. By J.
Hughllngs Jackson, M.d7, F.R.C.P. 287
HOSPITAL REPORTS.
Richmond Suboical Hospital—
Urethral Stricture. Cases under the
care of Mr. William Stokes. 224
PAOE
Da. Stekvens’ Hospital—
Fracture of the Clavicle Caused by
Muscular Action. — Polypus of the
Rectum.—Traumatic Enchondroma of
the Finger. — Aneurism of Aorta.
By Edward Hamilton, F.R.C.S.I.
[Illustrated) ... 225
Kino’s Colleqk Hospital—
Cases under the care of Dr. Beale, F.R.S. 226
St. Gsohob’s Hospital—
Dr. Ogle’s cases of Abdominal
Tumours. 227
LEADING ARTICLES.
The Ailments of the Medical Body
Corporate. No. I.— The Materiel of
Tnc Profession. 230
A Few Words About Fees . 231
NOTES ON CURRENT TOPICS.
The Public Health.—The City Police
(London).—A Medical Man Fined.—
Over-Laying and Death Certificates.—
Medical Capacity for Coronerships.—
The Medical Act against Quacks.—
Qualification of Medical Assistants.—
PAGE
Scottish Longevity.—Professional Ap¬
peal. 232-4
LECTURE.
Lectures on Venereal Diseases Delivered
in Dr. Steevens* Hospital. Lecture IV.
By Robert McDonnell, M.D., F.R.S. 234
CORRESPONDENCE.
M.D. on the Title of Doctor. 240
A Member of Three Corporations on the
London College of Physicians. 240
Not a Disciple of Malthus on Lord
Amberley. 240
LEGAL INTELLIGENCE.
Conviction of a Surgeon under the Vac¬
cination Act. 239
MISCELLANEA.
The New Examination for Pharmaceuti¬
cal Assistants. 240
Medical News.241-2
Original CtfMMHiriralifliis.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION : THEIR
DIAGNOSIS AND TREATMENT.
By S. SCOTT ALISON, MJ>. Edin.,
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON, AND
PHYSICIAN TO THB HOSPITAL FOB CONSUMPTION AND DISEASES OF THR
CHEST, BROMPTON, AND THE SCOTTISH HOSPITAL.
No. VI.
For stethoscopic purposes, the neck may be divided into re¬
gions after the following simple manner—viz., an anterior
region and a posterior region. One line for the anterior region
is drawn from the middle of the hyoid bone to the middle of
the upper edge of the sternum. A line drawn from the
mastoid process of the temporal bone passing down the
neck to the acromion process forms the posterior boundary,
and separates the anterior from the posterior region. The
posterior region is bounded behind by the spines of the
cervical vertebrae. These two great divisions of the neck
may be again subdivided into superior and inferior by a
line drawn round the neck from the cricoid cartilage of the
larynx to the spinous process of the fourth cervical vertebra.
The superior anterior cervical region would include the
glottis and the larynx, and might be called the laryngeal
region, while the inferior cervical region would include the
trachea and the narrows immediately above the bifurcation.
The superior posterior cervical region extending from the
occiput to the spine of the fourth cervical vertebra would
include the pharynx, the posterior nares and the posterior
aspect of the tonsils.
The auscultation of the throat may be effected with the
ordinary wooden stethoscope, but the flexible stethoscope of
Caroan, or the differential stethoscope of the writer, is greatly
preferable. The air sounds of the throat are well made
out with Caman’s instrument; the sounds are well collected
by the cup without undue pressure upon the comparatively
trader and yielding neck, and they are distinctly perceived
by the two ears being employed upon them. The same ad¬
vantages are procured by the differential stethoscope, but
toe additional advantage of very ready location of the seat
of disease appertains to the latter by its possessing two
■rand«ooUecting cups, placed at different spots of the neck
Md connected with the two ears respectively.
The absence of pressure on the neck, which the flexible
jtethoscopes afford, gives them a very great superiority over
the ordinary wooden stethoscope ; and if we regard this
fact, and also bear in mind, in the case of children,
the advantage we enjoy with these instruments, of sitting
in front of the patients and almost of amusing them, we
shall come to the conclusion that any examination of the
throat must be imperfect and incomplete without one or
other of them.
The differential stethoscope
has two tubes—one for each
ear—and instead of communi¬
cating with one collecting cup
only, as in the case of the
double (Catnan’s) stethoscope,
they have each a separate cup
A A. It presents a separate
stethoscope for each ear. These
are mechanically combined for
facility of management, but
they are in an acoustic sense
totally separate. The tubes
are partly made of metal, C
C, and partly of elastic tube,
B B, to admit of some degree
of motion. The two tubes are
connected together, as in Ca-
man’s stethoscope, by a jointed
metal bar, E, and an india-
rubber band, F. There are two
ear knobs, D D, of ivory for
insertion into the two ears re¬
spectively.
The principle of Caman’s
instrument, and indeed of any
other double stethoscope, is
very different from that of the
differential stethoscope. The
double stethoscope enables us
to hear the sound of the same
part with both ears,—virtually
to place both ears upon one
part of the chest, and thus
receive a simply heightened
sensation. The differential
stethoscope enables ns to do more than this ; we hear, or
deal with the sounds of two parts at the same moment, and
virtually place our two ears upon two different parts of the
Scott Alison’s Differential
Stethoscope.
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222 The Medical Press and Circular. WARING-CURRAN ON INPANTILE ICTERUS.
Septembers, 186&.
chest at the same instant. While the double stethoscope
of Caman, having only one sound collector, cannot be con¬
verted into a differential stethoscope, by collecting sounds
from two parts of the chest at once, the differential stetho-
cope may be made simply a double stethoscope by placing
its two sound-collecting cups upon the same part of the
chest. The property which my differential stethoscope
possesses of eclipsing a minor auditory impression in one
ear, upon conveying a major amount of the same sound
into the other ear, is of very great value in practice. When
the respiration or vocal sound in one part of the throat or
chest is weaker than in another part, this is signified in an
unmistakable manner by the sound being heard in that
ear, and in that ear only, connected with that part of ,the
body emitting the larger amount of sound. One ear mono¬
polises the sensation, as it were, and the other is deprived
of all sensation, as it were ; for we seem to hear only
through one ear—viz., the more favoured one.
It was from observing the utility
of Caman’s stethoscope, as used by
Dr. J. Edward Pollock, in 1856,
at the Brompton Hospital, that I was
led to think of the differential one.
As was before mentioned the mechan¬
ism is much the same, but in point of
acoustic results the two instruments
are very different, as I have more
fully explained in my work on the
“Physical Examination of the Chest in
Pulmonary Consumption,” published
in 1861.
It may be useful to say, and it is
done from no feeling of vanity or un¬
due partiality that, the differential
stethoscope is used in many distant
parts of the globe, and that, some of
the first stetnoscopists in the world
have been the most earnest in its
recommendation. Gairdner, of Glas-
f ow ; Hughes Bennet, of Edinburgh ;
tree, of Colchester; M‘Kinnon, of
Netley Hospital ; and Frank, of
Mentone, were among the first to
appreciate the value of the differential Caman’a Double stetho-
8teth0SC0De. scope.
These nexible instruments are so specially suited for the
auscultation of the neck, and to such an extent, as to seem
to me to justify this short account of them in this com¬
munication.
The laryngoscope hitherto has purposely been left un¬
noticed in this paper, for it has been a primary considera¬
tion with me to enforce the propriety of auscultating the
neck, and indeed of regarding that region as only second
to the chest in its call for the employment of the
stethoscope. In all cases of simulated consumption,
combined with throat symptoms, it is incumbent upon the
practitioner to employ the laryngoscope and obtain for his
guidance in the relief of the patient the benefit of ocular
inspection. On the mode of employing this instrument,
or series of instruments, it is not my intention here to
dilate. So much has been written on the subject, both
abroad and in this country, that the reader can be at no
loss for information.
The writings of Gibb, Morell MacKenzie, George John¬
son, and Prosser James, are, perhaps, the most worthy of
the attention of the English practitioner.
CANNABIS INDICUS IN CATARRHUS SENILIS—
VERATRUM VIRIDE IN PERICARDITIS-
BELLADONNA IN INFANTILE ICTERUS.
By J. WARING-CURRAN, L.KQ.C.P.I., Ac.
Ik the July number of the Practitioner I briefly directed
attention to the invaluable and important nature of canna-
tys i^dious in catarrhus senilis ai a therapeutic agent. Sinoe
the publication of that journal I have had additional oppor¬
tunities afforded me of still further testing the efficacy of
the drug in this distressing complaint, and of verifying
the statements I then made. I refer to those cases of senile
catarrh where the mucus accumulates in the bronchia,
which the patient is unable to expel, where the constant,
dry, hacking cough affords no relief to the pent-up mucus;
while it harrasses the patient, and increases the prostration
where there is orthopnea; and unless the distressing symp¬
toms are quickly relieved by remedies which will cause
or promote a free and copious expectoration, blue blood
will quickly circulate through the brain, the lungs become
congested, and a fatal termination occur to the patient
sooner than was anticipated or expected by either the
attendant or relatives. Cases, owing to their repeated
occurrence, over which the usual antispasmodic mixtures,
expectorant pills, opiates, and counter-irritants seem to
have lost their influence and power, yet in which cannabis
appears to act speedily and satisfactorily—speedily by its
specific action in overcoming the spasm of the muscular
fibre in the bronchial tubes, and thus allowing a free and
copious expectoration; satisfactorily in its consequences,as
it possesses none of the disadvantages of opium and medicines
of its class, in blocking up the secretions, increasing the
fever attendant upon the complaint, producing headache
and impairing the appetite; in fine, when administered in
such affections, its effects are to be witnessed rather than
described.
Case 1.—R. S., aged 57 years, of delicate appearance
with narrow shoulders and contracted chest, has suffered
from repeated attacks of chronic bronchitis, of which she
states the present is the worst attack of all. Has been ill
four days. The usual domestic nostrum, paregoric, linseed
tea, and Spanish juice, et hoc genus omne , have lost their
virtue, ana failed to afford relief.
The skin over the anterior part of the chest is well Mis¬
tered, owing to the repeated applications of mustard poul¬
tices. The secretions are normal, and the bowels have
received attention. The patient has been unable to lie on
the back since the commencement of her illness, depending
on the constant and distressing nature of the dyspnoea.
On stethoscopic examination all sorts of sounds are
audible, on both inspiration and expiration; sibilant rales
are most distinct at the base and rhonchi at the superior
part of thorax. There is a constant, dry, protracted cough,
which “ cannot get round,” to use her own words, “ the
obstruction.”
The pulse is 120 ; the skin moist; the lips livid, and the
face blanched and indicative of suffering.
R Tr. Cannabis indicis 3ii.
Pulv. Tragacanth co. 31-
Ether chloric 3iss.
Aquae anisi ad gvj.
Fiat mist., et capiat Ji- 2ndis horis.
The following day, 1 learned before three doses of the
mixture was taken, the cough became “ loose, and the ex¬
pectoration easy and most profuse.” She expectorated
freely for several days, and rapidly recruited on a liberal
regimen, and bark and ammonia mixture.
Case 2.—A. B., aged 69, subject to frequent bron¬
chitic attacks, hits been ill for a w'eek, expectorates
but little, and with considerable difficulty ; is very feeble,
and has been taking ammonia and senega with little alle¬
viation, ordered the Tr. cannabis in mixture, which produced
the desirable effect of liberating the mucus and affording
relief to the cough. Speedy recovery.
Case 3.—R. P., 70 years of age, has been previously
under treatment for catarrh, now presents all the unequi¬
vocal symptoms of chronic catarrh. Has recovered sooner
under the effects of cannabis than from any of her pre¬
vious attacks ; has grown fond of her medicine, which
produces free expectoration after the administration of
each dose.
Case 4.—J. P., aged 60, speedily and satisfactorily i*
covered from a severe and protracted attack of catechus
senilis after the exhibition of cannabis indicis.
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Vl»)fodkdPra« and Circular. WARING-CURR AN ON INFANTILE ICTERUS. September*,1868. 223
VERATRUM VIBIDE IN PERICARDITIS.
The August number of the Practitioner contains a con¬
densed paper of mine on the important therapeutic effect
which I have obtained from the administration of veratrura
viride in pericarditis. I believe it to be preferable to opium,
which hitherto has been our sheet-ancnor in this disease,
when combined with calomel, because of its magical in¬
fluence in overcoming that irritable condition of heart,
so pathognomonic of the malady ; by its certain power,
if carefully watched in its administration, of reducing the
frequency of the pulse, thereby affording relief to the violent
palpitation and tumultuous action of the heart, giving
steadiness to the hitherto irregular pulse, auieting tne re¬
spiration, alleviating the darting pains so characteristic of
the complaint, and enabling the patient to swallow with
less difficulty, and change his position in bed as it becomes
painful, while it increases to a marked degree the renal
and hepatic secretions, of no little moment in such a disease
as pericarditis.
1 invariably employ the extract—considering it the
safest and surest preparation—made by inspissating the
juice of the root, and prescribe it in two grain doses, with
one grain of calomel in the form of pill, every two hours
until its effects are readily discernible. The distressing
symptoms are then kept at bay until the calomel does its
duty, and the disease mastered. Advocates for local or,
perhaps, general depletion, have only to observe its thera¬
peutic influence once, to feel convinced that we do possess
a remedy which will afford all the benefits to be obtained
from either bleeding, leeching, or cupping, without im-
poverizing the blood and increasing the tendency to serous
effusion, constituting hydrops pericardii , which has been
Unfortunately not an unfrequent consequence of this dis¬
ease, particularly in hospital practice.
The history of the three following cases will impart all
that I would fain convey on the subject:—
Case A. —R. R., aged 27 years, the subject of rheumatic
fever, for which he has been under treatment six days; on
the seventh day of his illness he presented all the well-
marked symptoms of pericarditis. On going into the
room I noticed that peculiar distressed, broken-hearted ap¬
pearance of face so indicative of cardiac mischief; there was
visible pulsation of carotids, hurried respiration, tumultuous
action of heart, and decubitus on right side. He com¬
plained of severe lancinating pain extending up between
the Bhoulderblades to the left side of neck, thence extend¬
ing down the arm of same side ; pulse 130 ; respirations
40 ; skin dry ; tongue parched ; secretion arrested ; high
fever. On practising auscultation, a well-marked to-and-
fro sound is audible, all the unequivocal symptoms of acute
pericarditis being present. I immediately put him on two
grains of the extract of veratrum viride, and one grain of
ealomel, to be given in pill every two hours, with a potass
mixture, and a mustard blister to be applied over the
cardiac region.
Evening Visit. —Pulse 60 ; respiration 20; bowels have
been operated on twice, bilious, feculent stools ; passed a
large quantity of acid urine; more free from pain, and ex¬
presses himself easier.
Owing to vomiting, which set in later in the night, I
discontinued the veratrum, and prescribed an effervescing
mixture containing dilute hydrocyanic acid.
The following day there was an aggravation of the
symptoms—the veratrum was renewed, and steadily em¬
ployed, discontinuing it when the symptoms required me,
until a complete and satisfactory cure was effected. The
patient recovered without a bad symptom, and is now at¬
tending to his usual avocation.
Case B. —This was also a well-marked case of rheumatic
pericarditis, presenting all the symptoms of the complica¬
tion to a marked degree. The veratrum brought down
the pulse from 120 to 70 in the course of twenty-four
hours, increased the secretions, and produced a most de¬
sirable termination.
Case C. —Pericarditis with severe dyspnoea and violent
nter-scapular pain; irregular pulsation and congestive
tendency. The veratrum produced its usual effects, and,
combined with the calomel, in a few hours alleviated the
suffering of the patient, increased the secretions, and re¬
lieved the pulmonic circulation. The patient is now as
well as ever he was.
In three cases of acute rheumatism, in which pericardial
symptoms threatened, although did not positively mani¬
fest themselves, I feel assured that the mischief was
baffled by the early and careful exhibition of ten-drop
doses of the tincture of veratrum viride in the athritic
mixture.
BELLADONNA IN INFANTILE ICTERUS.
Sir Thomas Watson, in his elaborate work on the u Prac¬
tice of Medicine,” states that he believes icterus neona¬
torum is not icterus at all, and has no relation to the
biliary organs, but that the child at the time of its birth
being in a hype Hemic or congested condition, presenting
an universally bruised appearance, which gradually fading
gives, as the redness disappears, shades of yellow, which in
a day or two pass, or are converted into the genuine flesh
colour. This is all very nice in theory, but in practice,
when one meets with an infant jaundiced over the surface
of the body universally, the conjunctiva tinged, abdominal
disturbance indicated by constant symptoms of pain, in¬
cessant crying, pressing the legs spasmodically against the
abdomen, general muscular twitchings, vomiting, and dis¬
coloured and foetid evacuations, one does not feel inclined
to wait for the yellow tinge to pass into the normal flesh
colour.
Having paid considerable attention myself to the sub¬
ject, I have found that infantile icterus is of very frequent
occurrence, and in many cases requires prompt remedying.
In several instances which lately came under my notice
the symptoms were very severe, painful to witness, and
disturbing to the entire household.
I am of opinion that the bile in these cases is not sup¬
pressed in its secretion, but that it is retained , that the
liver and gall bladder become surcharged and distended,
that little, if any, bile passes through the ductus communis
choledochus, and have reason to think that the mischief lies
either in the duodenum or common bile-duct, that a
spasmodic condition of these parts, from the irritation or
passage of the bile through the delicate structures, is the
cause of the mischief. The duct becomes spasmodically
closed, the bile, instead of being eliminated as it is secreted,
is blocked up in the liver, and we have re-absorption of it
taking place into the blood.
A few months ago I had the opportunity of making a
post-mortem examination of a child aged seven days, who
died from an injury to the head produced by falling from
the nurse’s arms. It had been previously out of health,
and from the generally tinged condition of the skin, I was
induced to examine the liver. I found it preternaturally
enlarged, distended with bile, and in carefully examining
the duodenum and common bile-duct, I found the duct
narrowed, and the characteristic tinge made by fresh bile
entirely absent. I came then and there to the conclusion,
that the duct had been spasmodically closed during life,
and thus the egress of the bile prevented.
That I have been correct in my opinion is best exemplified
by the immediate relief afforded in the treatment of similar
cases by tincture of belladonna in two-drop doses. After
its administration, there is an end to the incessant crying,
the child falls asleep, passes bile freely by the bowels, and
rapidly recovers its natural state and condition. The ad¬
ministration of calomel I consider unnecessary and cruel.
The act of secretion has gone on naturally enough. The
elimination of the bile is what is required, and for this
purpose tincture of belladonna will be found expeditious
and curative, by overcoming the spasmodic condition of
that portion of biliary apparatus so frequently affected in
children a few days after birth.
2
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224 The Median Press and Circular.
HOSPITAL REPORTS.
September 9,18tt.
AMPUTATION OF THE PENIS FOR CANCER :
RECOVERY.
By HENRY GRAY CROLY, F.R.C.S.I.,
8UROEOX TO THB CITY OF DUBLIH HOSPITAL, ETC.
Mr, -, aged 65 years, was brought to me by
his medical attendant to have the penis amputated for
cancer.
History .—Had congenital phymosis. Six months before
consulting me he felt a hard and tender spot on the inside
of the prepuce at the left side : he thought it was pro¬
duced by the saddle, as he was in the habit of riding long
distances on horseback. He never suffered from venereal
disease in any form. The hardness in the prepuce extended
to the glans penis, which soon became entirely involved in
the disease. The patient suffered intense pain of a burning,
lancinating character, and was obliged to take large opiates
to produce temporary relief. His prepuce was slit up by
his medical attendant a few days before I saw him.
Appearance of patient and diseased part before operation.
—General health excellent. Arcus senilis well-marked.
Heart’s sounds strong and natural. Penis enlarged. Foetid
discharge of sanious fluid from beneath the prepuce. On
examining the glans it feels as hard as a stone. The
hardness extends to within one inch and a half of the pubes.
No glands enlarged in the groin or on the dorsum of the
penis.
The patient was most anxious for immediate operation,
which 1 accordingly performed at his residence, assisted by
his surgeon. Chloroform having been administered, I
grasped the penis and drew it gently forwards. With one
sweep of the catlin the organ was severed behind the dis¬
eased part. The dorsal arteries and those of the corpora
cavernosa were ligatured, and a small branch close to the
urethra. When all haemorrhage was controlled I passed a
scissors into the urethra, and divided it fully half-an-inch.
The angles of the divided mucous membrane were then
stitched to the integument at each side. A No. 8 gum-
elastic catheter was introduced into the bladder, and re¬
tained. The ligatures came away within a week, the wound
healed, and the patient made an excellent recovery.
Microscopic examination showed the disease to have
been epithelial cancer.
I devised a silver funnel to fit over the pubes, which
enables the gentleman to pass water without wetting his
clothes, thereby contributing much to his personal comfort.
The appliance was manufactured by Weiss, of London,
by direction of Fannin and Co., Grafton-street, Dublin.
Remarks .—Diagnosis of cancer of the penis must be
carefully made, especially if the disease occurs at or before
the middle period of life, when syphilis is more likely to
exist than in advanced life. Congenital phymosis is a
cause of cancer (according to Hey), the preputial discharge
being retained producing irritation. In operating, the
penis should not be drawn too much forwards, as retrac¬
tion of the skin is liable to occur, thereby leaving the
stump exposed. All bleeding vessels must be secured by
ligature or acupressure; torsion is not suitable for vessels
oi the corpora cavernosa—secondary haemorrhage is to be
apprehended, and pyaemia has followed the operation. Re¬
moval of the penis by the ecraseur, if effected slowly, to
? revent haemorrhage, prolongs the operation unnecessarily.
'ree division of the urethra is of much importance, to
avoid stricture at the orifice; and retaining a catheter in
the bladder, for the first forty-eight hours, prevents irrita¬
tion from the urine on the freshly-cut surface.
A CASE OF ILEUS SUCCESSFULLY TREATED
BY ELECTRICITY.
Under the care op T. A. VESEY, AB., M.B. T.C.D.
On July 14, 1868,1 was called to see John Hughes, aged
59, a pensioner. Always healthy. Three months since
was treated for enteralgia ; subject to constipation. On
the 12th, his bowels not being moved for two days, he took
a dose of castor oil, followed by senna and salts, without
effect
Present Symptoms. —Spasmodic pain, starting from a
hard moveable mass to the right of the umbilical region;
pressure here caused increased pain; belly tympanitic;
tineas transverse deeply marked ; face pale, anxious; eyes
sunken, dull; skin cool, clammy ; feet and hands cold;
tongue coated; vomiting (not stercoraceous) set in same
morning ; constant loud gurgling in bowels ; pulse 94,
fair volume.
Treatment. —A sinapism, followed by turpentine stupes,
an emollient enema (3 pints) was given by a long tube, and
retained one hour; came away unchanged ; turpentine
enema twice administered without carrying away any
faecal matter. Subsequently a 3 pint enema of warm oil
(Dr. Head, Carlisle)‘brought away a trace of faeces.
No purgatives by the mouth ; belladonna and opium in
full doses with relief to pain, spasms, and vomiting.
15th.—Passed a tolerable night; had some sleep ; pain
less; abdomen becoming tender; pulse 104; vomiting very
troublesome since 4 a.m.
Finding that the measures adopted for his relief did not
produce any good effect, I determined to use electricity,
applied as follows :—
Patient being placed on the left side, a “ Radford’s
Uterine Director” was introduced into the rectum, and
the negative wire of the electric machine attached to it.
The sponge attached to the positive pole was rapidly
passed over the whole abdomen from coecum to left iliac
region. This caused intolerable agony, as all the abdo¬
minal muscles were thrown into violent action. The elec¬
tricity was applied (at intervals) with gradually increased
power for lialf-an-hour, when such exhaustion was pro¬
duced that it was discontinued.
As he complained much of pain in the back, a vulcanite
hot-water bag was applied to it with relief.
In two hours after the use of the electricity, he had
several copious, dark-coloured, offensive stools. Daring
the rest of the day and night following, his bowels were
moved twelve times. The pain disappeared, the hard
mass was so much reduced as to be made out with diffi¬
culty. He made a rapid convalescence.
The failure of the ordinary measures in this case induced
me to try the effect of electricity, and the successful issue
furnishes additional evidence of the great therapeutical
value of electricity in the treatment of ileus.
In the ninety-sixth number of the Dublin Quarterly
Journal of Medical Science , will be found a case reported
by Dr. Finney, in which electricity was used on Dr. Stokes’
recommendation. It was the recollection of that case, and
the favourable result, that gave me confidence in the trial
of a similar remedy, and happily with similar good fortune.
The battery used was a Davis and Kidder’s electro-magnetic
machine.
-♦-
RICHMOND SURGICAL HOSPITAL.
Cases under the care op Mr. WILLIAM STOKES.
(Reported by Mr. J. A. Ross, L.R.C.S.I.)
urethral stricture.
The results of the treatment by internal urothrotomy of
the following cases of urethral stricture, tend considerably
to confirm Mr. Stokes in the high opinion he has formed
of the operation for the cure of this affection.
Case 1.—STRICTURE OP THE URETHRA OP THIRTEEN TEARS*
DURATION, PREVIOUSLY TREATED TWICE BY THE u IMME¬
DIATE DILATATION” method: internal urothrotomy.
Michael B., set. 43, was admitted into the Richmond Hos¬
pital, under Mr. Stokes’ care, on the 22nd of last May,
suffering from a very tight stricture of the urethra, situ¬
ated in the region of the bulb, and Which, with great diffi¬
culty, would admit No. 1 catheter.
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The Medical Frees and Circular.
HOSPITAL REPORTS.
September 0,1868. 223
The patient stated that in 1865 he had been treated by
the “ immediate method,” and that the stricture having
returned, the operation was performed a second time, by
another surgeon, in July, 1867. The stricture had a second
time recurred, and the difficulty in passing water was con¬
siderably greater than it had ever been.
On May the 23rd the operation of internal urothrotomy
was performed by Mr. Stokes, and immediately after a No.
10 gum-elastic catheter was introduced.
No rigor or other evidence of any constitutional disturb¬
ance occurred during the patient’s convalescence.
On the 27th the patient left hospital.
On September 3rd No. 9 catheter was introduced with¬
out the slightest difficulty.
The patient has been perfectly well ever since the ope¬
ration.
Case 2.—stricture of the urethra of ten tears’
duration: internal urothrotomy: recovery.
Cornelius M., aet 32, was admitted into the Richmond
Hospital on the 10th of last March. The case presented
all the symptoms of urethral stricture, which the patient
attributed to gonorrhoea, and which the patient stated he con¬
tracted about eleven years previously. The stricture, situ¬
ated in the membranous portion of the urethra, was so
dose a one, that it was not until after repeated trials that
a No. 2 catheter could be passed. When this was done,
Mr. Stokes then passed in the filiform bougie of the
urethrotome, and completed the operation then, in the
ordinary manner. A large gum-elastic instrument was
immediately introduced after the operation.
Nothing untoward occurred during the convalescence of
the patient, and more than four months after the operation
No. 9 catheter could be introduced with the greatest facility.
Case 3. —stricture of the urethra of two years’
duration: internal urothrotomy: recovery.
Peter S., set. 22, was admitted into the Richmond Hos¬
pital under Mr. Stokes’ care, on the 20th of last March,
suffering from stricture of the urethra, which he had, he
stated, for the last two years. He attributed it to an attack
of gonorrhcea, which had been treated by injections, and
which he did not believe had ever been quite cured.
Mr. Stokes treated the case for some days by partially
dilating the stricture by wax bougies, as the ordinary small
sized gum-elastic catheter could not be introduced. As
soon as the filiform bougie of the urethrotome could be
passed, the remaining steps of the operation were com¬
pleted in the ordinary manner. After the operation No.
10 gum-elastic catheter was introduced.
Four hours after the operation the patient had a rigor,
but no other evidence of any constitutional disturbance
supervened during the convalescence of the patient. A
week after the operation, he left hospital able to pass water
in a full and uninterrupted stream.
Case 4. —stricture of the urethra of four years’
duration : internal urothrotomy : recovery.
Peter 6., act. 45, was admitted into the Richmond Hos¬
pital under Mr. Stokes’ care on the 6th of last April. The
stricture, situated in the membranous portion of the
urethra was of four years’ standing. The patient stated
he never had any gonorrhcea, nor had he ever received any
injury to the perineum. There was some obscurity therefore
as to the cause of the stricture. The gradual dilatation
method had been tried only, however, for the stricture
to return afterwards in a still more contracted state.
The stricture was situated in the membranous portion
of the urethra. At the time of the operation No. 2
gum-elastic catheter could alone be introduced, and
that with much difficulty, and requiring very delicate
manipulation. The operation was performed in a simi¬
lar manner as in the preceding cases, and immediately
after No. 9 gum-elastic catheter was introduced. There
were no rigors after the operation. Twenty-four h ours after
the operation, the instrument was withdrawn, and no instru¬
ment re-introduced for four days. No. 10 catheter was
then passed without any difficulty. The patient then left
hospital.
The first of these cases, operated on on the 23rd May,
Mr. Stokes had an opportunity recently of examining.
No. 9 catheter was introduced without any difficulty.
Cases 2 and 4 have also been recently seen and examined,
and the condition of these two patients was found most
satisfactory. Case 3 has not been seen since the operation,
the patient having neglected to return to hospital for exa¬
mination as he was directed.
The following points are of some practical importance:—
1. The operation should not be performed unless the
grooved metallic director can be introduced with facility.
Any forcing of this portion of the instrument into the
bladder will, in the great majority of cases, be followed by
rigors and other symptoms of constitutional disturbance.
2. The patient’s bowels should be cleared by an enema
on the morning of the operation.
3. Immediately after the operation a full opiate with
quinine should be given.
4. The catheter introduced after the operation should
not be allowed to remain longer than twenty-four hours.
If it is, it will probably give rise to irritation, and the for*
mat ion of an abscess where the stricture is divided.
5. No instrument should be re-introduced for at least
three days.
6. The patient should be kept on milk diet for forty*
eight hours after the operation, and no stimulants given,
DR. STEEVENS’ HOSPITAL.
CLINICAL reports
By EDWARD HAMILTON, F.R.C.S.I.
fracture of the clavicle caused by muscular
action.
This bone, so frequently fractured by indirect violence, is
rarely broken by muscular action, and yet cases now and
then present themselves, which place the possibility of the
occurrence beyond doubt. Various muscular acts have
been recorded as resulting in fracture of the clavicle— e.g .,
securing a carriage trace, mounting a horse, whipping a
dog, shaking a wet coat. The following case illustrates
this accident:—
J. H., a cabinet-maker, aged 48, a healthy man, fairly
developed, presented himself at the hospital with all the
symptoms and evidences of a fracture of the clavicle of the
right side , a little external to the centre. He stated that
a week previously he was pulling the lath from the hem of
a linen blind, which, after considerable resistance, sud¬
denly gave way ; he felt something crack in his shoulder,
with great pain and loss of motion in the limb; he did not
mind it subsequently, but finding that the limb was still
weak, he applied for relief. The fracture appeared to be
quite transverse, and there was no difficulty in procuring
perfect union. There was no history of syphilis, or other
constitutional disease, to cause structural change in the
osseous tissues.
polypus of the rectum.
E. D., 12 years of age, presented himself as an out¬
patient ; he had suffered for the last four or five years from
tenesmus and constant haemorrhage from the rectum ; his
aspect was pale and delicate, which his mother attributed
to loss of blood : these symptoms at this early age sug-
f ested the idea of polypus—he was accordingly placed on
is hands and knees, and directed to force down, when a
polypus was protruded about the size of a filbert, very red
ana vascular; a wine ecraseur was applied to the neck of
the tumour/and while it was being tightened the growth
was drawn down, exhibiting a neck of fully an inch in
length, attached to the posterior wall of the gut; steady
traction was made on it, while a silk ligature was slipped
round the pedicle, below which it was divided with a scis-
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226 The Medical Press and Circular.
HOSPITAL REPORTS.
September 9,1969.
sors. The age of the patient and the long narrow pen-
duncle at once served to distinguish it from a pile, although
the colour, the appearance of the surface, and the bleed¬
ing, might easily lead the superficial observer to an erro¬
neous idea of its pathology.
TRAUMATIC ENCHONDROMA OF THE FINGER.
A. B., aged sixty, ten years ago received a severe
blow on the index-finger of the left hand by the falling of
a plank. The pain at the time was not very severe, but
the finger remained sore and swollen, and gradually in¬
creased in size until about three years since, when it began
to increase more rapidly, and was also more painful. Cfn
examination, the finger was considerably enlarged—about
the size of a hen’s egg,—had a peculiar elastic feel, amount¬
ing in parts to a sense of fluctuation ; it felt hot and throb¬
bing, and was very painful, but the pain was removed by
gradual and steady pressure. The disease was limited to
the finger ; the metacarpo-phalangeal joint was perfect;
there was no trace of glandular contamination ; no evi¬
dence of cachexia. In every respect the case was favour¬
able for operation, which was suggested to the patient
twelve months before, but he was afraid to encounter it.
The amputation was performed in the ordinary way. The
end of the metacarpal bone was removed, as his occupation
did not require the breadth of surface in the palm of the
hand. Two vessels spouted during the operation, but
ceased to bleed almost immediately, so that they did not
require haemostatic treatment. The wound was closed by
means of sticking-plaster, one stitch only being inserted
into the lower part of the wound. Silk steeped in
carbolic oil was used for the purpose. The parts were
covered with the antiseptic putty and tinfoil, and the
bandages well soaked in the oil. The dressings were not
disturbed until the fifth day, but were each day saturated
with the oil, a little matter appeared under the edge of
the bandages, but the entire suppuration did not amount
to half an ounce.
On making a section of the tumour it presented all the
characters of enchondroma, which were corroborated by
the microscope. It had grown from the second phalanx,
which was completely merged in the tumour, and from
thence extended up on each side of, but did not implicate,
the first phalanx. The digital nerves on each side were
much enlarged and flattened, which may explain the in¬
crease of pain.
Altogether, the disease was a fine specimen of traumatic
enchondroma :—
ANEURISM OF AORTA.
W. M., a plasterer, aet. 29, was brought under my notice
through the kindness of Dr. Shortt. He presented a well-
marked tumour of right lumbar region, projecting between
the last rib and the crest of the ilium. Also, somewhat in
front, it exhibited distinct diastolic impulse, and bruit de
soufflet audible in front, but not behind. His general ap¬
pearance was anaemic and unhealthy, and he suffered severe
pains of a neuralgic character in the back, groin, and knee;
he stated that he was in perfect health, and worked hard at
his trade until six months ago, when he became affected
with pains, which he attributed to rheumatism. He did
not observe any enlargement of the side until three weeks
before. He was admitted to hospital, and underwent a
careful physical examination, from which was deduced the
diagnosis of an aneurism of the aorta behind the coeleac
axis, becoming diffused toward the right side. The tumour
rapidly enlarged, attended with the most agonising pain
and loss of sleep, which was with difficulty procured by the
strongest anodynes. The tumour became somewhat dark
on its posterior surface, and after a few days the extremi¬
ties became cold, and he gradually became weaker and
weaker. The post-mortem examination revealed an enor¬
mous mass of blood occupying the right side of the abdo¬
men, behind the peritonaeum, extending up behind the liver
to the diaphragm, and down in the substance of the psoas
muscle, which encapsuled it to Poupart’s ligament. Imme¬
diately behind the mouth of the cceleac axis and superior
mesenteric artery a large aneurism existed, eroding the
vertebra. It became diffused behind the liver and kidney,
both of which organs were projected forward.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. BEALE, F.R.S.
(From brief notes by Dr. Tonge.)
Dyspepsia. —G. A., set. 36, gardener. Admitted March
8 ; discharged March 26. In hospital 18 days. Recovery.
Five weeks ago while straining at work sudden pain in
loins, epigastrium, and right hypochondrium, continuing up
to present time. Loss of flesh and strength, disturbed
sleep, sour risings, occasional retching, pain aggravated by
food.
Mist. rhei. co. iodide of potassium, bicarbonate of
potass, and chloric ether; castor oil and opium; linseed
and laudanum poultice.
Dyspepsia.— Mary A. C., set. 19, servant. Admitted
December 18 ; discharged February 13. In hospital 57
days. Recovery . Slight haemoptysis six months ago ; loss
of flesh six months ; epigastric and dorsal pain after food;
sour risings.
Mist. rhei. co. ; bismuth, magnesia, soda, calumba, and
hydrocyanic acid ; pepsine and hydrochloric acid ; quinine,
sulphate of iron, and sulphate of magnesia.
Dyspepsia. —Cornelius K., set. 38, street fruit seller.
Admitted December 1 ; discharged December 20. In hos¬
pital 19 days. Relieved. Abdominal pain and vomiting
14 days ; bowels confined for one week before ; much ten¬
derness at a spot two inches above umbilicus ; tongue
furred.
Hydrocyanic acid and carbonate of soda ; pepsine and
hydrochloric acid ; grey powder, rhubarb and henbane.
Dyspepsia. —Mary A. P., set. 40, married. Admitted
February 2 ; discharged February 20. In hospital 18
days. Relieved. Catamenia ceased two years ago; pain
in right side 18 months, constant last three months;
tremor of right leg and arm 18 months ; haematemesis 10
weeks ago ; loss of flesh and colour of late. On admis¬
sion pain in right side; small deep-seated moveable
tumour in epigastrium ; occasional vomiting; appetite
bad ; tongue furred ; bowels confined ; right leg dragged
slightly in walking.
Pepsine and hydrochloric acid ; effervescing mixture ;
quinine and sulphuric acid; purgatives ; hydrochloric add
lotion.
Hydatid (?) Tumour of Liver.— Mary A. M., aet. 22,
widow. Admitted July 1 ; discharged August 3. In
hospital 33 days. Relieved. Occupation sedentary ; had
acute rheumatism six years ago ; since then a tumour to
right of epigastrium only occasionally painful up to one
month ago, since then constantly so ; never jaundiced; no
loss of flesh. On admission tumour 3^ inches transversely,
nodulated (?), extending two inches below costal margin to
edge of liver, felt in same situation and descending with
liver on inspiration ; appetite good ; tongue clean ; pain
and tenderness became much less while she was in hospi-
tal.
Liq. ammon. acetatis and aromatic spts. of ammonia;
belladonna plaster.
Re-admitted October 1; discharged November 9. In
hospital 39 days. Unrelieved. Since discharge the tu¬
mour has become larger and more tender, but there has
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1b »Ihdiod Prem and ditnlar. HOSPITAL REPORTS. Septembers, 19«8. 227 J
been no loss of flesh. The tumour got slightly larger and
more painful while she was in hospital.
Quinine and dilute sulphuric acid.
Colic. —W. P., set. 23, a blacksmith. Admitted May
26 ; discharged May 30. In hospital 4 days. Recovery.
Slight epigastric pain and purging 6 days ; much vomiting
ana intense abdominal pain on day before admission ;
scybala brought away by injection. Then slight jaundice.
Castor oil and warm water enema. Aromatic spts. of
ammonia and sulphate of magnesia.
Colic.—R. B., aet. 50, smith. Admitted July 14; dis¬
charged July 16. In hospital 2 days. Recovery. On
morning of admission ate some tainted meat, and, a few
minutes afterwards, was seized with severe abdominal
pain, vomiting, and purging, followed by faintness.
Warm bath. Aromatic spts. of ammonia and chloric
ether.
Abscess of Liver. — W. R., aet. 22, sailor. Admitted De¬
cember 2, 1863; discharged March 23, 1864. In hospital
112 days. Unrelieved. Left West Indiestwo years ago; soon
afterwards jaundice 7 weeks, followed by loss of strength;
pain and enlargement of liver 6 months ; diarrhoea for 1
month, 4 months ago. On admission, skin dark, slightly
jaundiced ; pain and tenderness on pressure in right hv-
pochondrium and epigastrium ; pain sometimes in right
shoulder; liver from sixth rib to below umbilicus; slight
dulness and faint tubular bruit over base of right lung;
motions dark; frequent paroxysms of severe pain in liver;
diarrhoea after 30th day from admission. Forty days
later, expectoration of pus streaked with blood ; dulness
and crepitation at left apex. Slight haematemesis 35
days later.
Chloric ether and iron (first sesquichloride, then citrate).
Nightly opiates. Hydrochloric acid lotion over liver.
Re-admitted April 5. Died on May 20. In hospital 45
days. Pain in liver has increased since discharge ; right
side now extremely tender. Eighteen days later began to
expectorate viscid, brownish-red sputum ; two days
later, pain worse ; much dulness and crepitation at right
base; some dulness at left base ; nineteen days later,
purged five or six times daily; expectoration abundant,
foetid, yellowish-brown; orthopnoea; exhaustion; death.
Post-mortem. —Liver fatty and much enlarged, extending
to one inch above umbilicus; the upper two-thirds of right
lobe occupied by an abscess, lined by a cyst one-fourth of an
inch thicK, containing stinking pea-soup coloured pus, its
anterior surface adherent to the abdominal wall; base of
lower lobe of right lung yellow and disintegrated, and
communicating with abscess by an aperture in diaphragm,
which was adherent around it to liver and lung. Old dys¬
enteric ulcers in large intestine.
Cod liver oil; quinine; cod liver oil and syrup of iodide
of iron; logwood and opium, and opiate enemata for diar¬
rhoea. Locally, opiate poultices, lin. belladonna, and
I. P.
Jaundice. —E. G., set. 37, milliner. Admitted January
21 ; discharged February 13. In hospital 23 days.
Recovery. Acute rheumatism 15 years ago; jaundice 3
years ago, and twice subsequently; each attack prolonged.
Previously ill one week ; shivering ; itching of skin ;
headache; sleeplessness; low of spirits; ocular spectra. On
2nd day after admission, became slightly jaundiced. Gall¬
bladder distended and painful on pressure.
Aromatic spts. of ammonia; chloric ether and bicarbon¬
ate of soda ; quinine and dilute muriatic acid ; grey pow¬
der and rhubarb. Hydrochloric acid lotion over liver.
Jaundice. —Julia N., set. 68, married. Admitted No¬
vember 16. Died November 17. In hospital one day.
Was in King's College Hospital last summer under Dr.
Beale, for dyspepsia. Since discharge much pain in epi¬
gastrium and frequent vomiting ; 12 days ago was seized
suddenly with violent pain in hepatic region, recurring 2
and 4-days later. On admission very emaciated ; slightly
jaundiced ; great pain and tenderness in upper part of ab¬
domen ; tongue dry; double bruit over base of heart;
pulse 100, collapsing. On day after admission was seized
with severe pain and vomiting, followed by exhaustion and
death.
Post-mortem. —Heart nine and a quarter ounces ; left
ventricle slightly hypertrophied ; mitral and aortic valves
somewhat thickened ; a bony nodule at base of one aortic
valve, and bony plates in aorta; liver clay-coloured and
small, its ducts full of bile ; gall-bladder distended to size
of a large pear ; two gall-stones in it; mucous memt. ul¬
cerated ; recent lymph on its peritoneal surface ; a small
gall-stone impacted in lower end of common duct.
Stimulants. Enemata.
Cirrhosis of Liver.— R. S., aet. 45, law-writer. Ad¬
mitted July 19. Died on July 22. In hospital 3 days.
Has drunk gin freely. Ascites 3 months ; legs (edematous
3 weeks. On admission considerable ascites and oedema of
legs ; superficial abdominal veins much enlarged ; skin dry,
slightly sallow ; urine scanty and bilious, not albuminous ;
dulness and large crepitation at bases of lungs ; liver dul¬
ness as high as fourth rib in front. Pulse, 108; appetite
bad ; tongue furred. On second day after admission 517
ounces of fluid were drawn off by tapping. Sunk, and died
next day.
Aromatic spts. of ammonia, chloric ether, sp. junip. co.
and liq. ammon. acetatis. Pepsine and hydrochloric acid.
Purified ox bile. Paracentesis abdominis.
Cirrhosis. —T. K., aet. 42, miner. Admitted Septem¬
ber 30. Died on October 24. In hospital 24 days. Has
drunk spirits freely. Ten weeks ago, vomiting, diarrhoea,
loss of appetite, and debility ; dropsy 1 month, commenc¬
ing in legs ; motions loose and frequent, sometimes bloody;
slight jaundice ; legs cedematous ; much ascites (girth at
umbilicus, 38i inches); skin of genitals, abdomen, left
chest, left axilla, and inside of left arm, deep purple (be¬
gan in left axilla 7 days ago); large crepitation and sibilus
over chest; tongue brown in centre ; red at tip and edges ;
pulse 96 ; urine bilious ; no albumen. The jaundice ascites
and dyspnoea increased, and he died on the 24th.
Post-rnortem. —Much turbid serum, the colour of yolk
of egg, in peritoneum ; liver contracted, fissured and no¬
dulated, bright yellow on section; weight seventy-three and
a half ounces ; lungs much congested; some patches of
pulmonary apoplexy in lower lobes; heart healthy ; sto¬
mach rather inflamed.
Chloric ether and carbonate of ammonia (19 days). Then
hydrocyanic acid and bicarbonate of soda. Turpentine
stupes.
Cirrhosis.—Granular Kidneys. — G. G., aet. 65,
compositor. Admitted May 25. Died June 25. In hos¬
pital 31 days. Intemperate. Jaundice 25 years ago;
cough and shortness of breath 3 months ; oedema of
legs and great dyspnoea, 10 days. On admission slight
ascites, legs cedematous ; dulness and crepitation under
right clavicle and over right supra superior fossa ; wheez¬
ing elsewhere; expectoration frothy, viscid and puriform ;
pulse 110; respiration 36 ; urine albuminous ; became
weaker; passed much clotted blood by rectum on 28th
day after admission. Died 3 days later.
Post-mortem. —Much fluid in pleurae and peritoneum ;
lungs cedematous and emphysematous; old cnalky bodies
and cicatrices in their upper lobes ; liver 43 ounces ;
slightly granular; contracted and tough ; deep oblique
fissure on upper surface of right lobe; kidneys granular and
contracted ; cysts in cortex.
Chloric ether, carbonate of ammonia and senega. Log¬
wood, sulphate of copper, and opium.
ST. GEORGE'S HOSPITAL.
Dr. OGLE’S cases of abdominal tumours.
Nothing in the whole art of medicine is involved in
greater uncertainty than certain tumours in the abdominal
regions. Some of the most obscure cases have been very
patiently investigated by Dr. J. W. Ogle, who published
his conclusions and full details of the cases in the last
volume of the St. George's Hospital reports, upon which
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HOSPITAL REPORTS.
228 The Medical Press and Circular.
September 9,1868.
we have previously drawn so fully. We now purpose to
give an epitome of these important cases for the benefit of
such of our readers as have not already studied them, and
as an encouragement to others to work in the same field.
We have only to preface the cases with our thanks to Dr.
Ogle for his kind assistance in the matter.
Case I. —large tumour formed by thickening and
TUCKING-UP OF THE OMENTUM, WHICH WAS OCCUPIED
BY SCROFULOUS DEPOSIT.
F. K., set. 47, admitted August 17th, 1843, and died
December 11th. No history of the case was obtainable,
but the preparation may be seen in the museum of St.
George’s, and the post-mortem found in the books as fol¬
lows :—
Post-mortem examination. —The whole of the subperi-
toneal areolar tissue (visceral and parietal) was thickly
studded with miliary tubercles. The large omentum was very
much thickened by a similar deposit, and being tucked up,
formed a large tumour situated to the right of the. umbi¬
licus, on a level with it. This tumour was united by re¬
cently effused fibrin to the anterior wall of the abdomen ;
and the various coils of intestine were similarly united.
No ulcerations of intestine existed. Here and there was
a small quantity of serum between folds of intestine,
which had not been united, forming a species of encysted
dropsy .
The left lung at its apex contained numbers of miliary
tubercles and a vomica. Right lung and heart healthy.
Case II. —distension by serum of the smaller omen¬
tal CAVITY, WHICH WAS CONVERTED INTO A SHUT SAC
BY CLOSURE OF THE FORAMEN OF WIN8LOW : PECULIAR
DEPOSIT BENEATH THE PERITONEUM.
J. I., set. 39, admitted March 24th, 1841, and died
August 26th. As in the former case, no history exists.
Post-mortem examination. —The peritoneum of the whole
of the intestine, liver, and other organs, and also that lin¬
ing the abdominal walls, was covered by a thick layer of
fibrin, which could be scraped off; also beneath the peri¬
toneum of the bowels and parietes a quantity of black
material was deposited. The upper cavity of the omentum
had been converted into a shut sac by a false membrane
which blocked up the foramen of Winslow ; and the cavity
of this sac contained a quantity of straw-coloured serum.
The liver, spleen, and kidneys were much diseased.
The left ventricle of the heart was much thickened ; and
much disease of the mitral valve and oedema of the legs,
with fluid in the pleural and pericardial sacs, existed.
Case III.— large mass occupying the centre of the
ABDOMEN, FORMED BY HYDATID CYSTS CONNECTED
WITH THE OMENTA. CAVITY, LINED BY FIBRIN, AND
CONTAINING PURULENT FLUID, FORMED BY BREAKING
DOWN OF THESE CYSTS. PURULENT DEPOSITS IN THE
LIVER J PUS IN THE PORTAL VEIN.
Josiah S., set. 38, was admitted Jan. 30, 1850. For
many years he had not been quite well, and also had been
getting large in the abdomen ; but on the whole enjoyed
fair health, until one week before admission, when he
experienced severe pain in the region of the liver, epigas¬
trium, and right shoulder. He had several times had rigors.
When admitted, the skin was brownish yellow, and the
abdomen was very large and hard, with rounded
nodulated tumours, to be felt through the parietes, almost
over its whole surface. Extensive dulness, continuous
with that of the liver, extended very high into the chest,
and passed across the umbilicus to the left iliac region, but
nowhere could any edge be discovered; and though there
was much softness, no positive fluctuation could be de¬
tected. There was some resonance in the left hypochon¬
driac and iliac regions. The urine was very dark and very
albuminous. The conjunctiva yellow. Purgatives were
freely given, and ether to alleviate a spasmodic kind of pain
of which he complained ; the alvine evacuations were very
pale. Though in some respects he improved, the abdomen
became larger. The albumen and bile diminished in the
urine, but oedema of the legs came on, and then diarrhoea.
He lost strength and flesh ; and pain in the lower part of
the abdomen was great. He finally became delirious before
death, which occurred Feb. 2nd.
Postmortem Examination. —The lungs were somewhat
conjested ; the right one being much pushed up by the
liver which reached as high as the third intercostal space.
The great omentum was at its lower part adherent to
the anterior wall of the abdomen. In the areolar tissue,
between the layers of peritoneum, forming the lesser and
greater omentum, were numerous cysts containing hydatids
which formed an enormous mass, occupying the whole of
the central part of the abdominal cavity, and much dis¬
placing the viscera ; the small intestines occupying chiefly
the left iliac fossa. Behind the umbilicus, in the anterior
and lower portion of the mass of cysts, was situated a large
irregular cavity of sufficient capacity to contain a child’s
head. This cavity was apparently formed by the coalescing
of several cysts, the interposed partitions having been
destroyed. It was lined by a thick layer of false membrane,
which gave great consistency to its walls, and it contained
a thin yellowish, purulent, and very offensive fluid, in which
floated many hydatids, apparently long dead. The re¬
mainder of the mass consisted of cysts containing hydatids,
some ruptured and collapsed, others in various stages of
development. The containing cyst-walls were in places
almost of fibro-cartilaginous character. Isolated cysts also
existed ; as, for example, in the transverse meso-colon,
beneath the peritoneum of the sigmoid flexure of the colon,
between the rectum and bladder, between the peritoneum
and the fascia transversalis near the umbilicus.
The liver contained several small purulent deposits,
slightly tinged with bile, and the branches of the porta*
vein also contained pus. Kidneys congested. Other organa
natural.
Case IV.— large sac, formed of fibrinous material
AND FILLED WITH FLUID J SITUATED IN FRONT OF THE
INTESTINES.
Jane L., set. 29, admitted May 8,1850, with ascites and
diseased liver. At first the swelling, as she said, had ap¬
peared to begin on the left side, where pain existed ; and
for some time she thought she had been pregnant. When
admitted, the abdomen was enormously distended, and no
resonance existed at its upper part, but it could be traced
on either side towards the spine. Tapping had to be re¬
sorted to several times.
Post-mortem Examination. —The cavity of the perito¬
neum was found lined by a tolerably thick layer of firmly
organised lymph, which passed in front of the intestines
and formed a sac, filled with yellow serum. Numerous
slender bands of recent lymph were stretched across the
sac. All the abdominal organs were matted together, and
bound down to the back of the cavity by old adhesions.
Case V. —cysts filled with serum, formed by
FIBRINOUS LAMINjE INTERSECTING THE GENERAL PERI¬
TONEAL CAVITY, THEJRE8ULTS OF PERITONITIS. LARGE
CYST OF THE RIGHT OVARY ; SMALLER ONES OF THE
LEFT OVARY.
Mary T., ret. 34, the mother of eight children, was ad¬
mitted October 19, 1853, with a swelling of the abdomen,
which she said had been attended with most pain on the
right side. The catamenia had been regular ; she had had
no illness. The abdomen was very generally and uni¬
formly distended, and fluctuation was manifest; the reson¬
ance of the bowels always occupying the most prominent
parts of the abdomen when she changed her position.
There was no evidence of disease of the heart or kidneys.
Under the use of diuretics and purgatives the abdomen
was reduced almost to the natural size ; and she left the
hospital, but continued as an out-patient. On the 19th of
October she became again an in-patient, having a ver 7
large abdomen, and suffering from pains therein, and from
vomiting, with constipation. The resonanoe of the bow«»
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The Medical Press and Circular.
HOSPITAL REPORTS.
f September 9,1868. 229
was only to be heard very high up. Still there was no
anasarca, and the urine was free from albumen though
scanty. Paracentesis abdominis was performed, and much
clear limpid fluid withdrawn. She went on pretty well for
some days, until thirst and vomiting came on, and symp¬
toms of some degree of peritonitis. She became low and
depressed, and, in spite of certain favourable changes,
sank, and died December 2nd.
Post-mortem examination .—There was some cedema of
the lungs behind, but the various thoracic organs were
natural. The abdomen contained a large quantity of straw-
coloured fluid, enclosed in spaces formed by fibrinous la-
mime intersecting the peritoneal cavity; so that, in
making a puncture into one of these, the fluid escaped
from that space alone. The parietal peritoneum was lined
by a thick layer of vascular false membrane. The intes¬
tines were contracted, and accumulated into a very small
space in front of the spine. The kidneys were healthy ;
the liver small, with an opaque capsule. A large cyst, of
the size of a foetal head, was connected with the right
ovary, and occupying the pelvic cavity : this was filled
with dark gelatinous fluid and soft vascular solid masses.
Several small cysts were also connected with the other
ovary.
Case VI. —peritonitis. peculiar fetid grumous
FLUID, OF UNCERTAIN ORIGIN, IN THE DEEP CAVITY
OF THE PERITONEUM.
Mary H., set. 45, was admittd July 18, 1858, in a dying
state, and suffering from great tenderness over the whole
of the abdomen and sickness of three days’ standing. The
bowels had been confined, but had operated three days
previously. No hernia could be ascertained to exist. She
died in great suffering a few hours after admission.
Post-mortem examination .—The heart was very flabby,
and a small quantity of atheroma existed on the anterior
flap of the mitral valve. The other thoracic organs were
natural.
The various coils of small intestine and the abdominal
viscera were adherent to each other by recent adhesions,
and the cavity itself (where not obliterated by other ad¬
hesions) was filled with a fetid grumous fluid much resem¬
bling the contents of the small intestine ; and, as the ad¬
hesions in various parts of the cavity were broken down,
this fluid oozed out from circumscribed cavities in the peri¬
toneum, giving, at first sight, the impression that the in¬
testine was perforated. This was, however, not the case,
as the internal surface of the intestine, examined all the
way frojm the stomach to the anus, was nowhere diseased,
though the external surface was covered by lymph and in¬
flamed. The subperitoneal areolar tissue was occupied by
a peculiar deposit, of a strongly fetid odour, and of a gru¬
mous character, the origin and nature of which was un¬
certain.
The stomach and other abdominal mid pelvic organs
were quite healthy.
CA8E VII. —ENORMOUS SOFT ENCEPHALOID TUMOUR,
WEIGHING 30 LBS., CONNECTED WITH THE GREAT OMEN¬
TUM. A FEW NODULES OF THE SAME CONNECTED WITH
THE MESENTERY. OTHER ORGANS NATURAL.
J. B., ajt. 42, was admitted November 22, 1865, having
had “a swelling of the stomach” six weeks. It appeared
that he noticed it first in the region of the ilio-csecal valve;
and that it was attended by vomiting, but was accom¬
panied by some pain ; the bowels having been regular.
On admission, a huge, soft, quaggy, ill-defined, smooth,
superficial tumour, free from pain or tenderness, existed at
the lower part of the abdomen. The urine was natural;
the bowels were opened (the evacuations appearing as if
they had been long retained), and the tumour seemed
smaller afterwards; but they were sluggish, requiring
strong purgatives. The belly became more swelled and
tense, but the general health did not suffer. No fluctua¬
tion was found, but the whole anterior of the abdomen
was dull on percussion (not otherwise, on change of
position), the flanks being resonant. The distension be¬
came much increased by flatulence. On the 25th of January,
vomiting for the first time set in, and continued until
death. Be now began to lose flesh and to become un¬
healthy-looking ; the bowels only acted by enemata. He
sank and died January 28th.
Post-mortem examination .—The thoracic organs were
natural. The abdominal walls were adherent to a large
mass beneath. After the adhesions had been removed
an enormous tumour of soft encephaloid carcinoma was
found occupying the whole front of the belly, extending
from the diaphragm to the pubes. This was connected
with the great omentum, and could be turned out of the
cavity so as to display the viscera behind. The mass was
divided into lobules, so that it had a very close resem¬
blance (in appearance as well as consistency) to the sur¬
face of the brain. It weighed 30 lbs. A few small no¬
dules, varying in size up to that of a walnut, of similar
material, were met with in the mesentery, and attached,
in some parts by pedicles, to various folds of peritoneum.
The other organs were natural
Case VIII.— quantity of a peculiar material, re¬
sembling DEGENERATED FIBRINOUS DEPOSIT, SITU¬
ATED BENEATH THE PERITONEUM, LINING A LARGE
PORTION OF THE ABDOMEN.
Emma F., aet. 35, an intemperate woman, was admitted
January 25, 1866. She had rheumatic fever fourteen
months before, and since that she had been low and weak.
She had been for two weeks suffering from sickness and
dyspepsia, when, during the catamenial period, she was
attacked with cold and was seized with pain in the region
of the uterus ; and, on admission, had much pain in the
lower part of the abdomen, and was constantly retching.
There was much distension and some tenderness of the
abdomen generally. The urine was not albuminous. Her
symptoms were at first relieved by calomel and opium,
and turpentine fomentations. Later on, she had symp¬
toms resembling those of incipient delirum tremens. At
the right side of the navel some kind of substance was
felt within the 'abdomen, which was painful on pressure.
Diarrhoea became very great, and her aspect became jaun¬
diced. She constantly had pains above the pubes ; the
tongue was furred and the pulse weak ; the pupils were
very small ; and she gradually sank and died.
Post-mortem examination .—The lungs were found loaded
with frothy fluid. The heart was natural. On examining
the abdomen, a large quantity of what resembled de¬
colourised fibrin was found lying behind the peritoneum,
extending from the diaphragm to the brim of the pelvis,
lying in front of both kidneys and around the duodenum,
and also to a certain extent penetrating into the mesen¬
tery and being in close relation with every part of the
colon. It was abundant about the pancreas and supra¬
renal capsules, and closely surrounded the large vessels of
the liver and spleen. Here and there, in the immediate
neighbourhood of this deposit, were small circumscribed
pustules below the peritoneum ; one, of small size, lay just
under the mucous membrane of the large bowel. In some
places the above-described material was white, like
mortar; in others, of a reddish or brownish colour.
Microscopically examined, it had all the characters of de¬
generated fibrin, and contained no pus or blood-corpus-
cules. No source of this deposit could be discovered ; no
aneurusm nor disease of the bones of the back or pelvis
existed, and no traces of peritonitis. The liver was soft,
and of a somewhat orange tinge ; the kidneys were
natural,
Case IX.— small hard encephaloid masses sprinkled
OVER LARGE TRACTS OF THE PERITONEUM ONLY ; THE
SAME CONNECTED WITH THE PLEURAL SURFACE OF THE
DIAPHRAGM.
Rose P., set. 55, was admitted March 23, 1863. She
had observed an enlargement in the lower part of the abdo¬
men for three months, which had gradually spread over the
Digitized by v^ooQle
230 The Medical Press and Circular. AILMENTS OF THE BODY CORPORATE.
September 9,1808.
whole body, creating only slight pain, but much uneasi¬
ness and occasional vomiting. On admission, the abdomen
was distended with flatus, and a large mass—without,
however, any distinct edges, and which appeared to belong
to the whole abdominal cavity—was found. No fluid
could be detected; and pressure only occasioned pain down
the right side. The urine was high-coloured, not albu¬
minous; the evacuations from the bowels were natural.
In spite of treatment, she got thinner and more pain came
on; vomiting and tenseness of the abdomen followed, and
she sank, and died April 12th.
Post-mortem examination .—The peritoneal cavity con¬
tained a large amount of clear serous fluid. Scattered
upon the peritoneum, in every part, were numerous white
firm deposits, as large as a pea or mustard-seed, resembling
hard encephaloid carcinoma. These small bodies were
chiefly abundant in the great omentum, and the folds
of peritoneum about the uterus were much thickened by
similar, but softer, deposit. The liver was contracted and
adherent to the diaphragm by adhesions, and on the upper
or pleural surface of the diaphragm were several large de¬
posits of the same kind as that attached to the peritoneum.
A very small growth also was found under the capsule
of one kidney; but none of the viscera contained any.
Microscopically examined, the deposits were found to
consist of small cells, mostly without nuclei; some with a
single one.
Case X. —pulsating tumour in the epigastrium
FORMED BY SCIRRHOUS OF THE PYLORUS OF THE
STOMACH; SCIRRHOUS ALSO OF OTHER PARTS; SCROFU¬
LOUS DEPOSIT AND VOMKLE IN THE LUNGS; EPILEPTIC
ATTACKS.
Elizabeth D., set 46, was admitted February 13, 1847,
with symptoms of disease of the stomach, having pain there
after eating, pyrosis and frequent vomiting, chiefly after
food, but at other times also. For two months she
had perceived a tumour at the epigastric region, which on
her admission was of about the size of a walnut. It was
then quite circumscribed, painful on pressure, and situated
a little above and to the right of the umbilicus. It pul¬
sated as if from transmitted impulse. Shortly after admis¬
sion the patient had an epileptic attack, followed by raving
delirium. Then other convulsive attacks subsequently
occurred, during which the pupils were contracted to the
size of a pin’s head, and again became dilated when the fit
ceased. She became weaker, and died February 18th.
Post-mortem examination .—The tumour of the abdomen
was found to be the pyloric end of the stomach, contracted
and surrounded by scirrhous deposit, which internally was
ulcerated; the omentum adjoining contained similar deposit.
Similar scirrhous tubercles also existed beneath the peri¬
toneum, covering the liver, spleen, and one kidney. In
the substance of one kidney was also a small tumour of the
same nature. Lungs congested and somewhat emphyse¬
matous. One vomica. Brain softened and contained much
serum.
East London Children’s Hospital.—T his thriv¬
ing special institution for children at the East end of London
began its work with eight beds in January last. Within a few
months the number had increased to twenty-six, and the appli¬
cations for admission have shown how much work there is to
be done by the little hospital. We learn from the first annual
report that during the last six months 90 in-patients have been
received, and 2300 out-patients attended to. The free-hold of
the hospital has been generously purchased for £2000 by Mr.
and Mrs. Heckford. The institution had our approval at the
outset of its career, and we can only repeat that it is fully en¬
titled to the support of the public.
As Mr. Hains, Surgeon, of Totnes, was attending
the bedside of a patient at Harberton, the portion of the flooring
on which he was standing suddenly gave way, precipitating
him into the room beneath. Happily, beyond being shaken
and receiving some slight bruises, Mr. Hains was not much
the worse. Mr. is a gentleman of unusual weight and
rotundity.
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 9, 1868.
THE AILMENTS OF THE MEDICAL BODY
CORPORATE.
No. I.
THE MATERIEL OF THE PROFESSION.
In proceeding to ask and answer the categorical enquiry,
“ Is a doctor a gentleman,” as the first stage in our proposed
discussion of the ailments of the Medical Body Corporate,
we aim rather at putting the issue in a decisive than in a
flattering form before the profession; and while we are
glad to believe that the inuendo of our query implies an
unmerited slur on a great proportion of our brotherhood,
we are feign to confess that in the public valuation of the
profession, a sufficiently inferior social estimate attaches to
doctors, viewed in the abstract, to justify us in meeting
the prejudice face to face, and discussing it in a spirit of
belief, and with the hope of thoroughly probing the offen¬
sive cloaca which mar the social health of the profession.
It can hardly’ be said that a profession which for ten
years has paid for, and with still greater self-sacrifice, even
listened to the uninstructive wranglings of the Council of
Medical Reform, is unconscious of its corporate rottenness,
or lethargic over its unfortunate sanitary condition. That
after a ten years’ puzzle of the medical brain over the
medico-educational enigma, the professional body should
not have become thoroughly sick and careless of the sub¬
ject, proves that the condition which has called forth the
debate is thoroughly well recognized, and the attainment
of a remedy foremost in the aspiration of our brethren.
Are we certain that we have not been all along looking
too remotely for the disease and its treatment while its
final cause is right before us ? In discussing the palpable
causes which make a good student into a bad doctor, have
we forgotten to inquire whether the materiel of the stu¬
dent is good, in other words, whether the class from which
the embryo doctor comes is always such as to give a fair
ground for the fructification of the educational seed which is
now credited with the poorness of the harvest ?
We are not as medical journalists charged with the duty
of making things pleasant for the profession, or tickling
the vanity of medical students, either in the raw or finished
form. We do not desire to make ourselves ridiculous, by
pretending to deny that which is patent to all the world,
nor do we think the extra-professional public will think
*
Digitized by v^,oooLe
Tfie Ifedktl trm and Circular.
A FEW WORDS ASOffT FEES.
September 0, 1868. 23
tiie worse of us for calling our faults by their proper names.
The simple fact is that the class from which medical stu¬
dents come is not always such as gentlemen are made of, and
no system of subsequent education however perfect, could
be expected to confer social qualities on the man which
the boy either takes away with him from school, or else never
possesses.
In innumerable instances medical education, with talent
and industry, do everything that can be hoped for; but
they cannot effect that which, for the Profession at large,
is most to be hoped for. They make a skilful Surgeon, an
original-minded and astute Physician, a thoroughly expe¬
rienced and reliable medical attendant; but they always
Util to make a gentleman where the nameless and indefin¬
able combination of gentleness, honour, and fine feeling
embodied in that title does not already exist. The utmost
energies of teachers, students, and examiners can only
bring tiie medical man into professional contact with the
first class of his patients; they can insure to him respect
and confidence as a master in his art, and afford him the
monetary reward ofhis work and labour done, but without the
self-contained qualities which make a gentleman, they never
can raise the doctor to the level of a personal friend, or
confer the influence and social position which the Profes¬
sion at the present day wants more than anything else.
Why is it that the public influences of the Profession as
a body are so painfully insignificant ? Why is our repre¬
sentation in State—honour—emolument, or confidence below
that of any other profession ? Why is it that the Depart¬
mental snub is administered to the doctor with more insolent
disregard ofhis feelings than to any other class of suppliant?
The social status of doctors in the aggregate supply the
answer, and suggest the remedy. If the personel of the
medical man, as it is in too many instances, is but slightly
removed from that of the local druggist; if he estimates
the pecuniary value of his own sendees in greatly
inferior proportion to that of the Church or the
law; if he is not protected from degrading practices
and dirty little meannesses by a proper sense of
self-respect or a painful consciousness of shame, how is it
to be supposed that gentlemen of mind or ladies of good
breeding will disassociate him from the local druggist, or
that governments will open their ears to his complaints as
they do to those of the Church or the law. And experience
corroborates our theoiy, for the branch of the profession
into which gentlemen introduce their sons i3 that portion
of the body corporate whose status protects it from the
social faults of which wo have spoken, and which ac¬
cordingly enjoys all the social equality and all the public
influence which medicine can now boast of.
No doubt the grievance of which we complain repre¬
sents more or less the whole disease of the profession—no
doubt the inferior status of a section of the profession is
the natural result of the cheapening and underselling
system which opens the ranks of our body as a resort
for persons, the deficiencies of whose person and education
render their success elsewhere very doubtful. We are well
aware that the profession cannot be composed solely of
gentlemen as long as licensing corporations are happy to
accept illiterate vulgarians if they cannot get gentlemen,
and five shilling diploma fees if they cannot get guineas.
What we desire to convey by our argument is that in a
social direction much more is wanting to the profession
than mere medico-educational reform, and that, if the
Utopia of educational perfection should ever be reached,
the profession will still have advanced little or nothing in
respect of its status. We do not ask that medical edu¬
cation should be made more expensive, for such a move¬
ment, while it excluded that class who have the greatest
incentive to industry, would admit others, who though
thoroughly competent to pay, would do no social credit
to our body. We demand that the only test within the
power of those who hold the entrance-keys of the profes¬
sion-mental culture by a liberal education—shall be ex¬
acted. If we secure that, the candidates for admission
shall possess such mental acquirements as their
confreres in law and divinity can show. If we make oer-
tain that they shall not openly disgrace the body by cad¬
dishness or palpable ignorance, we shall possess a sufficient
guarantee that the discipline which their minds has
undergone will protect them and us from any practice
which might degrade medical men in the public estimation.
Let us make sure that the doctor shall write and speak the
English language with no fewer H’s than his compeers of
the Church or the law, and shall be as competent as they
are to give expression to his ideas on the ordinary topics of
conversation, and we may rest satisfied that he will be as
readily received into good society as the rector or the
lawyer, and will never depreciate his position by mean or
unworthy practices. When we have demanded and ob¬
tained in the Candidate such attributes, it will be an easy
task even with the multitudinous deficiencies of the teach¬
ing system to make him a competent surgeon or a reliable
physician.
A FEW WORDS ABOUT FEES.
Many of our readers have, doubtless, perused with pleasure
Sir Walter Scott’s inimitable description of Doctor Luke
Lundin, in that admirable novel of 44 The Abbot.”4
The Doctor is depicted as a fussy, empty-headed, good-
for-nothing medicus, whose head was stuffed with Latin
aphorisms and proverbs, but whose skill, when required in
a case of supposed poisoning, was weighed in the balances,
and found wanting.
This doctor found in his day, as many a physician has
found in ours, that however popular the Doctor may be in
time of illness and nature’s extremity, once the patient is
cured and the disagreeable question of fees comes to be
considered, he is straightway voted a bore, and is not rarely
treated with barefaced ingratitude.
In one of Doctor Luke Lundin’s walks he meets some
of his patients, whereon the novelist proceeds thus:—“The
next whom the Doctor deigned to take notice of was a lame
fellow, by whom the honour was altogether undeserved, for
at sight of the mediciner he began to shuiUe away in the
crowd as fast as his infirmities would permit.
“ 1 There is an ungrateful hound for you,’ said Doctor
Lundin; 4 1 cured him of the gout in his feet, and now he
talks of the chargeableness of medicine, and makes the
first use of his restored legs to fly from his physician. His
podagra hath become a chiragra , as honest Martial hath
it—the gout has got into his fingers, and he cannot
draw his purse. Old saying and true— Prctmia cum
poscit Medicus , Sathan est. We are angels when we come
to cure, devils when we ask payment; but I will administe
a purgation to bis purse, I warrant him.’ ”
Need we point the moral ? probably not; for what
medical man engaged in active practice has not found Sir
Walter Scott’s description time to life, and few there
Digitized by
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232 Hm litdlMl Pmm and Circular.
NOTES ON CtJRRENT TOPICS.
September 0,1968.
are who have not experienced in their own persons, at some
time or other, the feelings of the Scottish medicus who
said, in words which ought to pass into a proverb, “We are
angels when we come to cure, devils when we ask payment.”
The best way to meet this spirit, against which we pro¬
test, is to urge our first-class physicians and surgeons to be
clear and distinct in stating and demanding their fees,
letting the old and unsatisfactory plan of “ leaving it all to
yourself” alone. Many do this, and as a necessary conse¬
quence, their services are highly valued, while the services
of their more complacent but less firm brethren are rated
by the public, as they themselves rate them.
A Dublin physician of eminence, not many years ago,
demanded and got his honorarium of two guineas per
visit, no matter how often he went to see the patient. On
its being objected to him that the number of visits made
his fees come high, he replied, “ You do not really require
my services ; there are many younger men who will serve
you as well for less, and if you wish for me, you must have
me on my own terms. If I should visit at a low rate,
what would become of my professional juniors?”
-♦-
pahs on Current Copies.
The Public Health.
The usual periodic return has been issued by the Registrar-
General, and contains the following statistics:—
In the week that ended on Saturday, August 29th, 4730
births, and 3364 deaths, were registered in London and in
thirteen other large towns of the United Kingdom. The
annual rate of mortality was 27 per 1000 persons living.
The annual rate of mortality last week was 23 per 1000 in
London, 24 in Edinburgh, and 28 in Dublin; 19 in Bristol,
30 in Birmingham, 36 in Liverpool, 39 in Manchester, 35
in Salford, 36 in Sheffield, 32 in Bradford, 39 in Leeds, 32
in Hull, 30 in Newcastle-upon-Tyne, and 26 in Glasgow.
In London the births of 1121 boys and 1126 girls, in all
2247 children, were registered in the week. In the cor¬
responding weeks of ten years, 1858-67, the average num¬
ber, corrected for increase of population, is 1993. The
deaths registered in London during the week were 1356.
It was the thirty-fifth week of the year ; and the average
number of deaths for that week is, with a correction for
increase of population, 1318. The deaths in the present
return exceed by 38 the estimated amount, but are less by
72 than the number recorded in the preceding week. The
deaths from zymotic diseases were 432, the corrected aver¬
age number being 462. Seven deaths from small-pox, 21
from measles, 57 from scarlatina, 5 from diphtheria, 24
from whooping-cough, and 51 from fever, were registered.
The mortality from diarrhoea and cholera is decreasing.
Last week the deaths of 174 children and 12 adults from
diarrhoea, and the deaths of 10 children from cholera or
choleraic diarrhoea, were registered. In the two preceding
weeks the deaths from diarrhoea were 245 and 246, and
from cholera 29 and 15. The widow of a sailor died on
August 25th, at 29, Chilton-street, Rotherhithe, at the age
(as stated) of 101 years. The deaths of 2 persons from
intemperance, of 3 persons from delirium tremens, of 8 in¬
fants and 2 adults from syphilis, of 3 persons from bums
or scalds, of 7 persons from drowning, of 2 infants from
suffocation, of six persons who committed suicide, and of 5
persons who were killed by horses or carriages in the streets
were registered.
The City Police (London).
Many hours of the twenty-four are spent by the policeman
on his “ beat,” whatever the peculiarities of the weather—
“ hail, rain, or shine”—hot, mild, or cold—day or night, he
must be there. His periodic exposure to these changes,
and his liability very often to injury and violence might
lead to the expectation that his health would necessarily
suffer, and his life be proportionably short. In former
years there might be some ground for the apprehension,
but since the opening of an hospital especially for the
members of the force, both the mortality and the severity
of sickness among the men has been much less. The
medical officer of the city force, Mr. B. Childs, has sent in
his returns to the police authorities, for the year ending the
23rd June last, which shows to what extent such has been
the case. The city force consists of 697 men, and is distri¬
buted into six divisions. That stationed in Moor-lane was
the healthiest—that in Bishopsgate-street the least so
During the year, 423 were admitted into hospital, five died
and upwards of eleven were constantly on the sick list,
the diseases being those resulting from exposure. Both the
sickness and mortality were found to be less among the
married men than the single. The married men numbered
498 and the single 199. Only one death occurred amongst
the former, while there were four among the latter. So with
admissions to the hospital; the proportions were 469 per
1000 married men, and 934 per 1000 single. A similar
though very slight difference is marked between those on
day and those on night duty. We cannot quote the whole
of Mr. Childs , figures, but it appears from his report that
the state of the force under his charge compares veiy
favourably both with the health of the metropolitan police,
and with that of the troops in the United Kingdom.
A Medical Man Fined.
Under the 23rd and 30th sections of the Vaccination Act
passed in 1867, Dr. David Roberts, of Great Dover-street,
Borough, was summoned by the parish authorities of Cam¬
berwell, for refusing to fill up and sign a certificate of suc¬
cessful vaccination performed by him. The case was heard
at the Southwark Police Court. It appeared that the Regis¬
trar of Births and Deaths wrote to him on his refusal, and
received a reply stating that he (Dr. Roberts) adhered to
his determination not to fill up the certificate, and assign¬
ing as his reason that he was not paid for it. This was his
plea also before the magistrate, to whom he stated that he
vaccinated successfully 600 children in the course of the
year, and it would be hard if his time was to be taken
up without fee or reward.
Mr. Partridge said it was a question of law, and the
defendant did not dispute the facts. He had. refused to fill
up the certificate because he was not paid any remunera¬
tion. After referring to the Act which mentions that no
fee should be taken by the public vaccinator or any medi¬
cal practitioner on giving his certificate, he’ said there was
nothing to show that he had not the remedy of getting his
fee as a private practitioner from the party who employed
him ; but it was clear that he was bound to give his certi¬
ficate to the registrar without fee. The fine, under the
30th section of the Act, was 20s.; but as the defendant
had only come forward to meet the case on those peculiar
grounds, he should mitigate it to 10s. and costs.
Dr. Roberts asked his worship to grant him a case for
the Court of Queen’s Bench, as it was most important to
the medical profession.
Digitized by v^ooole
The IbdieallfaeM and Circular.
NOTES ON CURRENT TOPICS.
September 9, 1868. 23ft
Mr. Partridge declined to do so, and told Dr. Roberts
that if he thought proper he might apply to the Court of
Queen's Bench himself.
Over-Laying and Death Certificates.
An inquest held last week on the bodies of two infants,
gives us a double text—public and professional—for the
discussion of the matter.. The mothers of the two little
victims excused themselves for the deaths of their children
on the ground that they were accidentally suffocated
by lying on them, and in the same breath they confessed
that they had insured the lives, or rather the deaths,
of the infants a short time before. The only evidence
besides the statement of the mothers themselves, was
the certificate of a surgeon who had never seen either
body after death, and yet legally declared that they died
of suffocation. The mothers were dismissed to the
enjoyment of their gains by the death of the babies,
and the surgeon was severely taken to task by the
Coroner for certifying that of which he knew nothing.
Medical Capacity for Coronerships.
Dr. Lankester, the coroner for Central Middlesex, has,
in the discussion of Dr. Tindal Robertson's late paper at
the meeting of the Association, debated the special quali¬
fications of the doctor for the office of coroner in a tone
which, though by no means enthusiastic as regards the
claims of the profession, is impartial and argumentative.
He considers that a medical practitioner is, by his habit of
deduction from theory as much as from fact, rather the
worse than the better as an investigator of simple occur¬
rences, and he declares that the medical man owes his supe¬
riority to his study of the natural sciences. This we believe
to be an accurate enunciation of the doctors special qualifi¬
cation, and one which ought not to be overlooked by the
public. A medical coroner is an embodiment, in cases in
which it is considered unnecessary to hold post-mortem
investigations, of the judge and the expert. He is in
the position which no lawyer can enjoy, of checking each
enquiry by his medico-legal knowledge, and under his
supervision it becomes improbable that in any case what¬
ever, suspicious circumstances and pathological appear¬
ances could be overlooked. Thus, the public has an extra
guarantee for the reliability of a medical coroner's enquiry,
which they cannot have at the hands of any other func¬
tionary, however astute he may be.
The Medical Act against Quacks.
At last it would appear that the powers of the Medical
Act against quacks are discovered to be sufficient for
their object, and the action of the profession which was
discouraged in the first instance by some very paradoxical
legal judgments, is beingrevived against illegal practitioners.
A druggist in Wales has been successfully prosecuted by
the North Wales Registration Society, for using the title
of Surgeon in a death certificate. The culprit endeavoured
to save himself by attaching the letters n. r. to his
falsely claimed qualification, which he explained to mean
“ not registered.” The fraud was too manifest for such a
ridiculous defence, and the practising druggist has had the
option of paying .£10 or going to prison for a fortnight. The
judgment of a member of the English Bench to the effect
that the use of any title was not illegal so long as the cul¬
prit did not represent himself to be registered—a decision
which has mainly deterred the profession from availing
themselves of the provisions of the Act—would thus appear
to be incorrect, as it is manifestly at variance with the
spirit of the law. It is justly held that a person who uses
the title of a medical qualification, thereby implies that he
is or might be registered for it, and he should be punished
accordingly.
It is satisfactory to find that justice seems likely to over¬
come the ridiculous legal quiddits which have hitherto
rendered the Medical Act nugatory.
Qualification of Medical Assistants.
The Privy Council has had before it a series of new re¬
gulations for the examination of assistants, framed in ac¬
cordance with the recent Pharmacy Act. We understand
that the proposed examination combines Materia Medica,
Pharmacy, Translation of Prescriptions, and the details of
ordinary Dispensing Manipulation. The Materia Medica
test will be principally on the identification of chemicals
and pharmaceutical agents, both in the officinal condition
and in the plant itself, and to pronounce on the quality
and adulteration of each article, the candidates will be re¬
quired to recognise the manufactured preparations, such as
tinctures, infusions, and extracts, and to know the relative
proportions of the various ingredients. Their capacity for
the manipulation part of their duty wiU be tested by
requiring them to translate prescriptions, to point out
excessive or insufficient doses in faulty trial prescriptions,
and to weigh, make up, and turn out neatly given prescrip¬
tions.
Scottish Longevity.
Whether from their occupations, the strength of their
constitution, their climate, their diet; whether from all
these combined, or from some other hidden and mysterious
agency, the Scotch can boast of far more instances of
longevity than occur in any other equal portion of the
population in the United Kingdom, the returns recently
issued by the Registrar-General for Scotland for the ten
years 1855-64 show that in that country as many as 6910
of the 651,295 deaths in those ten years were of persons
above 90 years of age. The mean population of the period
is estimated at not quite 3,050,000. The following notes
from Scottish local registrars' returns for the second or
spring quarter of 1868, just published, are remarkable :—*
Stromness, Orkney.—Of the nine deaths registered in the
quarter, two were of persons aged 94. Watten, Caith¬
ness.—Of the nine deaths, six were of persons above 70 $
the average age of the six was 80 years. Gairloch, Ross.—
Of the 15 deaths in the southern district, eight were of per¬
sons above 70, their ages averaging 81. Stornoway.—Of
the 37 deaths, 13 were of persons above 70 ; one was 100.
Rafford, Elgin.—Of the three deaths, two were of persons
aged 84 and 86. Huntly, Aberdeen.—Of the deaths, eight
were of persons above 70, their average being 77. Blan-
chory-Devenick, Kincardine.—Of the eight deaths, four
were of old persons whose ages averaged 78 years. Largo,
Fife.—Of the eight deaths, five were of persons aged 78,
82, 83, 84, 85. Kilmore and Kilbride, Argyll.—Of the 19
deaths, nine were of persons above 70. Portobello.—Of
the 30 deaths, seven were of persons above 70. Mid-
Calder, Edinburgh, population about 1400.—Only two
deaths, one of a person of 85 and one of 89. Dunscore,
Dumfries.—Of the nine deaths, five were of old people
whose united ages amounted to 387 years. Kirkcowan,
Wigtown.—Of the eight deaths recorded, six were of per-
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234 The Medical Press and Circular.
McDONNELL’S LECTURE.
September 6, 1606.
sons who had reached the respective ages of 68, 76, 79,82,
84, 86 years. At Girvan, Ayrshire, a death at 101 was
registered in the quarter ; at Inverallan, Inverness, the
death of a woman of 103 ; at Abbey, Renfrew, the death
of a very old Highland woman, said to be 109.
Professional Appeal.
We deeply regret that adverse circumstances, arising out
of illness, make it necessary to appeal in our advertising
columns to our brethren on behalf of a well-known and
highly esteemed member of the profession in Dublin. We
beg to refer our readers to that appeal, which we are con¬
fident will not be made in vain. The res angusta domi is
a possibility in every case, and a fact in many ; but we
can say of our brother in this instance—“ In prosperis
magnu8, in advcrsis major”
Antoine Clot-Bey, an eminent physician, died lately at
Marseilles, aged 73. He was induced to visit Egypt many
years ago by an agent of Mehemet-Ali, for the purpose of
organizing some medical establishments there. He also
founded a medical school at Alexandria, and was chief
agent in the erection of Abou-Zabel’s Hospital, twelve
miles from Cairo. He received the title of Bey from the
Egyptian Government, and by that of France he was made
a Commander of the Legion of Honour.
Dr. Samuel Fenwick and Mr. J. E. Adams have been
appointed Assistant-Physician and Assistant-Surgeon to
the London Hospital.
-♦-
LECTURES ON VENEREAL DISEASES
DELIVERED IN
DR. STEEVENS’ HOSPITAL.
LECTURE IV.
By ROBERT McDONNELL, M.D., F.R.S.,
ONB OB THB 8UBQKOB8 TO BTKEVEK8* HOSPITAL.
Gentlemen, —I do not mean to trouble you with any very
lengthened observations on the treatment of syphilis. I
have already said that the details of treatment must be
pointed out at the bed-side, yet I feel that my lectures
would very incompletely answer the purpose for which they
were intended if I did not briefly touch on some points
connected with the therapeutics of syphilis.
As students of the Irish School of Medicine you may
look, gentlemen, with very just pride to what has been
done in this department by practitioners of Dublin. To
Wallace we owe the introduction of iodide of potassium
as an anti-syphilitic agent—an agent now universally ad¬
mitted to be one of the most potent weapons which human
skill can wield against this disease in many of its forms ;
to Carmichael we are indebted for having led the van in
opposition to that free and reckless use of mercurials,
which has done, and indeed still does so much mischief.
He may almost be said to have inaugurated the all-impor¬
tant scientific study of the natural history of syphilis ;
while Colles, Abraham Colles (whose memory is so highly
revered within the walls of this great hospital), has, in his
work on “Venereal Diseases and the Use of Mercury,” given
the most masterly sketch with wliich I am acquainted as
to how we should handle the claymore against syphilis,
should it become necessary to draw it from its scabbard.
I shall speak now of the treatment of syphilis, first, as
regards measures of simple hygiene, and next as regards
that method which is generally spoken of as specific treat¬
ment.
Let me, however, before entering on these topics, lay
before you some of the conclusions lately arrived at on the
subject of syphilisation.
In the last volume of the “ Transactions of the Medico-
Chirurgical Society of London” you will find a very valu¬
able contribution to our knowledge on this subject by
Messrs. Lane and Gascoyen, surgeons to the London Lock
Hospital. These gentlemen give a report of cases treated
by syphilisation, or the repeated inoculation of syphilitic
matter in persons already the subject of constitutional dis¬
ease. It is true their own opinions do not agree as to the
curative influence of syphilisation; the facts, however,
which they record are not the less interesting and instruct¬
ing.
Syphilisation .—This peculiar method of treatment ori¬
ginated with M. Auzias-Turenne about 1845 ; owing to
the opposition of the French Academy of Medicine, it can
scarcely be said to have been tested in France, except by
the late M. Melchior Robert of Marseilles. M. Sperino*
of Turin, tried it in a considerable number of cases. Pro¬
fessor Boeck, of Christiania, however, is at this moment the
champion of syphilisation; he has developed the system
on a large scale, and the publications of himself and his
pupil, Dr. Bidenkap, have revived the interest in this sub¬
ject.
The strange idea of curing syphilis by repeated svphi-
litic inoculations had its birth in France. It toot its
origin in this way—M. Auzias-Turenne, when studying
the^effects of syphilitic virus upon animals, perceived that
after a certain number of inoculations, the inoculated animal
gained a power of resisting the chancrous virus. To their
immunity from the disease thus established, or rather to
the peculiar modification of the organism thus induced,
Auzias-Turenne gave the name of syphilisation. In
November, 1850, he announced the result to the Academie
des Sciences. He naturally conceived that it would not be
impossible to reproduce in man the effects which he had
observed on the lower animals ; some patients voluntarily
submitted themselves to his inoculations ; in these cases a
complete immunity was obtained ; and so the ideas of
Auzias-Turenne became admitted within the domain of
therapeutics.
The practice of syphilisation evoked extreme hostility in
England, in fact it was never fairly tried until undertaken
by Messrs Lane and Gascoyen, who commenced their series
of observations under the direction of Dr. Boeck himself
These gentlemen pursued the method recommended hy
Dr. Boeck, which is as follows :—At the commencement
three punctures are made on each side of the chest, and matter
is inserted derived either from a person who has a primary
syphilitic ulcer or from the artificial sores of a patient who
is undergoing syphilisation. After an interval of three
days, if the punctures have developed pustules, three other
inoculations are made from them in the same region of the
body, and this process is repeated so long as pustules are
produced ; the inoculations being made at intervals of
three days, and the matter being always taken from the
last-formed pustules. When at length these are not inocu-
lable, fresh matter is employed, and the above process is
repeated until a positive result can no longer be obtained on
the trunk. The same practice is then commenced on thearms
and continued there until the punctures fail, when a similar
process is pursued on the thighs until no more pustules result,
and a condition of immunity, more or less perfect, is arrived
at. In the ordinary run of cases this occurs in from three to
four months.
The average peri oil during which Messrs. Lane
and Gascoyen’s cases were imder treatment in hospi¬
tal, was five months and sixteen days. The average num¬
ber of inoculations practised in each case was 259, of which
145 produced chancres, and 114 were sterile. A method
of treatment which entails the production of some
150 chancres over the body can never, I think, be *
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The Medioal Press and Circular.
MCDONNELL’S LECTURE.
Septembers, 1868. 235
popular mode of treating syphilis. From a very careful
perusal of the valuable memoir of Messrs. Lane and Gas-
coyen, I most fully concur in the justice of the conclusion
at which they arrive as to the therapeutic value of syphil¬
isation. “ Differing,” they say, “ as we do on tbe scientific
aspect of the question, we are entirely in accord as to its
practical bearings, and we are decidedly of opinion that
syphilisation is not a treatment which can be recommended
for adoption. We consider that even if it could be ad¬
mitted to possess all the advantages claimed for it by its
advocates over other modes of treatment, or in many in¬
stances over no treatment at all, it would not sufficiently
compensate for its tediousness, its painfulness, and the life¬
long marking which it entails upon the patient.”
Has syphilisation any curative effect whatever ? It seems
strange, indeed, that at this period of the world’s history
we should not be able at once, and with certainty, to
answer this question. Yet, to our shame be it confessed,
we cannot. We do not as yet know enough about the
simple and undisturbed progress of syphilis to say whether
fifty cases of the complaint, with no other treatment than
the dietary, rest, regular hours, &c., of an hospital, would
take longer to get well than fifty similar cases submitted
to syphilisation. Mr. Lane believes that it dots exercise
some beneficial and specific influence over the progress of
the disease. Mr. Gascoyen, on the other hand, thinks that
the natural tendency to recovery, which an early and un¬
complicated constitutional syphilis exhibits with the lapse
of time, and under circumstances favourable to the gene¬
ral habit, is sufficient to account for the subsidence of the
secondary symptoms dining syphilisation. It is gratifying
to find so competent an authority as Mr. Gascoyen so
deeply imbued with the belief that “ an early and uncom¬
plicated syphilis” has so great a natural tendency to re¬
covery. For my part I should certainly agree with him.
If the possibility of the spontaneous cure of syphilis be
no longer contested, from that moment it becomes difficult,
if not impossible, to assign its true therapeutic value to
any mode of treatment—syphilisation among the rest. In
order to determine whether the cases of cure attributed to
syphilisation are not in reality due to the natural progress
of the malady, there must be some definite standard of
comparison. Hence, the extreme value of cases carefully
noted and accurately observed for years, and which have
undergone no other than treatment by hygienic measures.
Prophylaxis and Hygiene of Syphilis .—The prevention
of syphilis, or at least the attempt to check its ravages, is
one of the greatest objects connected with State medicine.
The rude machinery for this purpose adopted in Great
Britath has until quite recently contrasted most unfavour¬
ably with the schemes of our continental neighbours.
The Englishman’s respect for personal liberty, as well as
a sort of moral instinct which made him unwilling to
handle an unclean thing, caused us as a nation to shrink
from legislation on such a subject as the control of prosti¬
tution. Our soldiers, our naval and mercantile marine,
and of course the public, have in consequence suffered to
an extent quite incredible. We are, however, commencing
a better system. Of this aspect of the prophylaxis of
syphilis I do not speak at present.
Various plans have been devised in order to prevent the
occurrence of venereal disease in an individual after a sus¬
picious connection. These may almost all be summed up
m a few words:—strict attention to cleanliness, thorough
washing. There can be little doubt that proper attention
to this simple preventive measure would greatly lessen the
evils arising from venereal disease of different kinds. A
number of practitioners have recommended various lotions
with the design of adding to the wash such ingredients as
may destroy any venereal virus lurking in the folds, or
coming in contact with slight fissures or excoriations around
the corona or about the frenum. Lotions containing acids,
alkalies, alcohol, wine, sulphate of zinc, lead, &c., have
been thus ordered. Langlebert recommends a mixture of
soft soap, potass, and alcohol. Rodet of Lyons, a lotion
somewhat more caustic, viz.:—
R Ferri perchloridi liquoris fortioris.
Acidi hydrochlorici.
Acidi citrici aa. 3iv.
Aquae distillatse fll. Jiv.
M. Fiat lotio.
How long after contamination the use of such appliances
may serve to neutralize a poison remains doubtful. All
we can say for certain is that the sooner any poison is
washed away or destroyed the better.
When it is once admitted that syphilis is a true toxae-
mic disease, that it is a malady in fact depending upon the
admission into the system of a poison, which, under favour¬
able circumstances, is capable of spontaneous elimination,
then it follows that hygienic measures must play a capital
part in its treatment. If, as I have said in a former lec¬
ture, a struggle is going on between the constitution of the
patient and a disease which has made an inroad into his
system, it is of course of prime consequence that the con¬
stitution should be well backed up in the conflict.
To maintain the general health, to uphold the natural
vigour of the constitution, to keep the powers of the
organism up to that level which is best adapted to accom¬
plish the elimination of the virus—this is the object of the
hygienic treatment. When to this we add the use of those
simple medicaments which, acting on the skin, bowels, and
kidneys, tend to keep their functions in healthy play, yet
are not supposed to exercise any specific action, we then
have that plan of treatment which has been called the
rational or methodic treatment of syphilis.
As regards diet the syphilitic patient should, as a rule,
live generously. He should live on simple and nutritious
food, taking as much as his appetite indicates to be suf¬
ficient—neither weakening his frame by taking less, nor
striving to take more than his stomach can readily deal
with. In prescribing a dietary attention should always be
paid to the patient’s usual mode of living ; yet, believe me,
you will generally find it necessary to insist on your
syphilitic patients living tolerably well, many of them are
so imbued with tbe idea that abstinence is necessary for
their cure.
Next, probably, in importance to diet is good air, awell-
ventilatea sleeping apartment free from damp. The damp
and crowded dwellings of the poor exercise a most bane¬
ful influence over the complaint.
Let your patient have seven or eight hours sleep of a
night; let him give up theatres, balls, card and supper
parties ; let him have such moderate exercise every day
that, without being exhausted or absolutely fatigued, he
may be well satisfied to go to bed each night at ten o’clock.
If you have influence enough over your patient to induce
him to adhere to such directions; to shun those selfish in¬
dulgences which tend to debilitate the frame; and if he
has youth and a tolerably good constitution on his side,
you may look forward to his case running its course
favourably as one of “ v^role faible.”
If he is one of a delicate family, of a scrofulous or
gouty diathesis—then it is all the more necessary for him
to leave nothing undone to keep up his general health.
But if, on the other hand, you nave a patient to deal
with who will not forego his selfish pleasures; who haunts
the tavern and the billiard-room, smoking and drinking,
breathing foul air vitiated by gas and reeking with tobacco-
smoke, during the hours which he should give to repose,
let him expect that to him syphilis will come in “ all her
Gorgon-terrors clad.”
As adjuncts to hygiene, such simple medications as cod
liver oil, chalybeate tonics, and warm baths play an impor¬
tant part. The first is specially indicated when any stru¬
mous tendency exists; the second class of remedies, useful
through the whole course of the disease, is particularly
called for during those periods of syphilitic chlorosis
(chloro-ansemia), so usually the forerunner of an outburst
of eruption. Warm baths or vapour baths are the most
effective means of keeping the skm in action. Medicated
baths of various kinds are eminently useful; baths corre¬
sponding with those of the bromated and iodated waters
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236 The Medical Preis and Circular.
McDONNELI/S LECTURE,
September 9,1888.
of Kreuznach, the waters of Schlangenbad, Harrogate,
Bareges, can be readily obtained in all our cities.
Tonic and exciting medicated baths are of great service
in syphilitic as well as other affections of the skin; baths
containing iodide or sulphuret of potassium, or arseniate of
soda are eminently useful in the anaemia, chlorosis, or rheu¬
matism connected with syphilis.
Dr. NoeTGudneau de Mussy recommends three and a-
half ounces of subcarbonate of soda, with twenty grains of
the arseniate, in a bath. No unprejudiced practitioner
will deny the benefit of the Turkish and Russian baths.
We have no means of inducing diaphoresis comparable to
these.
Such a bath as the following:—
R Ferri sulphatis,
Sodae sulphatis, £vi. M.
Dissolve in thirty gallons of soft water at 98° Fahrenheit
for a bath—can be readily obtained even at the patient’s
home; and thus the advantage of the chalybeate and the
bath combined.
The bowels should be kept in action once or twice every
day : for this purpose, nothing answers better than some
of the sulphurous mineral waters made artificially; those of
Bagnfcres-du-Luchon, of Bareges, of Aix les Bains, in
Savoy, of Aix-la-Chapelle, have gained a well-deserved
reputation. The waters of Kreuznach are greatly praised
against the intractable combination of syphilis and scrofula.
I very commonly order the following imitation of the
Harrogate sulphur water—
R Sulphatis potass®, cum. sulphure, 3iv.
Bitart, potass®, Jij.
Sulphatis raagnesi®, Jiij.
M. Fiat pulvis.
one teaspoonful of this powder to be taken in a tumbler of
water every morning, or every second morning upon first
getting up. The dose should be increased or diminished
according to its effects. The patient should take a short
walk before breakfast, and by increasing the quantity of
fluid which he consumes daily, he should keep the kidneys
in good action.
Syphilitic patients are themselves sometimes aware of a
peculiar, faint, yet disagreeable, odour emitted from the
urine ; this is observed at intervals, and after each has
passed away the patient finds himself better. It seems to re¬
semble the odour which patients labouring under ague
know as indicating the approach of an attack of fever; and
certainly points to the necessity of keeping these organs in
good working order.
Some patients object to the large quantity of liquid
necessarily taken in consuming mineral waters, and
although this is one of the great advantages attending
their use, you may have to direct something else ; equal
parts of syrup of senna and fluid extract of sarsaparilla : a
teaspoonful once or twice a-day in half a cup of hot water,
acts well as an aperient, and suits those persons, not a few,
who still retain an unbounded faith in sarsaparilla.
Chlorate of potash used internally, as well as a gargle
and mouth wasn, is a great favourite with some. For the
slighter forms of sore throat, I often order the follow¬
ing
R Potass# chloratis, 3ii.
Mellis ft.
Aqu« 3xi., M.
to be used as a gargle several times a day, and one ounce
to be swallowed three times a day.
The doses ordered to be taken internally should be swal¬
lowed slowly, in fact, taken in sips, so as to be brought
well in contact, in the act of swallowing, with those parts
of throat and -fauces not reached in gargling.
The importance of the local treatment of all kinds of
venereal sores, whether primary, secondary, or tertiary,
cannot be over-rated. You have seen abundant proof of
this in the terrible case of rupia, lately in No. 9 ward.
The ulcers were so extensive that it was impossible to deal
with all at the same time. You saw those which were
touched with nitric acid, and afterwards dressed for some
days with creosote ointment, healed rapidly, far out*
stripping those less energetically treated.
You have often seen the almost magical effect of a large
blister upon the hideous lupoid ulcerations of tertiaty
syphilis. I have seen some cases in which the local action of
an accidental attack of erysipelas has entirely altered the
appearance of the ulcer and brought about rapid cicatriza¬
tion.
In short, whether in the genitals, the mouth and fauces,
or the skin, the local applications to venereal affections,
forms a chief part of the therapeutics of syphilis. Pro¬
hibit tobacco-smoking, and the source of irritation once
removed, “ mucous patches” and ulcerations on the tongue,
&c., for a long time recurring, will get well. Wash the
surface, attend to cleanliness, and simply dust the part
over with finely powdered starch, and you will quickly get
rid of troublesome condylomata. Learn to overcome the
more frequent and troublesome symptoms of syphilis, let
your patient know that in the natural course of things he
must expect recurrences ; do not make promises that re¬
lapses are at an end : by so doing you are pretty certain
to get a disappointment, and to lose the confidence of your
patient, and that equally whether you adopt a specific
treatment or not.
The beneficial action of iodine in the treatment of
syphilis is beyond doubt; in some eruptions, in severe
syphilitic rheumatism and most forms of tertiary syphilis,
its efficacy is unquestioned. In 1831, Lugol published
his observations on tertiary symptoms cured by iodides
without the combined use of mercurials. This led the
way to what must be considered the greatest discovery in
syphilitic therapeutics of modern times—namely, the in¬
troduction of iodide of potassium as a remedy against
syphilis. I have already said that it is to Wallace of this
city that mankind is indebted for this boon.
I am glad to find that Lancereaux, one of the most
learned and accomplished writers who has treated of the
subject ofsyphilis, gives, in his exhaustive work, full credit
to Wallace for being the first to introduce in practice this
agent.
Lancereaux says :—“ Wallace, of Dublin, has the merit
of having first employed iodide of potassium, of having
fixed the doses of it, specified the indications for its use,
and thereby of having definitely introduced the iodide into
the therapeutics of syphilis, placing this medicament
almost upon the same level with mercury. He commenced
his experiments in 1832, and gave the results four years
later in the form of four lectures. 1
“ One hundred and thirty-nine patients were observed, of
whom six were affected with iritis, six with affections of
the testicle, ten with divers diseases of the bones and arti¬
culations, ninety-seven with syphilitic skin affections,
twenty with lesions of the mucous membrane of the mouth,
nose, and throat ; finally, three pregnant women were also
submitted to the same treatment with the olriect of pre¬
serving the foetus from syphilitic infection. The prepara¬
tion employed mistura hyariodatis potassre (as it was then
called), contained £ij. of iodide of potassium in JviiL of
distilled water. Adults took half an ounce of this mix¬
ture four times a-day—that is to say, thirty grains of the
iodide per diem.” Lancereaux adds, “ The happy effects
of this remedy are so generally recognised, that we cannot
refuse to it, in the present day, a place alongside of mer¬
cury itself.”
Wallace’s success soon attracted the attention of other
physicians. In England, Judd, Savile, Winslow, Wil¬
liams ; in France, Trousseau, Ricord, Gauthier ; in Italy#
Brera, Sperino, Pellizzari; in Germany, Guzman made
trial of it and proved its good effects.
The acute observation of the illustrious Ricord soon de¬
tected that it is an agent which exercises more influence
over tertiary than secondary symptoms. The deeper
affections of the skin and mucous membranes, the gummy
tumours of the cellular tissue, the lesions of the bones—
such are the conditions which yield most readily t o the use
1 Bee Lancet, March, 1886. ~
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The Medical Pre* and CIrcalar.
JACKSON ON LANGUAGE.
September 0,1868. 237
of iodide of potassium. It has been likewise recognised
that it may advantageously be employed even in larger
doses than those at first recommended by Wallace ; by de¬
grees it may be increased from 15 grains to one drachm or
even more daily.
You have lately seen in No. 8 Ward a remarkable in¬
stance of the efficiency of this medicine in the case of a
woman named Looney suffering from nodes and very dis¬
tracting osteocopic pains. She was ordered 10 grains three
times a-day, but by mistake took double that dose, taking
60 grains in the day; she was relieved almost as by
magic.
Although less prompt in its action, you saw the large
nodes on the forehead of Williams in No. 2 Ward gradually
vanish under its use. Wallace made some amends for the
grievous offence he was guilty of in inoculating healthy
subjects with the poison of syphilis.
(To be continued.)
-♦-
[Abstract of a Paper read before the British Association for the
Advancement of Science, at the meeting at Norwich,
August, 1868.]
THE PHYSIOLOGY OF LANGUAGE.
By J. HUGHLINGS JACKSON, M.D., F.R.C.P.
Defects of language nearly always occur with a certain
form of paralysis on one side, called hemiplegia, and the
right is usually the side paralysed.
Hemiplegia is paralysis of those muscles which can move
independently of those of the other side— i.e., of certain
muscles of the face, tongue, arm, and leg; not of the muscles
which act bilaterally. Or, in technical terms—
It is a paralysis of the muscles engaged in chief volun¬
tary operations. The bilateral muscles used in all (physi¬
cally) involuntary, semi-involuntary, reflex, automatic, &c.,
processes escape.*
This kind of paralysis depends on damage to the very
highest parts of the motor tract —viz., the corpus striatum,
or thalamus opticus (in cases complicated with defects of
language usually, probably always, the corpus striatum).
In other words it shows loss of function of a motor centre,
which is embedded in the cerebral hemisphere; or, to speak
metaphorically, which lies close upon mind. In loose lan¬
guage, the corpus striatum is the “ way out” from the chief
organ of mind—through series of centres—to muscles
which serve in intellectual and voluntary actions.
Damage to the hemisphere near the corpus striatum pro¬
duces those defects which have been called aphasia, alalia,
aphemia, aphrasia, asphrasia, aphthenxis, defects of intel¬
lectual language, cerebral loss of speech, &c.
TWO KINDS OF LANGUAGE.
Healthy language is of two inseparable yet distinct
forms:
I. Intellectual— i.e.> the power to convey propositions.
II. Emotional—i.e., the ability to exhibit states of
feeling.
The two are separated by disease. It is intellectual
language alone which suffers in most of the cases to be
described. Emotional language usually escapes altogether.
Intellectual language suffers throughout— not only in its
most striking manifestation in (a) words, but in ( 6 ) writ¬
ing, and (c) sign-making.
It is the power of intellectual expression by “ move¬
ments” of any kind which is impaired—those most special,
as of speech, suffering most; those of simple sign-making
least, or not at all.
1 It in pointed ont later in the paper that the fact that the unilateral
muaclee of one aide only suffer when part of one of the corpora striata
is destroyed, does not imply that the bilateral muscles (or the centre or
centres for rudimentary bilateral) movements are not represented in
the corp or a striata.—This is an exposition of Broadbent’s hypothesis.
“ An Attempt to remove the Difficulties attending the Application of
Dr. Oarpenter’s Theory of the Function of the Sensori-motor Ganglia
to the form of Hemiplegia.” By W. H. Broodbent, M.D.
Med. Ckir. 1ieview, April, 1866.
Emotional language is conserved throughout , not only
in its most striking manifestation, by (a) variations of
voice, but in (6) smiles, &e.; and in its most simple mani¬
festation by (c) gesticulation.
Althougn thus circumscribed by the term defects of
intellectual language, there are within this limit many
varieties of defects met with in actual experience.
It is easiest to say what they are not.
1. They are not defects of voice .—The patient who cannot
say anything will vary the tone of his stock phrase or
jargon and may be able to sing.
2. They are not defects due to mere paralysis of the tongue
and other articulatory muscles .—Nevertheless the defect
may be when most rudimentary a disorder of articulation
(Ataxy); but this differs very widely from paralytic arti¬
culation.
The tongue is not paralysed even when the patient may
not be able to put it out voluntarily.
3. They are not owing to any fault in the outward
organs of reception .—The patients are not deaf mutes.
Speech has been lost suddenly after being fully acquired.
THE SPECIAL NATURE OF THE DEFECTS OF INTEL¬
LECTUAL LANGUAGE.
The author arranges the cases he has to mention for con¬
venience of exposition in two classes. In the first class
the author supposes that the sensori-motor processes for
speech are more or less destroyed; in the second that they
are unstable.
Class I.—Severe cases in which the patient is speechless
or nearly so, or in which speech is very much damaged.
In the worst of these eases the patient can only utter some
one unvarying word or two words, or some jargon.
He relates several cases varying in severity. In these
cases power to read write and make simple signs is im¬
paired, but the facts bearing on reading, writing, and
sign-making in the cases related will be more conveniently
considered after Class II.
Class II.—Cases in which there are plentiful movements
but wrong movements, or plenty of words but mistakes in
words.
Under Class II. he points out that taking the phenomena
of many cases, we. find evidences of damage to sensori¬
motor processes, higher or lower in evolution according to
(a) Complexity of movements, (b) Width of interrelation,
(c) Number of associations from ataxy of the grosser
movements of articulation to an “ ataxy” of movements
embodying ideas. He is obliged, however, to speak of
sounds, taking it for granted that in the following pheno¬
mena (1), (2), (3), &c., the disorder is of evolutions of
movement and sensation in the triply-compound ascent
just mentioned.
1 . Ataxy of articulation—often an unintelligible gabble.
2 . Alterations of words, as “ sift for “ stiff.”
3. Alterations of syllables, as “ gippin” for " pigeon.”
4. Mistakes in words—recognisable symbols— (a) Re¬
lated more or less in general idea, as “ dinner” for “ break¬
fast,” “ smell” for ‘‘taste.” (b) Related hi sound, as
“ Dustman” for “ Busman.” (c) No traceable relation, os
“ Where is the wind ? ” for “ Where is the ink ?”
5. Mistakes in compound symbols, (a) Related clearly
in idea—“What am I to say it is o’clock ?” for “What
day of the month am I to put down ? ” or ( 6 ) obscurely
related, as “ When the warm water comes all the weather
will go away ! ” for “ When the sun comes out all the fog
will go awayi”
When the defect is of processes so high in complexity,
(interrelation and association) there is usually a traceable
similarity, although it may be vague and deformed, betwixt
the phrase used and the one intended.
6 . Probably such defects as the following are of pro¬
cesses higher still, “ Light the fire up there” for “ Light the
gas.”
He then considers very generally, and with regard to all
varieties of cases, the defects in complimentary modes of in¬
tercommunication which accompany defects of speech, and
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JACKSON ON LANGUAGE.
September 9, 1868.
takes the opportunity of considering a question asked,
u What is the degree of intelligence these patients have ? ”
He expressly guards himself against any implication that
language and thought exist separately. The question is
not How is general mind damaged ? but What aspect of
mind is damaged ?
He considers the mental condition of patients Classes I.
and II. as regards—(a) Sign-making—simple. ( 6 ) Writ¬
ing. (c) Ability to understand what is said to them, (d)
Ability to repeat words said to them. («) Reading, (f )
Ability to play games. ( g ) Counting, (h) Music.
(a) Sign-making is least affected, sometimes seeming to
escape altogether. He urges that we should distinguish
in degree betwixt power to make simple signs which idiots
can make, and the elaborate signs—saying nothing of
finger language—which people make who are healthy, ex¬
cept for congenital deafness, and that we should observe if
the patients can make signs to signify abstract quality as
“ blackness.”
(b) Writing. This suffers more or less in nearly every
case of defect of speech from disease of the hemisphere,
but varies as muen as the defect of speech itself does.
Indeed, writing, and we may add reading, is the same de¬
fect in another form. For in each we have to reproduce
the motor symbols of the words. Written or printed sym¬
bols are symbols of symbols .
The patient may (1) not write at all; may (2) scrawl;
(3) make pothooks; (4) write bits of words; (5) may write
plenty of words, but omit words and spell badly.
The patient who cannot write can usually copy writing
correctly.
Patients can often sign their own names without copy
when they cannot or will not write anything else.
(c) Do the patients know what is said to them ?
It is usually held that “aphasic persons” do. The
author thinks they usually do when they are speechless
except for some unvarying jargon, t.e., cases in Class I.,
but that when—cases m Class II.—they have free but dis¬
orderly utterance so high as mistakes in words they often
do not understand, i.e ., quickly understand words said to
them ?
&
Can the patients repeat words said to them ?
they cannot in Class I.; in Class II. they can, with or
without blunders.
The author supposes the reason in (c) and (d) to be :
That in Class I., the sensori-motor arrangements for
speech are destroyed in their lowest processes by limited
disease near to, aDd involving .the corpus-striatum. The
sensory aspect of the sensori-motor processes of mind is
not reached. It is the “ way out ” which is broken up.
That in Class II., the sensori-motor processes are im¬
paired but not destroyed, and that the change is not
limited to the region of the corpus-striatum, but reaches
deeper in brain.
(t) They cannot read, but they can—often at least—
understand what is read to them.
(f) and (g) These points are very cursorily considered.
EDUCATED MOVEMENTS.
The movements of speech are educated movements and
thus differ widely from those movements which may be
said to be nearly perfect at birth, such as those for respir¬
ation, smiling, swallowing, &c. All the muscles repre¬
sented in the corpus-striatum unilaterally 1 require a long
education, and the most special of these are those engaged
in the movements of speech, and next those of the arm.
The muscles (see p. 3) always acting bilaterally, and chiefly
represented bilaterally in the corpora-striata, are born
with their centres for movements nearly perfect. Thus
then the term “ Intellectual language ” merges in the
larger term “ Special movements acquired by the indivi¬
dual,” and the term “ Emotional ” language in the term
1 It is true that the tongue acta bilaterally, and that it is represented
on both sides of the brain. But still it differs from other muscles act¬
ing bilaterally in that each of its sides has a distinct representation in
its corresponding (opposite) side of the brain.—See Broadbent’a paper,
Med. Chir. Bey., April, 1866, p. 479.
" Inherited movements,” (common to the race). There is
a still more fundamental distinction.
THE MOST GENERAL NATURE OF THE DEFECTS.
The author first considers Class I. Here the words
previously used give way to terms larger still. In its
highest or worat form it is a loss of voluntary power with
conservation of involuntary capability.
(a) The author first illustrates by the case of gross
movements, e.g. y a speechless patient may be unable to
put his tongue out, although it moves well in reflex, Ac.,
processes.
He next shows that there is a corresponding difference
even in quasi-mental movements. “ Speechless ” patients
sometimes ejaculate involuntarily.
Here again, taking into consideration the phenomena of
many cases, it will be seen that there is, so to speak,
an ascent in “compound degree” from utterances, like
the common explosive oath, most generally related to
general external circumstances, to actual propositions
specially related to special external circumstances—i.e.,
until the difference betwixt voluntary and involuntary
utterance is effaced.
(b) It will be found that some of those patients who
cannot talk voluntarily can swear. They utter other
ejaculations which are of the same category—meaningless
for the expression of ideas about things although useful as
vehicles for the exhibition of feeling. They swear or ejacu¬
late when excited and cannot repeat the words of the in¬
to ijectional utterances when they try.
(e) Next he instances ejaculations more appropriate to
the circumstances under which they are uttered, and which
are a step higher in speciality.
(d) Next, and highest, a man usually utterly speechless
may get out an actual proposition.
The above-mentioned series of phenomena show, the
Author thinks, that there are sensori-motor processes for
words somewhere, though usually the “ will ” cannot get
at them.
This somewhere can scarcely be on the left side of the
brain, for damage of this side has made the man speech¬
less. These involuntary utterances are, the author sup¬
poses, the result of action of the right side. In other
words, he thinks that the left is the leading side, and the
right the automatic.
THE WILL.
He then tries to shew the relation of the so-called “will*
to the rest of sensori-motor processes, and this time takes
his illustrations from the stock-words or phrazes which the
patients always use. First, he points out that it is pro¬
bable that the stock phraze was the leading sensori-motor
process, when the brain was suddenly damaged, and speaks
of two cases in illustration. A man becomes speechless
after hard work at making a catalogue , and can afterwards
say only, “ List complete.” (Recorded by Dr. Russell, of
Birmingham.) Another man receives a wound in the left
hemisphere in a brawl , and can only say, “ I want proton
tion.”
He then speaks of Spencer’s views on the “will,* and
as he believes in accordance with those views, calls the
“ will ” the leading sensori-motor process of the moment
—there being no such separation as Will and Mind.
THE LEFT SIDE OF THE BRAIN THE LEADING SIDE, THE
RIGHT THE AUTOMATIC.
The author does not think as Dr. Moxon does, that the
left side of the brain only is educated, but that both are
educated. It is certain that damage to the right side of
the brain produces no defect of speech in most cases, and
equally certain the author thinks that the disease of the
left side only does not prevent the patient getting out
words when a forcible circumstance outside himself is »
very special relation with the processes for those word*.
For he points out that although there is in cases of in¬
voluntary ejaculation no prompting by the wiB of
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LEGAL INTELLIGENCE.
September9,1868. 239
patient so to speak, the occasional utterances are developed
with more or less appropriateness to the then external
circumstances.
Although the cerebral hemisphere are twins, the left
may, if we accept Gratiolet’s* statement, be said to be the
first-born. It is bom with the lead, and thus a patient
who has damage to the left side of his brain cannot initiate
movements on the iuida llr> *g |ft ^ right side, either objectively
as in talking, or subjectively as in reading.
The author has recorded a case of loss of intellectual
language in a patient who was left-handed, but states that
in other cases this explanation will not apply, and he ad¬
mits that there are cases of defect of intellectual expression
with left hemiplegia which cannot be explained. Some of
the patients, however, have been previously paralysed of
the right side—although perhaps without any accompany¬
ing defect of speech. Still he has never seen a case of
disease of the right hemisphere only as proved post-mortem
with defect of speech of any kind, but has recorded three
eases in which this side of the brain (including Broca’s
convolution) was diseased without defect of speech. And
all are agreed that when hemiplegia occurs with loss of
speech, the hemiplegia is nearly always of the right side.
He has, however, received reports of two cases—one re¬
corded by Dr. Long Fox, of Bristol, and one by Dr. Pye
Smith, in which the Broca’s region (on the left) was
diseased without loss of speech.
LOCALIZATION.
The author does not attempt to localize language in any
limited spot. The object is to find in mind the latitude
and longitude of the aefect, and in brain the corresponding
latitude and longitude of the damage —the corpus striatum
being the Greenwich.
Destruction of parts of the hemisphere at a distance
from the motor tract need produce no obvious mental
symptoms of any kind. An equivalent quantity of
destruction of parts near the (left) corpus striatum will,
however, cause defects of intellectual expression. He
thinks that the quantity of defect depends generally on the
(1) quantity of destruction of tissue, and (2) on its nearness
to the highest part of the motor tract (the corpus striatum),
“ the point of emission of the orders of the * will’ to the
muscles.” (The author here quotes Mr. Dunn, who has
long held essentially similar opinions).
He next proceeds to show that there is a more special
kind of localization. He believes the principle of
totalization is essentially the same as that given by Spen¬
cer.
Taking the corpus striatum and optic thalamus as the
illustration, the author speaks of the “ localization of the
limbs.” He thinks the facts supplied by an observation
of many cases of damage to these bodies show—
1. That both the arm and leg are represented through¬
out these bodies.
2. That there is an order of representation according to
the “ intelligence” of parts.
The arm is more represented than the leg, the hand than
the arm, and the thumb and first finger than the rest of
the hand.
3. That there is also a representation of speciality, there
being localities where even the less intelligent ports have
the leading representation.
Or, puttmg the above in another way. He thinks that
pathology shows the corpus striatum to be made up of
physiological units—this term he takes from Spencer—
each representing potentially the whole of the limb. Yet
1 €hmtSolet*fi observation* show not only that the frontal convolutions
(Qm oottvotattons •peoUUy related to the corpus striatum, which is a
cunt T+ckitfv motor) of the left side are developed in advance of those on
bright, 1 >at that the sphenoidal and occipital convolutions (the convolu-
tfetw specially related to the thalamus opticus which is a centre chbj Cy
y) are in advance of those of the left. May we not su ppose that the
l the l e ading aids, end the left the automatic side for “ educated
• I” Such “crowed action •* of the brain would be in
__» with the crossed action in the spinal cord which Brown-
. guard?b Teswernhwi have established, and is in accordance also with
of motor and sensory nerves laid
that these are not repetitions of exactly similar units, but
that each unit superintends a different movement of the
whole limb.
So admitting that speech resides in each part of the
brain, he supposes that there are points—-probably in
Broca’s convolution—where the most immediate processes
for talking are specially represented, and that there will
be others near tne corpus striatum where other acquired
“ faculties”—for instance, the movements of the arm for
playing the violin, &c., &c., are specially represented, but
that there is no localization in the sense that one part
superintends one thing and no other.
The corpus striatum represents, to use arbitrary terms,
the highest physical evolution of movements for articula¬
tion, for the arm and for the leg ; from this point start the
psychical movements of speech.
It is thus interesting to inquire if there be not starting
from the corpus striatum a traceable evolution of move¬
ments for the educated psychical movements of the limbs.
The author believes the phenomena of certain nervous
diseases show disorder of the most rudimentary of these
processes.
il
CONVICTION OF A SURGEON
UNDER THE VACCINATION ACT.
At the Southwark Police-court, on Thursday, Mr. David
Roberts, M.D., of Great Dover-street, Borough, was sum¬
moned by the parish authorities of Camberwell for that, on
or about the 4th of June, being a medical practitioner, he
did refuse to fill up and sign a certificate of the successful
vaccination of Henry Lownds, when submitted to him
according to law, he having successfully performed the
operation upon such child.
Mr. Irving, the clerk to the board of guardians, attended
to prosecute, and stated that the present proceedings were
taken under the provisions of the 23rd and 30th sections
of the Vaccination- Act, passed in 1867, which set forth that
whenever vaccination was performed successfully by a
medical practitioner he must fill up a certificate to that
effect, and forward it to the registrar of the district, or
render himself liable to a penalty of 20s.
Mr. Partridge asked if the act said anything as to fees
to be paid to them.
Mr. Irving replied that there was nothing said about
fees excepting to the duly appointed medictu officer. It
was quite clear that every medical practitioner who suc¬
cessfully performed vaccination was bound to fill up the
certificate.
Mr. Charles John Nicollas said he was registrar of
births and marriages for the sub-district of Peckhain, at
the parish of St. Giles, Peckham. It was part of his duty
to give notice to parents on the registration of the birth of
their children to nave them vaccinated. On the 21st of
February he registered the birth of Henry Lownds, bom
on the 11th of January, when he gave the father a vacci¬
nation certificate (produced) to be filled up by the medical
practitioner. He afterwards received information that the
defendant bad successfully performed the operation, but
refused to fill up the certificate. Witness wrote to him
about it on the 4th of June, pointing out the section of the
Act of Parliament bearing on the case, when he sent a
reply refusing to fill up the certificate, as he was not paid
for it. In consequence of that the Board of Guar dians
directed the present proceedings to be taken.
Elizabeth Lownds said that the child was bom on the
11th of January, and on the ?lst of February it was regis¬
tered through her husband by Mr. Nicollas. She received
a certificate, to be filled up by Dr. Roberts, which he re¬
fused to do, saying it was of no consequence.
Mr. Partridge here said that on looking at the act the
22nd section mentioned that no fee should be taken by the
public vaccinator, or any medical practitioner, on giving
his certificate, which seemed to be imperative.
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24(3 The Medical Press and Circular.
CORRESPONDENCE.
September 9,16<&
Mr. Irving said that the public vaccinator was appointed
by the Board of Guardians and paid by them. If a private
medical practitioner performed the operation he should
seek his fee from the party employing him, but be was
bound to sign the certificate or abide by the penalties spe¬
cified by the Act of Parliament.
Dr. Roberts considered that there was nothing in the
Act of Parliament compelling him to sign the certificate.
If so, it was very hard upon the Medical Profession alto¬
gether. It never could have been the intention of the
Legislature to impose upon medical gentlemen the duties
of signing such certificates without any remuneration. He
successfully vaccinated 600 children in the course of the
year, and it would be hard if his time was to be taken up
without any fee or reward.
Mr. Partridge said it was a question of law, and the
defendant did not dispute the facts. He had refused to
fill up the certificate because he was not paid any remune¬
ration. The 23d section of the act was clear upon that
point:—“ Whenever any successful vaccination is per¬
formed by a medical practitioner he is bound to sign and
forward a certificate to the registrar of the district.” There
was nothing to show that he had not the remedy of get¬
ting his fee as a private practitioner from the party who
employed him, but it was clear that he was bound to give
his certificate to the registrar without fee. The fine under
the 30th section of the act was 20s.; but as the defendant
had only come forward to meet the case on those peculiar
grounds he should mitigate it to 10s. and costs.
Dr. Roberts asked his worship to grant him a case for
the Court of Queen^ Bench, as it was most important to
the medical profession.
Mr. Partridge declined to do so, and told Dr. Roberts
that if he thought proper he could apply to the Court of
Queen’s Bench.— Standard.
- ♦-
THE NEW EXAMINATION FOR PHARMACEU¬
TICAL ASSISTANTS.
The following proposed regulations for the modified exa¬
mination for assistants under the Pharmacy Act, 1868,
have been submitted to the Privy Council:—
“Candidates will be examined in the following sub¬
jects :—
“Prescriptions.—Candidates will be required to read
autograph prescriptions, translate them into English,
render a correct translation of the directions for use, and
detect unusual doses.
“ Practical Dispensing.—To weigh, measure, and com¬
ound medicines, write the directions in suitable language,
nish and properly direct each package.
“ Materia Medica and Quality of Specimens.—To recog¬
nise the Pharmacopoeia chemicals in frequent demand, and
specimens of roots, barks, leaves, fruits, resins, and gums
in ordinary use ; the following plants, either in a fresh or
dried state, or from plates—Belladonna, stramonium,
hyoscyamus, conium, aconitum, digitalis, and sabina; also
to estimate the quality of each specimen submitted and its
freedom from adulteration.
“ Pharmacy.—To recognise the preparations of the Phar¬
macopoeia which are not of a definite chemical nature, such
as extracts, tinctures, and powders, and give the proportions
of the more active ingredients.
- ■»
THE TITLE OF DOCTOR.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,— In the important letter of Dr. Davey in your last issue
there is incidentally raised a question, on which I am astounded
to see so excellent a reformer as the President of the Medico-
Political Association defend men who have not a degree assum¬
ing the title of doctor.
Instead of the bye-law forbidding the registrar to address as
“Doctor” members who were not graduates being “ infamous,”
it is to my mind one proof that some honesty still remains in
the old club in Pall-Mall. If such an epithet is at all appli¬
cable, I should say it were more appropriate to the conduct of
those who hold themselves out as Doctors of Medicine, when
they have no right to do so. The degree of Doctor of Medicine
is only conferred by Universities. A man has no more right
to assume it because he possesses a licence to practise physic,
than a solicitor to assume the degree of LL.D. If a member
of tbe College of Physicians is a doctor, to is a licentiate—the
title, now appropriate to the general practitioner. If a licen¬
tiate of the college may take the title, why not a licentiate of
the Apothecaries’ Company, whose legal right to practise is
much clearer. The examinations are not very different, and
the Hall, in spite of all the odium cast upon it as a trading
depot, has never yet sold its diploma. Trading company, in¬
deed, pshaw ! Why this immaculate college, sir, which so
despises trade, openly sold its diplomas of membership at ten
guineas each. The trading company has had sufficient trade-
honesty to give value in return for cash, and to refrain from
the infamous traffic (in diplomas), which has been bo profitable
to colleges of physicians—which are above trade / (Save the
mark !) Well, sir, if a purchased diploma is to give the title
doctor, why not at once give up all university distinctions ?
or at least let a license to practise obtained by such an exar
mination as the Apothecaries’ Company give an equal title.—
I am, &c., M.D., L.S.A
THE LONDON COLLEGE OF PHYSICIANS.
TO THE EDITOR OF THE MEDICAL PRES8 AND CIRCULAR.
Sir, —The letter of Dr. Davey on the “Fellowship of the
Royal College of Physicians of London” touches on several
points in reference to this oligarchical corporation which ought
to interest all true medical reformers. The one point, however,
of extreme importance is the proposal to recognise the existenoe
of that non-descript class of persons yclept members. This is
indeed not the first time such a just measure has been pro¬
posed, and I hope the agitation existing may not end until
justice is done.
Dr. Davey is probably aware of the details of a large scheme
of medical reform sketched by Dr. Prosser James, in his ad¬
dress to the members of the Scottish Universities already pub¬
lished in your paper, and he may have seen the correspondence
that has been elicited on the question. Now, what I wish to
point out is that the proposal of Dr. Prosser James includes
such a reform of the College of Physicians as that advocated
by Dr. Davey, and therefore deserves his active support.
Surely Dr. Davey’s sympathies are not confined to his own
college. He can see and feel the injustice perpetrated by
every one of the corporations, which has been so often de¬
nounced in your columns, and the reform of all of which is as
necessary as that of Dr. Davey’s college. Every corporation
needs reform, and because the plan of Dr. Prosser James
accomplishes this, and through this the reform of the Medical
Council, it is unquestionably the most important scheme ever
submitted to the profession. I ask, therefore, Dr. Davey to step
out of the ranks of his own college, look upon medical reform
in a larger sense, and support the only plan that is both effec¬
tual and feasible.
Dr. Davey and other members of the Pall-Mall College are
anxious to reform that corporation. Dr. Prosser James risks
his election by giving so much prominence to a reform of all
the medical corporations. Surely he may hope for the support
of the advocates of the partial reforms which his complete
scheme involves. Let Dr. Davey say what he will do in the
matter.—I am, &c.,
A Member of Three Corporations.
LORD AMBERLEY ON LARGE FAMILIES.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —Although I agree with much that you have written re¬
specting the opinions advanced by Lord Amberley at the late
meeting of the Dialectical Society, I confess that, to my mind,
you have scarcely done him justice. Admitting the interpre¬
tation you have put upon his lordship’s words as a possible one,
I think it may fairly be said that this is pushing things to an
extreme, and although that may serve the purpose of his poli¬
tical opponents it could scarcely actuate a medical journalist.
As your report shows, Lord Amberley distinctly condemned
abortion, and if he did not venture on as long a moral essay
as you have done, it is but just to remember that thatcriibe
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MEDICAL NEWS.
September 0,1868. 24i
was only vaguely connected with the subject proper of the
debate, and that each speaker was limited to 15 or 20 minutes.
How impossible it is in such a short time to give a complete
sketch of a large question, I need not remind you.
Whether the Malthusians are right or wrong as to its cause,
no one can deny the existence of much distress, and it is, to
say the least, rather uncharitable to put the worst construction
on the words of those who seem to have committed themselves
to the doctrine of a philosopher who has had enough obloquy
cast on his name. It would appear, from many facts that have
lately transpired, that the theoiy of Malthus is likely to be
again hotly contested. Whether true or false, discussion if
carried on in a spirit of truth-seeking must be beneficial. But
any attempt to excite prejudices against it by making it appear
to justify immorality, should be repudiated by every one who,
like your correspondent, is
Not a Disciple op Malthus.
gpicd I(eta.
List of Entries in the Branch Medical Council
(Ireland) for the month of August, 186S :—St. Laurence
Mullen, Ardmullen, Tuam, county Galway, M.D., 1868, and
M.Ch., 18C8, Qu. Univ. IreL ; Joseph Backhouse, Carrick-on-
Shannon, county Leitrim, Lie., 1868, and Lie. Mid., 1868,
K.Q.C.P.I., Lie. R. C. Surg. Irel., 1868 ; Thomas Lyle Homer,
Dungiven, county Derry, Lie. R. Coll. Phys. Edin., 1868, Lie.
R. CoU. Surg. Edin., 1868 ; Samuel Hamilton, Victoria Lodge,
Cork-street, Dublin, Lie. R. Coll. Surg. Irel., 1866, Lie.,
1867, and Lie. Mid. 1867, K.Q.C.P.I. ; John Nyham, Drimo-
league, county Cork, Lie. R. Coll. Phys. Edin., 1868, Lie. R.
CoU. Surg. Edin., 1868 ; T. Browne Macauliffe, Newcastle,
W., Limerick, M.D., 1868, and M.Ch., 1868, Qu. Univ. Irel. ;
James Love, Lislaird, Castlederg, county Tyrone, Lie. R. CoU.
Phys. 'Edin., 1868, Lie. R. CoU. Surg. Edin., 1868 ; Francis
Edward Clarke, St. Helen’s, Dunfanaghy, county Donegal,
M.B. University of Dublin, 1868.
Speaking of the elevation of M. Nelaton to the
office of Senator, L'Union Midicalc states that during the first
Empire but one physician was raised to a like position, M.
Cabaius. No one is authorised to say, observes the same
journal, that any condition has been imposed upon M. Nfelaton.
He has not announced any intention to retire from practice ;
however, of his own accord, he last year resigned his profes¬
sorship.
Medico-Chirurgical Society of Clasoow.— At
the meeting of this society held on Friday, 4th September, in
the HaU of the Faculty of Physicians and Surgeons, the fol¬
lowing gentlemen were elected office-bearers, viz.:—President
—Dr. J. G. Fleming. Vice-Presidents—Dr. W. T. Gairdner,
Dr. E. Watson. Council—Dr. Dewar, Mr. Tindal, Dr. G. H.
B. Macleod, Dr. A. R. Simpson, Dr. Richmond, Paisley ; Dr.
F. Thomson, Mr. Torrance, Airdrie; Dr. H. Thomson. Secre¬
taries—Dr. James Adams, Dr. R. Perry. Treasurer—Dr.
H. R. Howatt.
Royal Sea-Bathing Infirmary, Margate.—
The annual meeting of the governors "of the above institution
was held lately at the hospital. The total number of patients
under treatment had, during the year, been 894, the greater
part feeing from London and its neighbourhood. More than
were discharged cured, and the great majority of the re¬
mainder left materiaUy benefited. There are 250 beds now in
the hospital, aU of which are fully occupied during the greater
part of the year, and more than half the number during the
winter months. The institution is now kept open for the whole
year instead of. the summer months only, this desirable alter¬
ation having been accomplished through the success attending
the “ fund in aid ” derived from the 5s. annual subscriptions
inaugurated thirteen years since by the Rev. Mr. Hodgson, the
honorary secretary; the number of subscribers to this fund
last year amounting to about 7000. The amount produced
last year had been £1653. During the last year an addition
had been made to the north wing, by which accommodation
had been obtained for twelve more beds, and another addition
was contemplated on the west side, which would provide ac¬
commodation for eighteen more beds. The total income for the
year, including £2000 received from patients, £1653 from 5«.
subscriptions, £1264 donations, and £450 legacies, had been
£13,962, 19s. lid., and after investing £5500 and paying all
expenses of the hospital, there was a balance in favour of
£1208, 9s. 3d. The chairman, in moving the adoption of the
report, said it was essentially a London hospital, nearly all
its patients coming from the metropolis. The report was
adopted, and a vote of thanks passed to the Rev. Mr. Hodg¬
son for his valuable services. According to annual custom
the hospital was then thrown open for a public visitation, and
a large number of visitors to Margate and Ramsgate availed
themselves of the opportunity of inspecting it. At three
o’clock in the afternoon, a public meeting was held in the
dining-hall, for the purpose of explaining the objects and use¬
fulness of the institution.— The British Medical Journal .
The Royal Hospital for Imbeciles, Putney.—
A gratifying meeting took place in the general room of the
above institution on Monday evening. All the patients, male
and female (except those who were bed-ridden or too ill to at¬
tend) assembled together to celebrate the first anniversary of
the appointment of the present governor and matron (Mr. and
Mrs. Haughton). The governor, with his usual good-nature
and kindness, had provided (out of his own pocket) special
refreshments for the occasion, and he and his wife amused
them for several hours with music, singing, recitations, and
readings, which seemed to bethoroughly enjoyed. The super¬
intending nurse, who is very popular with the patients, had at
their wish collected small contributions from those who de¬
sired to give, and purchased two handsome dressing-cases for
presentation to the governor and matron, as an acknowledg¬
ment of their unwearied efforts to promote the comfort and
happiness of the inmates generally. These dressing-cases,
with an appropriate address, were presented, and the governor,
who was unprepared for such a demonstration towards him,
was quite overcome at the cordial and enthusiastic manner in
which the presentation was made. It is hoped that the vastly*
improved condition of this institution under the efficient man¬
agement of Mr. and Mrs. Haughton will be properly ap¬
preciated by the authorities of this useful home for the afflicted.
—Medical News.
The fair sex of Marseilles have taken to poisoning
their liege lords. Three women have been arrested there on
the charge of disposing of their husbands in order to get mar*
ried to other Lotharios with whom they were on terms of in¬
timacy. On Saturday the magistrates, accompanied by the
Procureur Imperial and medical men from the hospitals, went
to the cemetery and exhumed the bodies in presence of the
accused. One of the latter, 35 years of age, when she saw
the corpse of her late partner, who died in January last,
showed signs of great emotion ; the second, about 45, a widow
since May, exhibited great coolness ; whilst the third, a young
person of 20, whose husband only died a month back, was,
according to the local papers, “greatly” moved. The intes¬
tines and viscera of the deceased| were handed over for analy¬
tical examination. The prisoners are said to have obtained
the means of committing their crimes from an herbalist, who
is also in prison.— The Standard .
The dentists of the Province of Ontario have
recently formed themselves into an association, and obtained
an act of incorporation from the local legislature. This asso¬
ciation holds regular meetings, and discusses subjects of prac¬
tical interest to the profession. With a view of supplementing
this important movement the projectors of the Canada Journal
of Dental Science are desirous of supplying a means of inter¬
communion which no foreign journal can be expected to sup¬
ply. We trust this worthy undertaking will be well sustained,
and that the Canada Journal of Dental Science will take rank
amongst the leading periodical literature of the Dominion.
The Journal is to be under the editorial management of J.
Stuart Scott, M.D., Cobourg, P. O., and of W. George Beers,
Esq., Montreal.— Canada Medical Journal .
Torture in Russia.— M. Emile Andreoli, who
took part in the last Polish insurrection, and on being captured
by the Russians was sentenced to twelve years* imprisonment
in Siberia, has just published in the Revue Modems the first
part of his prison recollections, some of which are certainly
curious. “I was told,” he remarks, “that on two or three
occasions an electric battery has been made use of by the
Russian police to loosen the tongues of the prisoners who
refused to answer the questions put to them, which shows that
the Russian Government is one of progress and knows how to
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242 The Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
September 9, 1&
turn the discoveries of science to account. After all, this was
not more cruel than the torture of the herring. I knew
several who underwent the latter, and they told me that
nothing could compare with the sufferings which they endured.
They were confined in a well-warmed apartment, salted herr¬
ings with bread and water for the first few days being their
omy food. If they refused to answer the questions of the ex¬
amining commissioners the bread was first of all withdrawn,
and then the water, whereupon the torture of intense thirst
commenced, depriving the sufferer of all moral strength, and
even making him abandon the resolution which he had formed
to die. Very rarely did anyone remain mute when brought
before the commissioners a second time. The sittings were
usually at night, in a splendidly-lighted apartment, with refresh¬
ments of all kinds temptingly displayed on the side tables.
The president would usually be most gracious. *By-and-bye
(he would say) we will, if you like, ask you to have something
to drink with us.* The fever and the vertigo caused the
prisoners to lose their reason, and they generally yielded.
Hunger would not have brought about the same result as
thirst, which loosens the tongue even far more readily than
drunkenness does.”
Death of Dr. Rogan. —The sudden death of one
of our most esteemed and best beloved citizens has brought
sorrow to the hearts of all, and has plunged his many friends
into profound grief. At the County Lunatic Asylum, on Sun¬
day morning, died Dr. Kogan, the Resident Physician of that
Institution. Son of one of our most respected local medical
men, and nephew of another, whose professional eminence was
natioual—he was trained for the same calling. To a rare
amount of natural talent, was added an education, as perfect
as industry and perseverance in the best schools and under the
best masters, could make it. At college he distinguished him¬
self as a first-class prize-man in more than one branch of
natural science, and his love of learning was such as to make
him an earnest student to the end of his life. His knowledge
and attainments, as a physician, were held in high estimation
by his brethren, who often asked for his assistance in cases re¬
quiring more than ordinary acumen. We have further heard
it said by competent critics, that his judgment and skill as a
surgeon were such as would have placed him in the front ranks
of metropolitan practice. His tastes, however, were different,
and his ambition soared no higher than the office he held. He
gave up a growing practice, and confident hopes of eminent
and lucrative position, to hold the unobtrusive appointment of
Resident Physician of the County Derry Asylum. Here his
energies were chiefly devoted to the study of mental disease,
and to the treatment of his unfortunate patients, duties for
which he was, in all respects, eminently qualified. But it was
not merely his talents, or his attainments that won the love of
all who knew him. The remarkable geniality of hia disposi¬
tion, his imperturbable sweet temper, his kind and unselfish
life, have endeared him to persons of every class and denomi¬
nation, and rendered his death a public loss. His unexpected
removal was caused by disease of the heart. We learn that
his professional brethren have asked permission to attend the
funeral as mourners; and that a similar tribute of respect is
intended by the members of the Society of Freemasons, of
which he was a distinguished brother and a bright ornament.
— Londonderry Standard .
Death of an Eminent Physician. —The death
is announced of Dr. Clot.-Bey, one of the notabilities of Mar¬
seilles, at the age of 75. He had acquired a well-merited
reputation by his success in establishing medical instruction
and practice in Egypt. During the last ten yearB he lived in
France in retirement, but had long been associate of the most
important academies of Europe, and Commander of the Legion
of Honour.
-»-
NOTICES TO CORRESPONDENTS.
Proofs reaching authors in England on or before Friday morning are
expected to be returned to the Editor, at the office, 30, King
William-street, Strand, W.C., before five p.m., on Friday afternoon.
Proofs reaching authors on Friday evening or Saturday morning
must be returned to the office by two p.k. on Saturday, which is
an early closing day. Duplicate proofs are sent to authors, in
order that they may correct and return one copy, and keep the
other for private use. Contributions should be leoibly written, on
one side of the paper only.
All Communications and Letters must be authenticated by the name of the
%niter, thouy k net ntc&sarily for fublioation,
Established 1848.
PROFESSIONAL AGENCY AND MEDICAL TRANSFER OFFICE.
50, Lincoln’ s-inn-fields, W.C.
MB. J. BAXTER LANGLEY, M.E.C.S., E.L8,
&c. (Kino’s Coll.), has always upon his books a lugs
number of desirable investments and available openings for Medical
Men commencing their professional career. Gentlemen wishing to re¬
linquish practice can be introduced without delay to competent succes¬
sors with means at their disposal.
Mr. Langley devotes his prompt personal attention to the negotiations
entrusted to him, and treats confidentially and with care all matters re¬
lating to professional business. The strictest reserve will be practised in
all the preliminary arrangements and no expense incurred (except in
special cases) unless a negotiation be completed.
The business of the Professional Agency is based upon the general
principle that no charge is made unless work has been done and services
rendered.
A prompt and just system secured a large measure of success to the
General Partnership and Commercial Agency Business formerly con¬
ducted by him at his City offices ; this has for some yean been trans¬
ferred to Lincoln’ s-mn-flelds, and he has invariably adopted the same
equitable policy in the more professional matters placed in his hands.
Thus his experience in the management of large commercial under¬
takings, combined with his medical, scientific, and literary acquire¬
ments, enable Mr. Langley to guarantee that all matters of busmea
placed in his hands will be carried out without delay, and with an equi¬
table regard to the interests of all the parties concerned. As an
arbitrator on matters of dispute between professional men, Mr. Langler
has had great experience, and he can refer to numerous cases in which
he has been the means of preventing expensive and tedious litigation,
and in which his awards have been made rules of her Majesty’s Courts
at Westminster.
Mr. Langley can also refer to the Professors of his College, Members
of Parliament, Clergy, Merchants, Bankers and others, as a guaastee
of his integrity and honour in all negotiations entrusted to him.
Full information as to terms, Ac., sent tree on application.
Office Honrs from 11 till 4; Saturdays from 11 tall 3.
D EATH VACANCY. — In one of the best suburbs of
London, the decease of a gentleman, in high class practice,
affords an unusually favourable opportunity for the introduction of a
successor. The receipts during the last and the present year are at
the rate of £1300 a-year. Usual midwifery fees from £2, 2s. to £5, ha
The connection lies within a radius of a mile, and is easily conducted.
The practice is in the care of a thoroughly competent gentleman, asso¬
ciated in the practice with the deceased, and well-known amongst
the patients, he will remain as locum tenens, and will, if desired, co¬
operate with the widow in the introduction. The house is convenient
and well situate, with garden and stabling; rent £110 a-year. The
successor must be doubly qualified, and accustomed to good society.
Address X. 367, care of Mr. Langley, as above.
A very Profitable Medical Establishment in London is
for sale, the proprietor retiring. Average income £400 a-year,
derived from private practice and an open surgery. The house is hdd
upon benefloial lease, with garden, stable, and yard. Terms moderate.
L ONDON.—In a good suburb, a Partnership for Transfer.
Present income upwards of £2000 a-year, and capable of stiff
greater increase. The house is well situate; rent £100 a-year. Ad¬
dress X. 861, Mr. Langley, as above. _
M IDLAND—PARTNERSHIP. — There is an opening for
a Junior Partner in an old-established Practice in a good tows.
The successor must be a Gentleman of superior education, Inoooie
£1400 a-year—capable of great increase. A Third Share to be nego¬
tiated upon the basis of two years’ purchase. There is ho dispensing,
and the fees are good. Excellent residence; rent £60. Address X.86&,
care of Mr. Langley, as above.
I N a pleasant country town, a Practice for Transfer. Be*
ceipts £450, appointments £260. House very convenient, with
garden and stabling. A year’s introduction given if required. Address
X. 360, Mr. Langley, as above.
S OUTHERN COUNTIES.— For Transfer an old estah
lished Practice, in an improving district, within easy access of
London. Receipts £1000 a-year; appointments £80. Population 2000,
and only one opponent within three miles. House, with garden,
stabling, &c., at a very moderate rent. As the vendor has the offer of
a desirable appointment, a moderate premium would be accepted.
Address X. 359, Mr. Langley, as above.
I N the suburb of a pleasant and enlarging town, within
easy access of the sea, a good dam Practice for Transfer-
Twelve months’ partnership introduction if desired. Income aver¬
ages nearly £600 a-year; but the practioe h** been restricted by
the ill health of the vendor, who is thus compelled to retire. Tbs
house is one of the beet in the locality ; but its occupation is op¬
tional to the suooessor. Address X. 375, care of Mr. Langley, ss
above.
Now ready. Second Edition, with considerable additions.
A DTICE on Buying or Selling Medical Practices,
Partnerships, &c. By J. BAXTER LANGLEY,
M.R.C.8., F.L.8.. Ac. Free by post for seven stamps, from the
Author, 60, Lincoln’s-Inn-Fields.
V IA HEDICA. Second Edition. 3**
“ Essential to every Principal and Assistant.”
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“SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 16, 1 86 8.
CONTENTS.
LEADING ARTICLES.
THI 8«LKCnoy OP A PttOFEHSIOH.PAOK 243
&KCOXMKVDATIHVK OF THE Gf.XEBAL
Medical Council. 244
PUBLIC 8ERVICE8. I
1£nglf«h Poor-law. — Irish Poor-law.— j
Army. — Netley Hospital. — Naval.— j
The Medical Assistant: His Duties and
Privileges. 244-7
OFFICIAL REGULATIONS.
The Army Medical Department. 249 I
Naval Medical Department. 250
REGULATIONS OF LICENSING
BODIES IN ENGLAND.
Universities of Oxford — Cambridge —
London—Durham. 250-53 1
Royal College of Physicians, London. 253 j
Royal College of Surgeons. England. 264
A othecariet*’ Society of London. 255
REGULATIONS OF LICENSING
BODIES IN IRELAND.
University of Dublin. 256
The Queen’s University in Ireland.
Faculty of Medicine. 257
Royal College of Surgeons in Ireland. 25S
King and Queen’s College of PhyBieims
in Ireland. 259
The ApotLcme.'’ Hall of Ireland. tlO
REGULATIONS OF LICENSING
BODIES IN SCOTLAND.
Universities of Edinburgh—Aberdeen—
Glasgow.. 261
Royal College of Surgeons of Edinburgh. 261
Royal College of Physicians of Edinburgh. 262
Faemty of Physicians and Surgeons of
Glasgow.. 262
The Scotch Double Qualifications. 262
University of St. Andrews. 263
Anderson’s University, Glasgow.. 264
LONDON HOSPITALS AND
SCHOOLS.
St. Bartholomew’s—St. Thomas’s—Guy’s
— The London— Middlesex—West¬
minster— University—Charing-c ouj . . 264-C8
PROVINCIAL 8CHOOLS OF
MEDICINE.
Manchester Royal School of Medicine. 266
Liverpool Royal Infirmary 8chool of
Mcdirine.. 267
Birmingham. —Sheffield.—Bristol. 267
Hull and East-Riding School. 268
IRfsH SCHOOLS OF MEDICINE.
School of Physic, University of Dublin.—
School of Surgery, Royal College of
SurgtMms.—The Leiwieh School of
Medicine, Peter-street—SteevenB* Hos¬
pital School.—The Carmichael School
of Medicine.—The Medical School of
the Catholic University —The City of
Dublin Hospital.—The Meath Hospital
and County Dublin Infirmary. —8t.
Vincent’s Hospital. — The Adelaide
Hospital — Sir Patrick Dun’s Hospital.
The Mater Misericordiro Hospital.—
Mercer’s Hospital.—Jervis-street Hos¬
pital —Ro»undo Lying-in Hospital.—
The Coombe Lying-iu Hospital.
PROVINCIAL COLLEGES OF
IRELAND.
Queen’s College, Belfast.—Queen’s Col¬
lege, Cork.—Queen’s College, Oalway.. 270
TN compiling our Students’ Number we have aimed not only at supplying Students with the practical
information which they really want, instead of prolix and verbose official regulations, but at giving
our subscribers and the profession some matter which may not be uninteresting, and which may, as far as
possible, atone tQ them for the yearly trespass which, in the interest of Students, we are obliged to make
on their forbearance. We omit nothing important. We simplify by removing from the official regulations
the semi-legal fog in which their phraseology is obscured. Our Students’ Number is for Great Britain
and Ireland, not for London alone.
THE SELECTION OF A PROFESSION.
The boy at school, full of life and enjoyment of physical
existence, has little inclination and few reasons to think of
his future. It is not until nearly the end of his scholastic
curriculum that either parents or youths ask themselves
and each other the question what is to be done, and what
the suitable prospective employment for the student ?
The boy chooses with too little care, the parent bestows
too much auxiety upon the matter, as a rule ; too little re¬
gard is paid to the special ability of the aspirant, and his
father exercises too much influence to induce his sou to
follow a particular walk in life. We believe that every indi¬
vidual has a special fitness for something, and that fitness is
usually indicated more by his habits than his words.
The student may have heard a brilliant barrister plead in
a case in which he was interested, and straightway is fas¬
cinated by a passion for the law, and declares that he will
be a special pleader, with ambition to be keeper of the
Privy Seal and Lord High Chancellor of England. But
the young dreamer has no conception of the difficulties
which must be overcome before he can hope to achieve
even mediocrity in such a career, and unless he have
special aptitude in a good memory, with capacity
for using promptly the knowledge he has stored, and
a fluency of speech to express it, he had better aban¬
don the idea. Another student may have been impressed
by the grandeur of an ecclesiastical ceremonial, and
have been carried away by the didactic eloquence of a
popular preacher—but beforo he decides to become a
teacher of religion he must be prepared to forego all mat¬
ters of worldly interest, and wholly to abnegate self in the
considerations of the future. In this case, far more than
in the former, the parent or guardian is bound to exercise
his influence to induce the student to pause and to con¬
sider well what he is about to do. In Tact, we are inclined
to the opinion that so much discouragement should be
shown in both cases as would deter the student selecting
either law or religion as a profession, unless he were so re¬
solved and felt so peculiarly fitted for it that his selection
could not be afterwards set aside by opposition or diffi¬
culties. For the profession of arms much more than per¬
sonal fitness and liking is necessary, because promotion,
and indeed social position, can alone be secured by money
and family influence. No young man of education, with
a sense of self-respect, would ever enlist as a private sol¬
dier. We have thus glanced at three of the professions,
leaving to the last that of medicine, because we propose to
treat of its prospects, &c., more fully.
Before the schoolboy selects medicine as his profession,
we advise him to consider the cost in brain and labour—
not as deterrent, but because such consideration may pre¬
vent failure and disappointment afterwards. In the writers
experience upon a large scale lie has come to the painful
conviction that of those who enter the medical profession^
at least one-third have wholly mistaken their vocation,
and their mistake is not only a disaster to themselves
and to their families and friends, but to a large number of
poor creatures whose lives may be dependent upon them.
The supposed free and easy life of a medical student at¬
tracts to our profession a number of young men who
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244 The Medical Pr«u and Circular. ENGLISH POOR-LAW MEDICAL SERVICE.
September 16 , 1668 .
arely do any good for themselves, and are the source of
infinite mischief to their associates—for no man can suc¬
ceed in the medical profession without earnest self-denying
work. The student, therefore, who enters at one of the
hospitals with the idea of having an easy life before him
makes a tremendous error ; he is sowing the seeds of cer¬
tain misery for himself.
But what are the preliminary conditions of fitness in the
student who proposes to enter upon a medical career?
Good physical health is, in our opinion, essential to suc¬
cess. All the senses must be perfect, for all are called
into requisition in our art—eye, ear, smell, and touch.
But it is not merely to see a foul tongue or a dislocated
limb ; it is not merely to hear a patient describe his
symptoms or to listen to abnormal sounds in the lungs ; it
is not merely to detect by the nose the foul smells which
are associated with the physical surroundings of fever ; it
is not merely to feel the pulse beating beneath the finger
or to touch the end of a broken bone ; the mere exercise
of the sense is of no value unless the senses are cultured
in a high degree, and associated with good observant facul¬
ties. His senses must be subordinated also, for some of
the duties which the physician and surgeons have to per¬
form are at first repugnant and even revolting tp the
ordinary observer. Mr. Langley, in his “ Via Medica,”
writing on this point says :—*
"The youth who shrinks from these duties neglects
golden opportunities which may, perhaps, make the diffe¬
rence between success and failure in after life. The senses
of the surgeon have to be subordinated as well as cultured,
and he must be prepared to see without shrinking that
which appals and sickens the ordinary observer. His sense
of duty must make him calm and firm, yet aware of all the
agony his patient suffers. The noblest operator is the
surgeon who is farthest removed from the butoner. Let
the student therefore shun everything which is calculated
to brutalise, whilst he seeks every occasion which can teach
him benevolent firmness and imperturbable self-reliance.
To make himself more and more fit to assist in emergencies
is not merely to mike the junior more valuable to the em¬
ployer, but enhances his own self-respect and increases his
power over his future destiny."
To the mind which finds its delight in the demonstra¬
tions of science and the applications of abstract truths to
practical purposes, the study of medicine affords the grand¬
est of all fields; but there are humbler and scarcely less
useful paths of benevolence and usefulness which consti¬
tute the unwritten heroism of the every-day life of the
ordinary medical practitioner.
The money value of the Medical Profession is not great,
because, like all the learned professions, it is over-full, and
therefore as a medium by which a fortune is to be made,
it is not to be thought ofi But even in this respect there
is a better time coming, and the future of the general prac¬
titioner will be better than the past. Quoting a gain from
Mr. Baxter Langley’s “ Via Medica," we would commend
to the student who contemplates entering the Medical Pro¬
fession the following remarks:—
" It appears to me a grave error to take a young man
from school and plunge him at once into the theoretical
studies of medical science, for it is absurd to expect that
during the short space of four years he shall learn the laws
of physics, chemistry, botany, zoology, human and compa-
pathology, practice of medicine, surgery,
midwifery, and medical jurisprudence. My experience and
observation leads me to the conviction that the most suc¬
cessful men are those who have some practical and general
knowledge, and are able to observe and to manipulate well
before they enter upon their attendance at lectures. Hence
I am strongly convinced that a year or two well spent with
a provincial surgeon is not time thrown away by the tyro
in medicine. Students are apt to think that the whole
object of their studies is to pass certain examinations; but
thousands of men find out the burden and calamity of this
mistake when they are called upon to prove their practical
acquaintance with their profession under some sudden and
terrible emergency. To know the theory of obstetric medi¬
cine—even to have attended a large number of ordinaiy
cases of midwifery with success—is a totally different thing
from being so thoroughly master of the subjqpt that no
emergency can arise for which the medical attendant is
not prepared. Many a surgeon has turned pale at the bed¬
side of his patient on finding himself suddenly in the
presence of some difficulty which he does not clearly under¬
stand, and with which he is utterly incompetent to deal
decisively. In such moments he would feel with deep acute¬
ness that “ cramming" and “ grinding" will not alone make
a professional man the “ master of tne situation," semper
paratus , and ready for “ the occasion sudden” with which
the practitioner will from time to time be called upon to
deal, and oftentimes alone. The student who resolves not
only to appear, but to be, qualified to take any and eveiy
surgical or medical responsibility which can present itoefl
will not be in a hurry either to begin or to end his curri¬
culum ; his whole purpose will be to gain knowledge and
experience for its own sake, and to fit him to practise suc¬
cessfully. Other men may at the first seem to outstrip
him in their apparent progress, but the man who is
thoroughly grounded in nis profession, and has become
familiar with the principles of the sciences before he enters
upon his lectures, will soon outstrip and take precedence
of those whose attention to the higher branches of their
profession is prevented by the necessity of studying out¬
lines and elements which ought to have been learned
before."
RECOMMENDATIONS OF THE GENERAL
MEDICAL COUNCIL.
The General Council of Medical Education and Registra¬
tion have issued to the various Licensing bodies, their
suggestions on the subjects under their supervision. These
Recommendations are not compulsory, ana in so far as they
have been adopted by the Licensing bodies provisions ill
accordance witn them will be found amongst the regula¬
tions of each corporation in other parts of our issue.
The gist of these suggestions is briefly as follows:—
1. The student must pass his Preliminary Examination
in General Education before he can be registered as a
student, and not more than a fortnight after he commences
professional study.
2. That twenty-one shall be the earliest age for qualifi¬
cation to practice.
3. That the examination be divided into two parts, one to
be undergone at the end of the second, and tne other at
the end of the fourth year.
-♦-
IfttMir %txbhn.
POOR-LAW.
In the first place, then, a young qualified practitioner, in¬
disposed to be an assistant, and desirous of commencing
general practice without investing any money in purchasing
a succession, may, perhaps, obtain a poor-law appointment,
though he should scarcely expect to obtain a livelihood
from this inadequately remunerated employment.
ENGI.ISn POOR-LAW MEDICAL SERVICE.
Prior to the Metropolitan Poor Act of last year, the
English Poor-law Meaical Service may be said to have
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ARMY MEDICAL SERVICE.
September 16, 1668. 245
been in the hands of the guardians, supervised by the
Poor-law Board. Each parish in England and Wales had
its guardians of the poor, and these parishes were grouped
together to form unions. The anions were divided into
districts for medical relief. Union Medical Officers, there¬
fore, have the care of a district, or sometimes the care of
the workhonse of the union—sometimes of both. The
officer was elected by the guardians, and the appointment
approved by the Board. He was required to have both a
medical and a surgical Qualification. In some instances
these were specified, but almost always the London College
of Surgeons and Apothecaries* Hall were the two most
favoured diplomas. For this reason London students will
still continue to take these qualifications whatever else
they may add to them. These appointments are not lucra¬
tive. In most cases the salary is very low. They are,
however, sought after by young men as a means of getting
into practice, and are often almost obligatory in the country
to prevent fresh opposition being introduced. The Metro¬
politan Poor-law Act, 1867, assimilates the Poor-law, so
far as London is concerned, to that of Ireland, and it will
probably shortly be extended to the country. It estab¬
lishes in London asylums and dispensaries, and distributes
the cost of supporting them over the metropolis. The
appointment of the Medical Officer will be made by the
Dispensary Committee, but the Poor-law Board has power
to modify many of the Arrangements. The Poor-law Board
is now a permanent body with increased powers, but since
the Act so few improvements have been effected that the
Medical Officers Are very dissatisfied.
IRIBH POOR-LAW MEDICAL SERVICE.
The appointments which come directly under the head
of the Poor-law are those to Dispensaries and Union
Hospitals. By the latest statistics there were 716 Dis¬
pensary Districts in Ireland ; but as there are sometimes
several dispensaries to a single district, the number of
dispensaries was 1037. Each of those dispensaries,
however, has not a separate Medical Officer, there being at
present 786 Dispensary Doctors in Ireland. Each district
is under the direct control of a committee composed of the
neighbouring landholders; the appointment of medical
and other officers are made by this committee, and the
entire management of the district is under their control.
Their acts are, however, subject to the approval of the Poor-
law Commissioners, who have the power either of interpos¬
ing their veto on any appointment, or even of expelling an
officer by a “sealed [ order,” without trial or accusation,
and without the resource of appeal or investigation. The
salaries of Medical Officers of these districts vary from
£100 to £20 a-year, the great majority being from £50 to
£75. This salary is paid by the Board of Guardians, and
no increase or decrease can be made in the amount without
their assent and that of the Commissioners. Under the
late Sanitary Act the committee made recompense to the
Medical Officer for special services, such as those during
an epidemic of cholera, or for sanitary reports. The quali-
fications for the medical charge of a dispensary or work-
house have, by a late order, Defen fixed at—a licence in
Surgery, a diploma in Medicine* and a diploma in Mid¬
wifery, and the candidate must be at least twenty-three
years of age. The success of an applicant depends, how¬
ever, to a great extent on his local interest and influence
with individual members of the committee, who are wont
to discover particular aptitude for the position in the per¬
son or character of their own relatives which they selaom
observe in a stranger. There is no pension, superannuation,
or allowance for Poor-law Medical Officers, and as their
salazy is almost alway.t quite insufficient for their mainte¬
nance, they must choose a proper field for private prac¬
tice, or they can never hope to attain an independent
position.
The number of unions in Ireland is 163, to each of which
is attached a Medical Officer, who is appointed and con¬
trolled, by the Board of Guardians in the same manner as
the Dispensary Burgeon is by his committee. The salary
is usually better than that of the Dispensary Doctor, and
the duties of a more easy and satisfactory description.
ARMY MEDICAL SERVICE.
The appointment of Assistant-Surgeon in the army is
open to all who can prove their claim to it by superior
answering. The Competitive Examinations are held at
Chelsea, usually in the first week of February and August.
The candidate is not required to produce any other quali¬
fication before presenting himself for examination, than
his licences to practise, and certificate of registration ; in
this respect the army service differs from the naval,
in which the very senseless practice of compelling a
candidate to produce all his certificates is enforced.
The candidate having sent in his papers and fol¬
lowed them to London, meets his competitors at Chelsea.
He is examined by Dr. Thomson on Natural History,
Botany, Chemistry, and Materia Medica; by Dr. Parkes
on Medicine, Midwifery, Therapeutics, Pathology, Phar¬
macy, and the writing of Prescriptions; by Dr. Pollock
on Surgery and Surgical Appliances; and by Dr. Busk
on Anatomy, Physiology, and Comparative Anatomy.
Natural History and Botany are voluntary subjects.
For the first two days of his examination he is em¬
ployed in penning answers to printed questions; for
the third and fourth days he is examined viva voce
on all subjects ; and on the fifth and sixth days he is
tested by the diagnosis of disease at the bedside in the
hospital, by the application of surgical apparatus, and by
operations on the dead subject. This trial finished, the
successful candidates (varying in number from fifteen to
thirty) are selected.
NETLEY HOSPITAL.
A certain number of candidates, whose answering has
been satisfactory, but not sufficiently so to entitle them
to a place, are offered appointments on the West Coast of
Africa. These situations, while they are subject to strong
objection on the score of the deleterious nature of the
climate, possess some advantages for those whose health
can resist its influence. The districts comprised under
the West Coast districts are Sierra Leone, Gambia, and
Cape Coast Castle. If the candidate accepts the appoint-'
ment he is sent out at once, without the period of proba¬
tion to which others are subjected at Netley Hospital. He
is allowed to spend a year at home, on full pay, for every
year spent in Africa, and the entire period at home and
abroaa counts as service for pension. The promotion is
sometimes rapid, owing to the dangerous nature of the
climate ; and we have known the rank of full Surgeon
reached in fire years from the date of appointment as
Assistant-Surgeon.
The competitor who has been so fortunate as to obtain a
place in the ordinary service, is not allowed to join a regi¬
ment at once. He is obliged to undergo a probation of four
months at Netley Hospital, near Southampton, where he is
compelled to attend the following lectures, viz.—Hygienie
by Dr. Parkes; Pathology, by Dr. Aitken; Military Surgery,
by Dr. Longmore; and Tropical Diseases by Dr. Maclean.
The lectures on Military Surgery include gunshot and
other wounds; arrangements for the transport of wounded;
duties of Army Surgeons in the field, during sieges,
on transport, &c.; and other special subjects. Those
on Military Medicine refer to tne tropical and other
diseases of the British possessions and colonies, and to the
losses by disease. The lectures on Hygiene relate to
the examination of wAter, air, food, clothing, &c., of the
soldier ; his duties and exercise, and the circumstances
affecting his health, meteorology, statistics, and prevention
of disease. The lectures on Pathology have reference
chiefly to the scientific examination of tropical diseases,
and of the other complaints which the Army Surgeon is
especially called on to investigate. The candidates also
attend the wards of the hospital under the Professors of
Medicine and Surgery, to make themselves acquainted
with the system of recruiting, and the modes of Keeping
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NAVAL MEDICAL SERVICE.
September lft, 188ft
the Army Medical Returns. They are also called on to
make post-mortem examinations, to operate on the dead
body, and pass through laboratory practice on the modes
of recognising the qualities and adulterations of food, and
on microscopic examination of morbid tissues and adultera¬
tions of food, &c. Daring his preliminary training here
the student is understood to be in Her Majesty’s service ;
he wears uniform, is under military discipline, and receives
pay at the rate of live shillings per day, and two shillings
f >er day for lodging money, if he be not provided with
odgings in the hospital. At the termination of the four
months he is again examined in the subjects in which he
has been instructed during that period, his marks are added
to those obtained by him at the Competitive Examina¬
tion, and his position on the list of merit determined
by the total. Successful candidates are now eligible to be
gazetted to a regiment, or employed on the staff, and
enjoy all the rank and honour, pay and privileges, of
Assistant-Surgeons, as provided by the regulations. The
official regulations will be found in another part of our
issue.
A sum of money, equal to the half-yearly interest on
£1200, the surplus from the “ Herbert Memorial,” is at
the end of each session awarded to the candidate who
has the highest number of marks ; the fortunate young
man who wins this “Blue Ribbon of Netley,” being tole¬
rably certain to be well provided for.
NAVAL MEDICAL SERVICE.
The medical department of her Majesty’s navy is at the
present moment in a condition of great depreciation. The
competition for admission to it is inadequate to the filling
up of the vacancies, and much discontent is evinced by
Home of the medical officers holding office in it. We have
not been able to satisfy ourselves that the complaints of
the disaffected are either universal in the service or well
grounded. We have knowledge of many gentlemen who
have attached themselves to the service, and express their
entire satisfaction with it, and of others who declare it to
be unfit for a gentleman’s occupancy. The special advan¬
tages of it in contradistinction to the army is that its mem¬
bers are more likely to “ see the world,” and that the
regular pay of the medical officer goes much further to¬
wards his support than in the army. We append valuable
practical information extracted from “Everything About
Them,” recently issued by Messrs. Edmonston and
Douglas. See also official regulations, page 250,
In applying to be admitted as an assistant-surgeon in
the Royal navy, it is merely required to address a letter to
the secretary of the Admiralty, stating that you are in
possession of a diploma from such a college—naming it;
that you are of the required age, stating the same; and
that you are desirous of being admitted as a candidate;
when, if there are any vacancies, you will be informed
when you will be required to present yourself at Somerset
House, London, for examination. If there should be no
vacancies you will be informed accordingly.!
For the essential qualifications, &c., see the official regu¬
lations at page 250.
Having passed your examination, you will, in the course
Of the following day, receive your appointment as acting
assistant-surgeon to one of her Majesty’s ships, either for
service on board that ship, or for service on shore, at one
of the naval hospitals—Haslar or Plymouth. You will at
the same time be informed that you are granted two or
three weeks, as you may require, leave of absence, to enable
you to provide your uniform and appointments. These
you can get at Gilliott’s, in the Strand, or at any of the
naval outfitters in Portsmouth or Plymouth.
1 At the present moment there are abundant vacancies for eligible
candidates.
The expense of an assistant-surgeon’s uniform is about
£47, 5s.
These are credit prices, but would, I presume, be con*
siderably less for ready money, a thing, by-the-by, to which
naval tailors are not much accustomed.
You must also provide yourself with a set of suTgical
instruments, which will cost you from ten to fifteen
guineas.
All kinds of underclothing, towels, handkerchiefs, &c.,
may be purchased much more advantageously from a regu¬
lar dealer in those things than from any naval outfitter.
ADVANCE OF PAY ON JOINING.
On joining your ship you will, if you wish it, be paid
what is termed three months in advance, .£'30. Of course
it is not all advance, as your pay will have been going on
from the date of your appointment.
Every article of mess traps is now furnished by the Ad¬
miralty gratis. The same with your cabin furniture; every
necessary article except bedding is supplied from the
dockyards. An officer on joining his ship has, therefore,
nothing more to pay than his mess subscription monthly.
This varies in ships according to the station they are on,
from £2,10s. to £3, 10s. per month. This subscription does
not include anything for wines or liquors of any kind.
Whatever amount of these you may consume will be paid
for by you separately, at the end of each month or quarter,
But as all wines are permitted, by sanction of the Admi¬
ralty, to be shipped free of duty, you drink them so much
cheaper on board, than you could the same qualities of
wine on shore.
The monthly subscription, of say £3, with the Govern¬
ment allowance of £11, 3s. 8d. per annum to each member
in lieu of provisions, is generally found sufficient to meet
all ordinary expenses of messing.
It is the custom in all wardroom messes to have an extra
dinner on two days of the week—generally Monday and
Thursday. The days so selected are styled “ field-days.”
It is on these days that guests are invited to dine by the
mess. The guests thus invited are called public guests,
and such invitations entail no extra subscription from any
one, except for the extra wine consumed.
It is usual to invite the captain, and any other superior
officer that may be on board, once a week; the other public
guests are so many of the junior officers of the ship; and,
if in port, officers of the sister service, and other public
functionaries.
The captain, or admiral, if there be one on board, usually
has two or three wardroom, and two or three gunroom
officers, to dine with him on every other day of the week,
than that on which he dines in the wardroom.
Any member of the wardroom mess inviting a private
friend to dine with him on board, pays usually from 2s. 6d-
to 3s. 6d. (according to the rule of the mess) for his friend *
dinner, in addition to any extra expense for wine.
The foregoing are the whole of the ordinary and extra¬
ordinary expenses of messing in the wardrooms of her Ma¬
jesty’s ships, and which should not, with drinking a reason¬
able quantity of wine, bder, &c., exceed fifty guineas per
annum.
Officers in the navy, wherever they may be serving, can
remit, by the paymaster of the ship, without any expense,
any portion, or the whole, of their pay that may be due to
them on the last day of each quarter.
SERVANTS.
Assistant-surgeons are allowed only half a servant each;
or, in other words, a servant between two of them.
These servants are entered on the ship’s books with the
rating of officer’s servant. Their pay from the Admiralty
is about £17 per annum and their provisions; and where
they are well-conducted, attentive lads, it is usual for each
of their masters to give them 10s. a month, which makes
their pay up to about £29 per annum.
This sum of 10s. monthly from the masters is entirely
gratuitous, and, of course, may be withheld at the pleasure,
or rather the displeasure, of the master.
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THE MEDICAL ASSISTANT.
September 16,1868. 247
PROMOTIONS.
An assistant-surgeon having served three years may be
examined as to his qualifications for promotion to the rank
of surgeon. If he be serving abroad he may, if he wish it,
be examined provisionally by an inspector or deputy
inspector-general and three surgeons; and as soon after his
arrival in England as may be convenient for him to present
himself at Somerset House, for his regular and final exa¬
mination.
To enable assistant-surgeons to pass this examination
satisfactorily they are granted, on application, two months’
leave of absence to prepare themselves for it.
The use of passing the provisional examination abroad
is, that the assistant-surgeon, having served five years, is
then eligible for promotion into any vacancy that may
occur, as acting-surgeon.
If the vacancy occurring shall have been caused by the
death of an officer of superior rank, this promotion as act-
ing-surgeon will be confirmed as surgeon on passing the
regular examination at Somerset House.
If the vacancy has occurred from any other cause than
that of death, the assistant-surgeon appointed to fill it,
whether he may have passed only provisionally or finally,
will be appointed only as acting-surgeon until the pleasure
of the Admiralty be known, who may either confirm him
in it, or supersede him by the appointment of a surgeon
from half-pay.
Surgeons are promoted to the rank of staff-surgeons on
twenty years’ service, provided that ten years lias been
completed since passing for the rank of surgeon.
By an Admiralty regulation dated the 12th of July, 1867,
promotion to staff-surgeon is to be open to officers for dis¬
tinguished or special services, although they may not have
completed twenty years’ service.
An officer may be promoted to the rank of inspector-
general on the completion of thirteen years’ service from
the date of his entry in the Royal Navy.
PRIZE-MONEY.
Medical officers share in the proceeds of all prizes cap¬
tured from the enemy, of captures and seizures under the
several Acts of Parliament passed relating to the revenues
of customs, and to trade and navigation, for the abolition
of the slave trade, for the capture and destruction of
pirates and piratical vessels; ana of the rewards conferred
for the same; as also in the awards of all salvage granted
to the crews of her Majesty’s ships and vessels of war, with
other officers of corresponding ranks.
THE MEDICAL ASSISTANT:
HIS DUTIES AND PRIVILEGES.
Wb avail ourselves of Mr. Baxter Langley’s kind permission
to copy from the pages of his instructive and useful little book
“ Via Medica,” such of the many hints to the student as our
space enables us to reprint. We know of no other work
which at all so well affords the class of information to which
its pages are devoted.
THE PUPrL ASSISTANT.
The pupil-assistant is usually a young gentlemen—an infant
In the eye of the law, t.c., a minor—who enters into the ser¬
vice of his employer to learn pharmacy and the manipulation
of dispensing without present remuneration, or who gives his
services in return for board and lodging with a nominal salary.
If there be any articles of apprenticeship or any such inden¬
tures contracting for service as have before been mentioned
the relations between the junior and his employer are those,
which exist under apprenticeships generally, subject to the
terms and conditions stated in the indenture itself. Whether
(here be such a contract in writing or not, the assistant, though
a minor, can sue for the necessaries or salary (if any) agreed
to be paid by his employer.
The unqualified assistant (without diploma) capable of
visiting patients, diagnosing disease, prescribing, dispensing,
attending midwifery, drawing teeth, bleeding, cupping, apply¬
ing the tourniquet, opening an abscess, dressing a wound, Ac.,
Ac., is generally a young man who has passed through his
pupilage or apprenticeship, seen something of country prac¬
tice, spent (or mis-spent) a year or two at the hospital and
medical school, and who, having limited means, desires to re¬
cruit his resources.
Qualified men (with single or double diploma) are gene¬
rally required for outdoor appointments, in w’hich the assistant
does not reside with his principal. Indeed, it may be remarked
that the tendency generally seems to be towards the employ¬
ment of gentlemen with diplomata in preference to those
without, because the employer is rendered more free to absent
himself, occasionally, if he can leave his practice in the hands
of a substitute who can legally take charge of his parochial
appointments, or, in case of accidents, give evidence before the
coroner.
Constant applications are made by gentlemen from the
“sister isle,” who, having degrees in arts, honours in medicine,
and high testimonials as to personal character, do not under¬
stand why they cannot at once obtain employment as assis¬
tants in England, in town or country practice. If they are
asked what they know of private dispensing, they reply that
they are competent to undertake anything of that kind because
they have done it at the hospital. They cannot understand that
aptitude in private dispensing—apothecary’s work—is essential
in English practice as it is at present conducted, and they are
unwilling to believe that a mere power of manipulation is an
absolute requisite if they would obtain employment here.
The prejudice against Scotchmen and Irishmen is general
and deep-rooted in England. In most cases I regard such
prejudice as unreasonable ; in some cases wholly unjust. But
there is the fact ; and it has a most important bearing upon
the probabilities that any Irishman or Scotchman will
obtain employment in England. My experience justifies me
in asserting that I have found some of the best assistants I
have ever known amongst the Irish Catholics, whom my
clients have received under protest, but who have demonstrated
by their eonduct that varieties in religious opinion do not make
much difference in man’s capacity for duty.
It is almost useless for gentlemen from Ireland and Scot¬
land seeking employment, unless they can produce testimonials
(those of college-teachers will not suffice) from persons who
know the applicants in private life, and who can give direct
evidence as to their private character and personal habits.
THE OUT-DOOR ASSISTANT.
The “ out-door assistant” is a gentleman who does not live
with the principal, but who usually resides near the house of
his employer. The term “ out-door” is not intended to convey
the idea that his duties are wholly “ extern,” but simply in¬
dicates his mode of life. The out-door assistant sometimes
lives in lodgings at his own expense, sometimes in rooms fur¬
nished and provided by the surgeon for whom he acts, some¬
times the rooms may be in the adjoining house where the
“ surgery” is, sometimes in a residence at some distance. In
the latter case there may be a “ branch practice” to be “ con¬
ducted. In all cases where the assistant resides elsewhere
than with the surgeon proportionately larger salaries are given
to compensate for extra expenses. These situations are sup¬
posed to afford greater personal freedom, but more completely
exclude the holder from pleasant society. Where a branch
practice is carried on, a separate house and surgery are pro¬
vided at the expense of the principal, who in such cases may
visit the locality only once or twice a week. Candidates for
these appointments are expected to have a double qualification,
and to be able to take sole charge of the cases entrusted to
them. No one who is not thoroughly competent in midwifery
should entertain the idea of taking a branch practice.
Assistantships, with time to attend lectures , are not un-
frequently sought after. Formerly 6uch appointments were
not uncommon, but experience has shown that they work so
badly both for surgeons and pupils that they may be said to be
almost extinct.
THE LEGAL RELATIONS OF THE PRINCIPAL AND ASSISTANT.
The engagement of an assistant may be made by word of
mouth or by writing. The usual written contract between
the parties (where apprenticeship is not intended) is an agree¬
ment of the ordinary character ; but in the case of unqualified
assistants the engagement is verbal, or made by correspondence
between the parties.
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248 The Medical Press and Circular.
THE MEDICAL ASSISTANT.
S*ptanWr:i«»U&
Arrangements are sometimes made under which assistants
are paid a certain percentage upon the fees received by the
principal for work done by bis subordinate; and often in cases
of branch practices, a proportion of the gross profits is awarded
to the assistant.
TERM OF ENGAGEMENT AND DISMISSAL.
In cases where there is no written contract with a per*
manent assistant engaged nominally for the year, and the
salary is paid weekly, it is the custom in the medical profession
to give and require a month's notice. But in temporary
engagements, such as those made for locum tenens, the invari¬
able custom is to pay by the week, the contract being termin¬
able at any time by the wish of the principal. In such cases
the gentleman employed is always expected to give reasonable
time—say seven days—to provide a successor, if circumstances
induce him to wish to resign the appointment.
The apprentice, or the “ pupil with indentures,” is bound by
the terms and conditions of his “ articles,” which are generally
to the effect that A.B., the pupil, will serve C. D., the principal,
for a certain term of years without salary ; C. D. in return
providing A. B. with board and lodging, and instructing him
in the business or profession of surgeon and apothecary. In
these cases the contract between the parties cannot be termi¬
nated except upon the conditions stated in the deed.
In-door assistants, whether qualified or not, can be dismissed
by a month’s notice at any time, or by the payment of a
month's salary by the principal; the assistant, however, who
leaves without giving a month’s notice is liable to summary
punishment by a magistrate, nor would the tender of a month’s
salary in lieu of notice relieve him from this liability to
punishment; moreover, he would also forfeit all claim to any
salary.due to him from his principal for any services rendered
previous to his leaving.
The out-door assistant, if resident in a house or lodgings
furnished and provided by his employer, can in like manner
be dismissed or terminate his engagement by a month’s notice ;
but if the assistant provide himself with lodgings, furnished by
himself by the wish or with the consent of his principal, the
engagement cannot be terminated except by three months’
notice or equivalent salary, and this notice may be given at
anytime.
The services of gentlemen engaged for special services and
temporary duties may be terminated without notice unless
there is a special understanding that the engagement is for
one day a-week, or four weeks.
LEGAL OBLIGATIONS ON THE ASSISTANT.
Every assistant is bound by law to obey all the lawful and
reasonable orders of his employer, and to be honest and dili¬
gent in the professional duties required from him; he is
required also to pay proper respect to the principal. But a
medical assistant could not be lawfully dismissed for refusal
to groom a horse, work in the garden, or perform any other
occupation of a menial and unprofessional character. He is
bound to take care of the property entrusted to him, and, if
guilty of gross negligence, will be liable to an action.
Where an assistant is engaged on account of his fitness to
perform certain duties (such as “ to visit, dispense and attend
midwifery”) and turns out to be perfectly incom patent to do
any one of these things, the principal will be justified in
rescinding the contract at once, and discharging the assistant;
and it would be of no avail for the latter to prove his “ quali¬
fications” in the highest walks of his profession, if he were in¬
competent to perform those duties which he proposed to be
able to do.
Temporary illness will not afford justification to the princi¬
pal to terminate the assistant’s engagement; but if the latter
be attacked with such illness as would render it impossible for
him to return to his duties for a month or more, it is very
commonly held in the profession (mos pro lege) that the en¬
gagement may be terminated by the payment of two weeks’
salary and the expenses of the transit of the assistant either
to his home or to the spot from whence he was engaged. .
TRAVELLING EXPENSES.
It is customary for the travelling expenses of an assistant to
be paid “ one way” by the principal, it being assumed that he
goes to the appointment for the convenience of his employer,
but leaves it for his own. Hence, the travelling expenses are
allowed (second-class) to the principal’s house, and are paid
irith the first month's salary. The assistant on leaving,
whether by notice on his own part or 'that of the employer,
pays his own travelling expenses. There are certain limit* to
this rule, however. For example, an assistant resident in
Aberdeen and engaged by a surgeon at Plymouth would not be
allowed his travelling expenses for the whole distance, but an
equivalent to the amount he would have paid from London—
i.e.f second-class railway fare, and a reasonable allowance for
cab and expenses en route. As a general rule, where the db*
tance between the parties is greater than from London to the
surgeon’s residence, the employer is not expected to pay a
greater amount than travelling expenses from London.
It is the duty of the principal to pay the assistant the salary
agreed upon at the periods arranged between the parties. But
the engagement must be clear and binding, or else the assistant
will have no remedy against his employer for default. And
where a stipulated salary has been agreed upon, no additional
remuneration can be claimed for services beyond those agreed
to be given, unless it is possible to prove a contract, expressed
or implied, for such additional services.
An assistant rightfully discharged has no claim for salary,
which might otherwise have been due to him..
One of the common fallacies is that an a s si sta nt who has
conducted himself with propriety can demand a t e s timoni al to
that effect. # ,
There is, however, no legal obligation upon a principal who
has engaged an assistant to give the party so employed any
testimonial on dismissal, and no action will lie against any
principal refusing to do so or to become a reference.
In making application for an assistant to a professional
agent, the principal usually asks only for an introduction to
gentlemen requiring appointments ; but he should always state
fully what he requires, and what special prohibitions he has
to make. Thus, he should explain whether the assistant is in
be qualified or unqualified, in or out-door, and, if the latter,
whether married or single ; whether be must be able to ride
and drive, attend midwifery, dispense, keep books, and accus¬
tomed to club and union practice ; whether he objects to any
particular religious views, or has any preference for Protestants
or Catholics, Dissenters or Churchmen, Ac., Ac. In addition to
this, he should also name the salary proposed to be given, and
the approximate age which would be most satisfactory, Ac,»
Ac., Ac.
SHIP APPOINTMENTS.
No honest agent desires to take payment for work which ho
cannot do, and that being the case, the agent who can do what
is required of him does not demand payment beforehand ; he is
content to be paid for services rendered. If an assistant on
application to an agent be told that the fee must be paid in
advance, he had better not pay at all. Persons, professing to
be captains of ships, occasionally advertise that they can seems
appointments for young surgeons on vessels belonging to the
best “ lines,” and when their victims call they are induced to
pay from half a guinea to two pounds to secure the good offices
of the pseudo-captain ; but they never getthe appointments,
and rarely recover back what they have paid.
Apropos of ship appointments, they are mostly secured by
private interest; those under the Commissioners of Emigrate*
are subject to great competition ; the Peninsular and Oriental
Company’s appointments are still more eagerly sought^and
are, therefore, more difficult to secure ; next, perhaps, m order
might be placed some of the private firms, and the American
packets. The Boy&l Mail service is more accessible, because
all the new appointments are made to the West India station^
from which the medical officers are promoted to other and
more eligible stations. Some very respectable agents g* Tf
their special attention to such appointments.
SALARIES.
The junior assistant, who can dispense only, will not earn
more than £30 a year, with board and lodging ; under scan®
circumstances, if time be allowed for reading, he will beM*
pected to give his services. The unqualified indoor asaiitaBt
who can visit, dispense, attend midwifery, and assist in keep®#
the books, will be able to get from £40 to £45; and n»
specially good man of experience, Ac., may obtain £55 or £W.
A qualified indoor assistant, able to take the general respon¬
sibilities of ordinary practice, with dispensing, Ac., can g«J*"
rally obtain at first £50 or £60 (with board and lodging) ) * **”
afterwards in proportion to his merits, £70 or even
I have known exceptional cases in which £120 a
board and residence, has been given to a favourite asririwia
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Hie Medical three* and Circular.
THE ARMY MEDICAL DEPARTMENT.
September ld f 1868. 249
u Gut-door assistants” obtain larger salaries, but have to pay
the expenses of their own maintenance and lodging ; thus non*
resident unqualified men who would receive £40 indoor will
obtain about £70 outdoor.
Doubly-qualified assistants are almost always now required
for out-door appointments, particularly for branch practices
where, perhaps, the assistant lives at some distance from the
principal, and may be called upon to hold parochial appoint¬
ments, give evidence before the coroner’s inquest, or at the
assises. The salaries range in such cases from £100 a year
without a house, to £150 a year with a house, attendance, &c.,
provided by the principal; in rare cases, where colliery ap¬
pointments are held by the assistant, a house with attendance
is provided, and £200 salary allowed.
-♦-
THE ARMY MEDICAL DEPARTMENT.
1. Every candidate must be unmarried, and not under 21
nor over 28 yean of age. He must produce a birth certificate
from the district registrar, or an affidavit from a near relative
will be accepted. He must also produce a certificate of moral
character from the parochial minister if possible.
2. The candidate must make a declaration that he labours
under no disease, imperfection, or disability. 1
3. The candidate must be registered under the Medical Act.
4. Certificates of registration, character, and age must ac¬
company this schedule when filled up and returned.
5. Candidates will be examined in Anatomy and Physiology,
Surgery, Medicine, including Therapeutics, diseases of women
and children, Chemistry and Pharmacy, and knowledge of
drugs. (The examination will be in part practical, and will
include operations, the application of surgical apparatus, and
the examination of patients at the bedside.) The eligibility of
each candidate will be determined by examination in these
subjects only. Candidates who desire it will be examined in
Comparative Anatomy, Zoology, Natural Philosopy, Physical
Geography, and Botany, with special reference to Materia
Medics, and their marks will be added to the marks obtained
in the obligatory examination, and the candidates’ position on
the list will thus be improved.
& After passing, every candidate must attend practical
instruction at the Army Medical School, Netley, on (1)
Hygiene, (2) Clinical and Military Medicine, (3) Clinical and
Military Surgery, (4) Pathology of Diseases and Injuries in¬
cident to Military Service.
7. At its conclusion, the candidate must pass an examina¬
tion on the subjects taught in the school.
See practical information under “ Public Services.”
Examination of A ssistant-Suryeons previous to Promotion.
This examination may be taken at any time after the
Anstant-Surgeon has served five years.
A series of printed questions will be sent by the Director-
General to the principal medical officers of stations where
Asri s t a n t-Surgeons may be serving, who will deliver these
sealed questions to the Assistant-Surgeons, and to see that they
are answered without the assistance of books, notes, or com-
munioation with any other person. The answers are to be
«gned, and delivered sealed to the principal medical officer,
"ho is to send them, unopened, to the Director-General,
together with a certificate from the Surgeon of the Regiment,
or other superior Medical Officer, that the Assistant-Surgeon
baa availed himself of every opportunity of practising surgical
operations on the dead body.
The Assistant-Surgeon will also be required to transmit a
Medico-Topographical account of the station where he may
happen to be, or of some other station where he may
have been resident, or else a Medico-Statistical report of hi
rc rimeat for twelve months.
If, the Examining Board and the Director-General are
"fttitfed with the certificates and answers, and with the report,
*he Ajttstant-Sorgeon will beheld qualified for promotion.
physical fitness will be determined by a board of medical
Who are required to certify that the Candidate’s vision is suffi-
°* jwa | 0 sd to enable him to perform any surgical operation without
apLjpf adames. A moderate degree of Myopia would not be oonsi-
Uj tosHflwifo p. provided it did not necessitate the use of
pro # 1 t&e pvrormanoe of operations, and that no organic
R g sysssr^ -
ROYAL WARRANT FOR FAY AND NON-EFFECTIVE FAT OF
MEDICAL OFFICERS.
1. The daily rates of pay shall be as follows :—
Medical Staff.
^ay.
Daily.
£ s. d.
Inspictor-General . . ,200
Deputy Inspector-General . . 1 10 0
Surgeon-Major . . . • . 14 0
After 25 years’ service . . .17 0
Surgeon . . . . , 0 17 6
After 15 years’ service . . .10 0
Assistant-Surgeon, on appointment . 0 10 0
After 5 years’ service . . . 0 12 6
„ 10 . . 0 15 0
„ 15 „ . . . 0 17 6
Apothecaries.
Apothecaries . . . .090
After 5 years’ service . * . 0 10 6
„ 10 „ . . 0 12 6
„ 20 „ . . . 0 15 0
„ 25 . . 0 16 6
„ 30 „ . . . 0 18 0
2. Every Candidate for a Commission as Assistant-Surgeon
shall be unmarried, and shall possess such certificates as would
qualify a civilian to practise Medicine and Surgery ; and be¬
fore receiving a Commission shall pass an examination in Mili¬
tary Medicine, Surgery, Hygiene, and Pathology, after attend¬
ing the authorised course in a General Military Hospital.
3. An Assistant-Surgeon shall pass such examination as our
Secretary of State for War may require, and shall have served
on full pay with the Commission of Assistant-Surgeon for five
years, of which two Bhall have been passed iu or with a Regi¬
ment or Depot Battalion, before he can be promoted to tne
rank of Surgeon.
4. Assistant-Surgeons shall, as a general rule, be promoted
to the rank of Surgeon in the order of their seniority in the
service. In cases of distinguished service, however, an Assis¬
tant-Surgeon may be promoted without reference to seniority ;
and in such cases, the recommendation detailing the services
for which the Officer is proposed for promotion shall be pub¬
lished in the General Orders and in the Gazette.
10. Good service Pensions shall be awarded under such
regulations as shall be from time to time determined. Six of
the most meritorious medical officers of our army, shall be
named our Honorary Physicians, and six our Honorary Sur¬
geons.
11. Medical officers shall have the right to retire on half¬
pay after 20 years’ service ; Surgeons-Major, Surgeons, or
Assistant-Surgeons, shall be placed on the retired list at the age
of 55, and Inspectors-General and Deputy Inspectors-General
at the age of 65.
14. An Apothecary shall have the right to retire on half¬
pay after 30 years’ good service.
Service on the West Coast of Africa.
15. A Medical Officer volunteering for service on the West
Coast shall serve on the Coast for a period of at least twelve
months, and shall be governed by the following regulations
16. Each year reckons towards premotion and retirement as
two yeare’ of service, but it shall not so reckon towards increas¬
ing pay, or qualification for the rank of Surgeon-Major. If an
Officer shall be permitted, at his own wish, to prolong his stay
on the Coast, his further service shall be allowed to reckon in
proportion.
17. For each year’s service on the Coast, a Medical Officer
shall be entitled to a year’s leave at home, and for every ad¬
ditional period beyond a year he shall have an equivalent ex¬
tension of leave.
NON-EFFECTIVE PAY.
18. A Medical Officer placed on half-pay by reduction of
establishment, or in consequence of ill-healtn, or age, shall bo
Inspector-General
After 30 years’ service
. 1 17
&
,, 26
II
. 1 13
0
„ 20
II
. 1 10
0
Deputy Inspector-General 80
)}
. 1 5
6
Surgeon
„ 15
II
. 0 13
6
ii
„ 10
II
. 0 11
0
Assistant-Surgeon
10
11
» 0 10
0
i> »
o
II
. 0 8
0
n n
under 6
ft
• 0 6
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250 The Medical Press and Circular.
UNIVERSITY OF OXFORD.
September 16,1866.
19. The rate of half-pay awarded to officers retiring for their
own convenience, after twenty years’ service, shall not exceed
one-half of their full pay at the time of retirement.
20. Ev£*y Medical Officer who shall retire after service for
25 years, shall be granted half pay equal to seven-tenths of his
pay, provided he shall have served three years in his rank or
abroad for ten years, or for five years with an army in the
field. An officer of 25 years’ service, whose service falls within
neither of these conditions, shall be entitled to only seven-
tenths of the pay he was in receipt of prior to last promotion.
*23. An Apothecary shall be granted pay at the following
daily rate, if placed on half pay by reduction of establishment,
or on account of age, or through ill health.
Apothecary to the Forces, after 30 years’ service, 9s. a-day.
„ » )» 25 j> 5 s ’ ”
„ „ » 20 „ „
,, 15 „ Os. „
„ 10 „ 5s. „
NAVAL MEDICAL DEPARTMENT.
1. A CANDIDATE for entry into the Royal Navy shall make a
written application, addressed to the Secretary of the Admir¬
alty; on the receipt of which he will be furnished with the
regulations and a printed form, to be filled up by him, to show
if he possesses the required qualifications.
2. As vacancies occur, the candidates will be ordered to at¬
tend at the Admiralty Office on the first Tuesday in alternate
months ; but no person can be admitted as an Assistant-Sur¬
geon unless he can produce evidence that his name has been
placed on the Medical Register as legally qualified to practise
both medicine and surgery. And further, he will be required
to make a declaration that ho is free from any mental or (
bodily disease, defect, or infirmity which could interfere with
the efficient discharge of his duties as a Medical Officer in the
navy.
3. Each candidate must produce a certificate of good moral
character, signed by the clergyman or magistrate of the district.
4. That he is not less than twenty nor more than twenty-
eight years of age.
6. That he has received a preliminary Classical Education.
6. That subsequently to the age of eighteen he has actually
attended a hospital for eighteen months, in which the average
number of patients is not less than 100.
7. That he has been engaged in actual dissection for twelve
months, and that he has performed the principal capital and
minor operations on the dead body under a qualified teacher.
The certificates of Practical Anatomy must state the number
of subjects or parts dissected by the candidate.
8. On producing the above certificates he will be examined
before a Board of Naval Medical Officers on the following sub¬
jects, viz.:
Anatomy.
Surgery.
Physiology, or Institutes of Medicine.
Practice of Medicine.
Chemistry.
Materia Medica.
Midwifery.
Botany.
lated five years’ service, may be granted two months’ leave of
absence on full pay on condition of their resuming their studies
at a Medical School or hospital.
13. A limited number of those candidates, who pass the
best examination on entering the service, shall be promoted
annually to the rank of Surgeon at an earlier period than would
occur under ordinary circumstances, as follows:—
The candidate who passes the best examination of his year-
after five years’ service.
The candidate who passes the second best examination—
after six years’ service.
The candidate who passes the third best examination—after
seven years’ service.
Provided, however, that their second examinations are
passed in an equally creditable manner, and that their conduct
has in all respects been satisfactory.
EXTRA PAY AND ALLOWANCES.
The following extra pay and allowances are paid to
naval medical officers under the conditions stated below:—
9. Although the above are the only qualifications absolutely
required, a favourable consideration will be given to the degree
of M.D. from a university,%r to those, who, by possessing a
knowledge of the diseases of the eye, or of any branch of
science, such as Medical Jurisprudence, Natural History, and
Natural Philosophy, appear to be more peculiarly eligible for
admission into the Service, observing, however, that lectures
on these or any other subjects cannot be admitted as com¬
pensating for any deficiency in those required by the Regula-
tions. .
10. Candidates found competent, will be forthwith Domin¬
ated to one of Her Majesty’s Ships, or to a Naval Hospital at
home ; or should their services not be immediately required,
their names will be duly registered for early appointments as
vacancies may occur. But candidates admitted into the Naval
Medical Service must serve in whatever ship they may be
appointed to; and that in the event of their being unable to
do so from sea-sickness, their names cannot be contiuued on the
Naval Medical List, nor can they, of course, be allowed half-
pav .
11. No Assistant-Surgeon can be promoted to the rank of
Surgeon until he shall have served five years, two in a ship
actually employed at sea, after which he will be required to
pan an examination before a Board of Naval Medical Officers.
}2. Assi stant-Surgeons at home, after completing the Bt pu«
At Home. Abroad.
Inspectors-Gencral, in lieu of provisions for their )
servants, and of the ordinary allowance for > £64 £130
provisions for themselves ... ... ...)
Deputy Inspectors-Gentral, Staff-Surgeons, and |
Surgeons, do. do. ... )
Assistant-Surgeons, do. do. ... £30 £108
Staff-surgeons, when serving in flag-ships on foreign
stations, are allowed extra pay of five shillings per diem.
Staff-surgeons, surgeons, and assistant-surgeons, when
serving in ships in which there is no accommodation for
residing on board, as in drill-ships for the Royal Naval
Reserve, are allowed £50 per annum for lodgings, and one
and sixpence per diem in addition, in lieu of ship’s rations.
Whenever medical officers are employed on extra duty,
they are allowed such extra pay as it may appear to the
Lords Commissioners of the Admiralty the nature of the
service merits.
Medical officers, when travelling on the public service,
are allowed on the home stations—in addition to all ex¬
penses of first-class fare by rail or otherwise—for subsis¬
tence:—
Special Service D itto
occupying for every
12 hours. 24 hours.
Inspectors-Gencral and Deputy In- | £o 12 0 £10 0
spectors-General ... ... ) *
Staff-Surgeons and Surgeons ... 0 7 6 at*
Assistant-Surgeons ... ... 060 0 7 0
PENSIONS OF MEDICAL OFFICERS.
Besides the half-pay awarded to medical officers, there
are three good-service pensions of 10s. each per diem
awarded to the three inspectors-general, who have com¬
pleted the longest and most meritorious services.
There is also one Greenwich Hospital pension of X80 per
annum awarded to a deputy inspector-general.
There are fourteen other Greenwich Hospital pensions
of £50 each per annum, awarded to those fourteen deputy
inspectors-general, staff-surgeons, and surgeons who are
considered by the Admiralty to be most deserving of them.
Ivcplatkttf aidr
of prmsmg §obics m (Swjlauit
UNIVERSITY OF OXFORD.
The affairs of the University are managed, and its wgul**
tions are made, either by a Convocation consisting of ^1 Doc¬
tors in Divinity, Law, and Medicine, and Masters of Arts,
by the resident Doctors and Masters, or by the Council.
There are 24 Colleges and Halls in Oxford. Every studens
must reside for three years. v
During these three years, he has to pass at
animations in Arts, and one in either Mathematics, INatunu
Science, or Law and Modern History, or a third in
A Student deciding to graduate in Medicine should proceea.
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The Medical Preaa and Circular.
UNIVERSITY OF CAMBRIDGE.
September 16,1868. 251
1st. To enter at a College or Hall.
2nd. Or reside in lodgings.
3rd. To pass the requisite Examination in Arts.
4th. After passing the Examination for the degree of B.A.,
to spend two years in study prior to Examination for
Bachelor of Medicine ; and two years more prior to the
final or practical Examination for the same Degree.
These four years of medical study may be spent in any
approved Medical school.
This Degree confers the Licence to Practise. There is no
subsequent Examination for the Degree of Doctor in M edicine.
A dissertation has to be publicly read three years after the
B.M.
The Medical Examinations take place annually in the
Michaelmas Term.
Scholarships of about the value of £75 are obtainable at
Christ Church, Magdalen, and other Colleges by competitive
Examination in Natural Science. Every year a Radcliffe
Travelling Fellowship is* competed for by any who, having
taken a first-class in the Natural Science School, propose to
study medicine. The travelling Fellows receive £200 a-year
for three years, half this period being spent in study abroad.
Regulation for Degrees in Medicine,
No one can become a Bachelor of Medicine unless he has
passed all the examinations required for the degree of B.A.,
and has also spent four years, not necessarily in Oxford, in scien¬
tific and professional study, after the last classical examination.
1. Candidates for the B.M. must pass two examinations,
each of which is held yearly, usually in November, the first by
the Regius Professor of Medicine and three Masters of Arts
or Doctors, nominated yearly by the Vice-Chancellor, the
second by the Regius Professor and two Doctors of Medicine.
Each examination is conducted partly in writing, partly viva
race , and part of each is practical. The subjects of the first
examination are Human Anatomy and Physiology, Com¬
parative Anatomy and Physiology, to a certain extent, and
those parts of Mechanical Philosophy, Botany, and Chemistry,
which illustrate medicine. Those of the second are the Theory
and Practice of Medicine (including diseases of women and
children) the Materia Medica, Therapeutics, Pathology, the
principles of Surgery and Midwifery, Medical Jurisprudence,
and General Hygiene. Every candidate at this second is
examined in two ancient authors, Hippocrates, Aretaeus, Galen,
and Celsus, or in one of those four and in some modern author
approved by the Regius Professor.2
Before a candidate is admitted to the first examination, he
must have completed eight terms from his Becond public exa¬
mination for the degree of B.A, unless he was placed in the
first or second class in natural science, in which case, if he re¬
ceived from the public examiners a special certificate in
Mechanical Philosophy, Chemistry, or Botany, he may be
admitted to this examination at once, and need not then be
examined again in any science specified in such certificate, or
if he have taken up an increased amount of classical work at
moderations he may then count his scientific studies from the
date of that examination, provided always he obtain honour
in the Natural Science School. Before a candidate is admitted
to the second examination, he must have completed sixteen
terms from the date of the same Testamur , and two years from
the first medical examination, and must deliver satisfactory
certificates of his attendance at some hospital. Every candi¬
date at either examination is required to give the Professor
notice a fortnight at least before the examination.
No one from another university can be incorporated as a
Graduate in Medicine without passing these two examinations.
2. A Bachelor of Medicine wishing to proceed to the degree
of doctor is required to read publicly, in the presence of the
Regius Professor, a dissertation composed by himself on some
medical subject approved by the professor, and to deliver to
him a copy of it.
UNIVERSITY OF CAMBRIDGE.
THE DEGREE OF BACHELOR OF MEDICINE.
A 8tudent proceeding to this degree must
1. Reside in the University two-thirds of each term (fornearly
three years).
% Pass the previous examination.
3. Pursue medical study for five years ; unless he has ob¬
tained honours, in which case four only are required.
Of these five years he must spend six terms in medical study,l
unless he has obtained honours, in which case four only are
required.
A Btndent who has not graduated in Arts must, in addition
to passing the previous examination, pass in Algebra.
There are three examinations for the degree of M.B., partly
written and partly viva voce. The examination includes che¬
mical analysis, description of specimens (healthy, morbid, and
microscopical), dissections, and examination of patients.
They take place in Michaelmas and Easter Terms ; an in¬
terval of two days Intervening between the first and second
examinations.
The subjects of the first examination are—1. Mechanics
and Hydrostatics. 2. Chemistry with Heat and Electricity.
3. Botany.
The student may present himself at any time after passing
the previous examination. He must produce certificates of
lectures on Chemistry, including manipulations, and one course
on Botany.
The subjects of the second examination are—1. Compara¬
tive Anatomy. 2. Human Anatomy and Physiology,
3. Pharmacology.
The student must have completed two years of medical
study, the time of medical study required to be spent in the
university being included He must have attended hospital
practice during one year, have practised dissection during one
season, and must produce certificates of lectures on—1. Ele¬
ments of Comparative Anatomy. 2. Human Anatomy and
Physiology. 3. Materia Medica and Pharmacy. 4. Patho¬
logy.
The subjects of the third examination are—1. Pathology
and the Practice of Physio (two papers). 2. Clinical Medi¬
cine. 3. Medical Jurisprudence.
The student must have completed medical study and atten¬
ded hospital practice during three years, and must produce
certificates of one course of lectures on—1. Principles and
Practice of Physic. 2. Clinical Medicine. 3. Clinical Surgery.
4. Medical Jurisprudence. 5. Midwifery.
After these examinations have been passed, an act must be
kept in the schools in the following manner :—
The Professor of Physic assigns the day and hour for keep¬
ing the Act, of which public notice has to be given eight days
before. The candidate reads a thesis, composed in English by
himself on some subject approved by the professor ; the pro¬
fessor brings forward arguments or objections in English for
the candidate to answer, and examines him in English viva
voce as well as on questions connected with his thesis as on other
subjects in the faculty of a more general nature. The exer¬
cise must continue at least one hour.
THE DEGREE OF DOCTOR OF MEDICINE
May be taken by a Bachelor of Medicine on the commence¬
ment day next following the admission to the degree. He is
required to produce certificates of five years’ medical Btudy,
to write an extempore essay, and to keep an act similar to that
for M.B. He pays ten guineas to the Professor of Physic for
this Act.
THE DEGREE OF MASTER IN SURGERY.
The subjects are—1. Surgical Anatomy. 2. Pathology and
the Principles and Practice of Surgery. 3. Clinical Surgery.
4. Midwifery.
The candidate must have passed all the examinations for the
M.B., and must produce certificates of the surgical practice
of a hospital for three years, of having been house surgeon or
dresser for six months, and of having attended—1. A second
course of Lectures on Human Anatomy. 2. One on Surgery.
8. One year on Clinical Surgery. 4. Ten cases of Midwifery,
5. Dissection during a second season.
The examination takes place at the same time as those for
M.B., and in a similar manner. The candidate is required to
perform operations and to examine patients in hospital.
Each candidate sends three guineas to the professor, with
the notice of his intention to offer himself for the first exami¬
nation.
The expenses of residences, lectures, &c., at College— i.c. f
in the University, need not exceed £150 per annum. That ia
quite sufficient; and an intelligent student, who has been well
1 If he have taken the higher honours in the Natural Science School,
he may go in for the 1st M.B. Examination on the first opportunity.
2 Such modem authors are Morgagni, Sydenham, Boerhaave.
1 By attending, in each term, courses of lectures delivered in the
University on two subjects, or by attending one course and the medical
practice of Addenbrooke’s Hospital.
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2
252 The Medical Press and Circular.
UNIVERSITY OP LONDON.
September 16, 1866.
»ught at school, may be pretty sure of defraying part of the
expense by obtaining one of the many scholarships at his Col¬
lege. These range in value from £20 to £80 a-year. They
are chiefly given for mathematical and classical proficiency.
Some may be obtained at once ; even before entering, and
notices of the times of examination for these, which vary at
the different colleges, Are given from time to time under the
head “University Intelligence,” in the Times and other news¬
papers, and information respecting them is forwarded to most
schoolmasters. Students sometimes try for these scholarships
at several colleges in succession. At Downing and Sidney
Colleges the examination is not confined to Classics and Ma¬
thematics, but Natural Science is taken into account. The
greater number of the Scholarships are given by competition,
after a year’s residence.. One at Cains is given for Anatomy,
another for Chemistry. One at Trinity, one at St. John’s, and
one at St. Peter’s for Natural Science.
UNIVERSITY OF LONDON.
The medical degrees of this university have now obtained
a reputation second to none, and no student can therefore
propose to himself a higher qualification. The training is
rather longer than that required for the college and hall
combined, or for the diploma of the two Royal Colleges.
The examinations are very stringent, and it is in after
years that the student will feel the gratification of having
obtained such a degree. Every student is required to go
through the full course of hospitial studies after he has
passed the matriculation examination. It is, therefore,
veiw desirable he should matriculate before entering a
medical school, otherwise two years will be lost. The
matriculation examination of this university is accepted as
a preliminary by the Medical Council, and therefore the
labour bestowed in preparation will serve the student’s
purpose even if he do not proceed to a degree. The
medical degrees of the university are Bachelor and
Doctor of Medicine, and Bachelor and Master in Surgery.
Degrees of Bachelor and Doctor of Science are also now
obtainable. There are, at each stage of the graduate’s
career, examinations for honours, which afford the student
the opportunity of gaining highly prized distinctions in
various branches. There are also scholarships for the most
successful.
EXAMINATION FOB THE DEGREE OP BACHELOR OP MEDICINE.
Candidates are required—1. To have passed the matricula¬
tion examination of this University, or to have taken a degree
In Arts in some other University, of the United Kingdom.
2. To have been engaged in their professional studies four
years subsequently to matriculation ; one year, at least, of
the four in the United Kingdom. 8. To pass the preliminary
Scientific Examination and two in Medicine.
The Preliminary Scientific Examination takes place on the
third Monday in July. The candidate must have completed
his seventeenth year, and have either passed the Matriculation
Examination or taken a degree in Arts.
Fourteen days' notice must be given to the registrar pre¬
vious to the examination. Fee £5, which is not returned on
rejection.
The examinations shall be conducted in the following
order:—
Monday — Morning, 10 to 1; A ftemoon , 3 to 6, chemistry, by
printed papers. Wednesday. — Morning , 10 to 1, Mechanical
Philosophy, by printed papers; Afternoon , 3 to 6, Natural
Philosophy, by printed papers. Thursday. — Morning . 10 to
1, Botany and Vegetable Physiology, by printed papers and
specimens; Afternoon , 3 to 6, Zoology, by printed papers and
specimens. Friday and Saturday. — Commencing at 10 A.M.,
Chemistry, by vivd voce and experiment.
Any candidate who has passed the Preliminary Scientific
Examination may, on the Tuesday and Wednesday in the
second week after the pass examination, be examined for
Honours in Chemistry and Natural Philosophy, and on the
following Thursday and Friday in Botany and Zoology.
FIRST M.B. EXAMINATION
Commences on the last Monday in July.
A candidate must produce certificates to the following
effect:—1. That he has completed his nineteenth year. 2.
Passed the Preliminary Scientific Examination at least one
year previously. 3. Been a student subsequently to Matricu¬
lation during two years at a recognised medical school ; and
that he has attended a course of lectures on three of the sub¬
jects in the following list:—Descriptive and Surgical Anatomy,
General Anatomy and Physiology, Comparative Anatomy,
Pathological Anatomy, Materia Medica and Pharmacy, Gene¬
ral Pathology, General Therapeutics, Forensic Medicine,
Hygiene, Midwifery and Diseases peculiar to Women and
Iufants, Surgery, Medicine. 4. That he has subsequently to
Matriculation dissected during the two winter sessions. 5.
Attended a course of Practical Chemistry, comprehending the
more important processes of General and Pharmaceutical
Chemistry ; the presence and nature of poisons ; the examina¬
tion of mineral waters, animal secretions, urinary deposits,
calculi, &c. 6. That he has attended to practical Pharmacy.
These certificates must be transmitted fourteen days before
the examination. Fee £5, not returnable on rejection.
The examinations Bhall be conducted in the following
order :—
Monday. —Morning , 10 to 1, Afternoon , 3 to 6, Anatomy,
by printed papers. Tuesday. — Morning , 10 to 1, Organic
Chemistry, by printed papers; Afternoon, 3 to 6, Materia Medica
and Pharmaceutical Chemistry, by printed papers. Wednes¬
day.- Morning , 10 to 1, Physiology, by printed papers.
Monday and Tuesday in the following week, commencing at
10 A.M.—Anatomy, by vivd voce. Demonstration from Prepara¬
tions and Dissection ; Physiology, by vivd roce and Demon¬
stration from Preparations ; Materia Medica, Pharmaceutical
Chemistry and Organic Chemistry, by vivd voce , Experiment,
and Demonstration from Specimens, including Medicinal
Plants.
The examinations for Honours take place in the week fol¬
lowing the First M.B. Examination, and are conducted by
means of printed papers.
SECOND M.B. EXAMINATION.
This examination commences on the first Monday in No¬
vember.
No candidate is admitted within two academical years of
the time of passing the first examination, nor without produc¬
ing certificates :—1. Of having passed the first M.B. examina¬
tion. 2. Of having subsequently attended a course of lectures
on two more of the subjects specified. 8. Of having conducted
twenty labours. 4. Surgical hospital during two years, and
lectures on clinical surgery. 5. Medical hospital two yetCn,
with lectures on clinical medicine. 6. Of having, subsequently
to hospital practice, attended to practical medicine, snigery, or
midwifery, with special charge of patients, in an hospital, in¬
firmary. dispensary, or parochial union, during six months.
Certificates of moral character from a teacher in the last school
at which candidates have studied. Fee £5.
The examinations shall be conducted in the following
order:—
Monday. — Morning , 10 to 1, Midwifery, by printed papers;
Afternoon , 3 to 6, General Pathology, General Therapeutic*,
and Hygiene, by printed papers. Tuesday. — Morning , 10
to i, Surgery, by printed papers ; Afternoon , 3 to 6, Medicine,
by printed papers. Wednesday. — Morning , 10 to 1, Forensic
Medicine, by printed papers; Afternoon , 8 to 6, Practical
Examination on Obstetric Preparations and Apparatus.
Thursday, commencing at 10 a.m. —Practical Examination in
Forensic Medicine. Friday. —Examination, and Report on
Cases, of Medical Patients in the Wards of a Hospital. Mon¬
day in the following week, commencing at 10 a.m. — Vivd roce
Interrogation, and Demonstration from Specimens and Pre¬
parations.
jV.R.—Candidates will be expected to write prescriptions m
Latin, without abbreviations.
BACHELOR OP SURGERY.
The examination for the degree of Bachelor of Surgery
takes place once in each year, and commences on the Tuesday
following the fourth Monday in November. A candidate is
admitted to this examination on producing certificates to the
following effect :—Of having taken the degree of Bachelor of
Medicine in this University. Of having attended a course of
instruction in operative surgery, and of having operated on the
dead subject. These certificates must be transmitted to the
registrar at least fourteen days before the examination
The fee for this examination is £5.
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The Medical Press and Circular.
COLLEGE OF PHYSICIANS, LONDON.
September 16,1838. 253
The ex am i n ations shall be conducted in the following
order ;—
# Tuesday, Afternoon, 3 to 6.—Surgical Anatomy and Sur¬
gical Operations, by printed papers. Thursday.—E xamina¬
tion, and Report on Cases, of Surgical Patients. Friday,
commencing at 1 p.m. —Performance of Surgical Operations
upon the Dead Subject; Application of Surgical Apparatus ;
Vii d voce Interrogation.
MASTER IN SURGERY.
The examination takes place the fourth Monday in Novem¬
ber.
Candidates admitted to this examination must produce cer¬
tificates :—1. Of having taken the degree of Bacnelor of Sur¬
gery.! 2. Of having attended, subsequently to having taken
the degree of Bachelor, (a) to Clinical Surgery two years in a
hospital; (b) to Clinical Surgery one year, and of three years
in the Practice of his Profession ; (c) of five years in the
Practice of his Profession. 3. Of Moral Character.
The examination shall be conducted by means of printed
papers and vied voce interrogation.
The examinations shall be conducted in the following
order :—
Monday.— Morning , 10 to 1, Logic and Moral Philosophy,
by printed papers ; Afternoon , 3 to 6. a Commentary on a
Case in Surgery, by printed papers. Tuesday.— Morning, 10
to 1, Surgical Anatomy, by printed papers ; A fternoon , 3 to
6, Surgery, by printed papers. Th UBSDAy.—E xamination, and
Report on Cases, of Surgical Patients in the Wards of a Hos¬
pital. Friday, at 1 p.m. —Dissection of a Surgical Region, or
performance of Surgical Operations ; Vied vocc Interrogation.
The candidate who shall distinguish himself the most in
Surgery shall receive a gold medal of the value of twenty
pounds.
Any candidate who has passed the B.S. examination may
be examined for honours in Surgery on Tuesday in the week
following the commencement of the pass examination.
If in the opinion of the examiners sufficient merit be evinced
the candidate who distinguishes himself the most shall receive
£50 per annum for the next two years, with the style of Uni¬
versity Scholar in Surgery. The first and second candidates
shall also receive a gold medal of the value of £5.
DOCTOR OF MEDICINE.
The examination is on the fourth Monday in November.
No candidate shall be admitted without certificates :—1.
Of having taken the degree of Bachelor of Medicine in this
Univereity. 2. Of having attended, subsequently, («) to
Clinical or Practical Medicine two years ; ( b) to Clinical or
Practical Medicine during one year, and of having been en¬
gaged during three years in the practice of his profession ; (c)
or of having been engaged during five years in the practice of
his profession, either before or after taking the degree. One
year of Clinical Medicine, or two years of practice, will be
dispensed with in the case of those candidates who at the
second M.B. examination have been placed in the first division.
3. Of moral character, signed by two persons of respectability.
Certificates must be transmitted fourteen days before the
examination. The examination is conducted by means of
minted papers and viva voce. Candidates are examined in
Logic and Moral Philosophy, and Medicine. The candidate
who shall distinguish himself the most will receive a Gold
Medal of the value of £20. The fee for each of the Degrees
of M.B., B.S., M.S., and M.D. is £5.
The examinations shall be conducted in the following
order :—
Monday. — Morning , 10 to 1, Logic and Moral Philosophy,
by printed papers ; Afternoon , 3 to 6, a Commentary on a
Case in Medicine or Midwifery, at the option of the Candi¬
date, by printed papers. Tuesday. — Moi-ning, 10 to 1, After¬
noon. 3 to 6, Medicine, by printed papers. Thursday. —Exa¬
mination, and Report on Cases, of Medical Patients in the
Wards of a Hospital. Friday, at 1 p.m. — Viva voce Interro¬
gation, and Demonstration from Specimens and Preparations.
UNIVERSITY OF DURHAM. .
This body now grants the degrees of Bachelor and Doctor
of Medicine and Master of Surgery, and also a licence in
1 Bachelors of Medicine previously to 1866 will be admitted for the
fisgsMUf Ifefe la forgery without haying taken the Degree of
medicine. For the last-named diploma, residence is not
imperative. Before proceeding to the M.B., the licentiate
must have obtained a B.A., or passed an equivalent exa¬
mination. Candidates for M.D. must be bachelors of the
standing of 21 terms. There is a medical scholarship of
the annual value of £25, tenable for 4 years, open to com¬
petition among the students.
The fees, both university and collegiate, are moderate.
Full particulars may be had on application to the Re¬
gistrar.
ROYAL COLLEGE OF PHYSICIANS, LONDON.
THE FELLOWSHIP.
The Fellowship is only attainable by election. No one
can be proposed who is not a Member of four years’ stand¬
ing. The mode of election has long given much dissatis¬
faction, as the readers of The Medical Press and Cir¬
cular are well aware, from the numerous articles and
communications that have lately appeared. There is a
general admission as to the justice of our strictures, and
from the liberal feeling of a large body of the Fellows, it is
not improbable that a generous reform may be effected.
We hope this may be the case, as the influence of the
college on the higher grades is of importance to the profes¬
sion. •
THE MEMBERSHIP.
A person may become a Member of this College with¬
out holding a degree in Medicine, or indeed any other
diploma. This is not very often done ; for the Member¬
ship gives no right to the use of the title doctor, though
some Members not possessed of a degree do so style them¬
selves. This is, however, in direct violation of the rules
of the College to which a Member pledges himself on ad¬
mission. The curriculum extends over four years.
I Graduates in Medicine of any British University are
admitted to an examination for the membership. Such
graduates are exempt from some parts of the examination
— e.g., Anatomy and Physiology. Even foreign graduates
of accredited universities have no difficulty in Being ad¬
mitted to examination. During the so-called year of
grace this diploma was given to any M.D., on payment of
ten guineas.
THE LICENCE.
This Diploma authorises the holder to practise Medi¬
cine as a Licentiate of the College. Unless a graduate of
some university he is forbidden to use the title of doctor,
but we regret to say many do so. It is a medical diploma
for the general practitioner intended to supersede that of
the Apothecaries’ Company, and, although not likely to do
this for some time, is rapidly growing in favour. The ex¬
amination is conducted by specially appointed examiners,
and is complete in the several departments. It has been
proposed to give this licence to Licentiates of the Apo¬
thecaries Company on payment of a fee without examina¬
tion. Such a course might bring a little money to the
College, but could confer no credit on any one. Those
who hold the Company’s licence have their legal right to
practise, and have already made their position. To confer
the College licence for cash, would degrade it in the esti¬
mation of all who have obtained it by examination. The
college has done its share of trafficing in diplomas, and
we trust will not load itself with another year of (dis-)
grace.
QUALIFICATIONS FOR THE LICENCE.
Candidates must produce evidence—
1. Of having attained the age of twenty-one. 2. Of moral
character. 8. Of having passed an Examination in General
Education. 4. Of having been registered as a student. 5.
Of Professional Study for four years, of which at least three
winters and two summers have been passed at a Medical
School, and one winter and two summers in one of the follow¬
ing ways (a) Attending the practice of an hospital; (b) As the
Pupil of a qualified Practitioner, holding a pubuc appointment
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254 The Medical Tress and Circular. COLLEGE OF SURGEONS, ENGLAND.
Beptemb er 16,
(c) Attending lectures on any of the required subjects. 6. Of
having attended , during three Winters and two Summers, the
Practice at an hospital , and of six months’ Clinical Study of
Diseases of Women. 7. Of having studied Anatomy (with
Dissections) two winters; Physiology, two winters; Chemistry,
nix months ; Practical Chemistry, Materia Medica, and Prac¬
tical Pharmacy, three months each ; Botany (may be attended
prior to Professional Studies), three months; Morbid Anatomy
(in the Post-mortem room), six months ; Practice of Medicine
(principles of Public Health should be comprised in this
Course, or in the Course on Forensic Medicine, attendance
not earlier than the second winter), two winters ; Surgery
(not earlier than the second winter), two winters ; Clinical
Medicine and Clinical Surgery (not until after the first |
winter), two winters and two summers each ; Midwifery and
Diseases of Women (not less than twenty Labours, and In¬
struction and Proficiency in Vaccination), three months ; For¬
ensic Medicine, three months. 8. Of having passed the Pro¬
fessional Examinations. ,
Candidates who produce evidence of having passed an Ex¬
amination on Anatomy and Physiology, or Surgery, conducted!
by any of the Licensing Bodies, shall be exempt from re¬
examination on the subjects of the Primary Examination.
“Registered Medical Practitioners,” whose Qualifications
have been obtained before 1861, will be examined on the
> Practice of Medicine, Surgery, and Midwifery ; but he will be
exempted from the other part^of the Examinations.
Licentiates of this College snail not compound or dispense
medicines except for patients under their own care.
The Fee for the Licence shall be Fifteen Guineas.
EXAMINATION FOB THE LICENCE.
Every candidate must sign a declaration, stating whether he
has been rejected within three months.
The first examination, on Anatomy and Physiology, will be
as follows First evening, seven to ten, written questions ;
second evening, seven o’clock, viva voce , on Dissections and
Preparations. The second or Pass examination will be as
follows:—First evening, seven to ten, written questions on
Surgical Anatomy, and Practice of Surgery ; second morning,
the candidate’s knowledge will be tested, either at the college
or in the surgical wards of an hospital ; afternoon, one to four,
on Materia Medica, and on Chemistry, partly by written ques¬
tions, and partly practical; evening, seven o’clock, written
questions on Midwifery and Diseases of Women ; third even¬
ing, seven to ten, written questions on Medical Anatomy, and
Practice of Medicine, including Public Health ; fourth morn¬
ing, the candidate’s knowledge will be tested, either at the
College or in the Medical Wards of an hospital; evening,
seven o’clock, viva voce, on Practice of Medicine, Surgery, and
Midwifery.
Candidates will not be admitted to the first examination
until after the second winter, nor to the Pass examination
until after the four years of study.
Any candidate rejected at the first examination will not be
re-admitted until after three months, and must produce a fur¬
ther certificate of dissections.
Any candidate rejected at the second, will not be re-admitted
until after six months, and will be required to produce an
hospital certificate for that time.
Examinations of candidates for the College Licence will
take place, commencing as follows :—
1868—First Examination.—Tuesday, October 6 ; Tuesday,
December 1. Second or Pass Examination.—Tuesday, Octo¬
ber 18 ; Tuesday, December 8.
1869.—Tuesday, February 2 ; Tuesday, April 6; Tuesday,
July 6 ; Tuesday, October 5 ; Tuesday, December 7; Tues¬
day, February 9 ; Tuesday, April 18 ; Tuesday, July 13 ;
Tuesday, October 12 ; Tuesday, December 14.
Every candidate for examination must give fourteen days’
notice, with the following certificates :— For the First Exami¬
nations —Of having passed in Arts ; of having been registered;
and of having completed the second winter. For the Second or
Pass Examination.— Of four years’ study ; of having attained
the age of twenty-one ; proficiency in the practice of Vaccina¬
tion ; and of having attended not less than twenty labours; a
testimonial of moral character is required.
ROYAL COLLEGE OF SURGEONS, ENGLAND.
The influence of this college on the profession in England
i* second to none. Very few surgical appointments are to
be had without its diploma. In every parish appointment
its membership, if not essential, carries great weight
Hence, most English students intend to prepare themselves
for this, which, together with a medical qualification, suf¬
fices for every purpose of the general practitioner. The
college haa two grades, Member and Fellow. It also gives
a diploma in midwifery, but this is mostly confined to
those who are already members.
THE FELLOWSHIP.
Members of long standing can be admitted by election.
As, however, this grade is also obtainable by examination
this is the more usual mode. Consulting surgeons mostly
take the Fellowship by examination, though there are
many hospital surgeons in London who have contented
themselves to remain members.
A member of the College of 8 years* standing is admitted
to examination on the production of a certificate of three
Fellows, that he has been engaged for 8 years in the prac¬
tice of surgery and is a fit and proper person to be admit¬
ted a Fellow.
TIIE MEMBERSHIP.
This diploma gives no vote in the affairs of the college.
It is in effect only a licence to practice, and corresponds
with the licentiateship of the Edinburgh and Dublin col¬
leges.
In future, candidates for the diploma will be examined
in the practice of medicine, and also in the practical em¬
ployment of splints, bandages, and other surgical appli¬
ances.
Preliminary General Education .
Candidates who commenced their professional education on
or after the 1st of January, 1861, will be required to produce
certificates of having passed one of the examinations in pre¬
liminary education recognised by the Medical Council.
Candidates not able to produce one will be required to pea
an examination in English, Classics, and Mathematics, by the
Royal College of Preceptors.
SUBJECTS OF PRELIMINABY EXAMINATION.
Reading aloud ; writing from dictation ; English grammar;
writing a short English composition—such as a description of
a place, an account of Borne useful or natural product, or the
like : arithmetic (first four rules, simple and compound, of
vulgar fractions, and of decimals); geography of Europe, and
particularly of the British Isles ; outlines of English history
—that is, the succession of the sovereigns, and the leading
events of each reign ; Euclid, book i. ; translation from the
first book of Caesar’s De Bello Gallico. Papers will also beset
on the following seven subjects, and each candidate must offer
himself on one at least, but no more than four subjects
Translation of a passage from the first book of Xenophon’s
Anabasis, in Greek; Sals tine’s “ Picciola,” Schiller’s “ Wilhelm
Tell.” The candidate will also be required to answer questions
on the grammar of each subject; mathematics (algebra to
simple equations inclusive); mechanics (questions elementary);
chemistry (elementary facts); botany and roology (classifica¬
tion of plants and animals). The quality of the handwriting
and the spelling will be taken into account.
N.B.—Each candidate, prior to examination, must pAy the
fee of £2. The examination is at present held in June and
December.
Professional Education.
Professional studies are not recognised prior to examination
in general knowledge.
The following will be considered as the commencement of
professional education :—Attendance on hospital, or other in¬
stitution recognised by this college. Instruction as the pupil
of a surgeon to an hospital, general dispensary, or union work-
house, or where such practical instruction is afforded as shall
be satisfactory to the council. Attendance on lectures on
Anatomy, Physiology, or Chemistry.
The commencement of professional study by pupilage will
not be admitted until a certificate shall be furnished for regis¬
tration at the college by the practitioner whose pupil the can¬
didate shall have become, or by the medical superintendent of
the hospital or other institution; and will, consequently, date
only from the reception of such certificate, tip certificate to be
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tiu Pmi and cinuUr. APOTHECARIES’ SOCIETY OF LONDON.
Septmbrf i«, IMS. 25$
accompanied by proof of having passed the preliminary exami¬
nation.
Candidates will be required to produce the following other
certificates :—Of being twenty-one years of age. Of having
been engaged during four years in the acquirement of pro¬
fessional knowledge. Practical Pharmacy three months. Lec¬
tures on Anatomy during two winters. Dissections, two
winters. Lectures on Physiology, two winters. On Surgery,
two winters; one course not earlier than the third winter.
One course on each of the following—viz., Chemistry, Materia
Medica, Medicine, and Midwifery. Of instruction and pro¬
ficiency in Vaccination. Of having attended, at a recognised
hospital, the practice of Surgery, and clinical lectures on Sur¬
gery, during three winter 1 and two summers sessions, and the
practice of Medicine, and clinical lectures on Medicine, during
one winter and one summer session. Of having, after two
years' professional education, taken charge of patients under
a surgeon during six months, at an hospital, general dispen¬
sary, or parochial or union infirmary recognised for this pur¬
pose, or in such other similar manner as shall afford sufficient
opportunity for the acquirement of Practical Surgery.
Certificates from a provincial hospital unconnected with a
school, will not be received for more than one winter and one
summer of attendance, and clinical lectures will not be neces¬
sary, but a certificate of having acted as dresser for six months
instead.
Certificates will not be received from London students
unless they register at the college their cards of admission to
lectures and hospital within fifteen days from the commence¬
ment of the session; nor from provincial students, unless their
names shall be duly returned.
Candidates who have studied in Scotland or Ireland will be
admitted upon the same certificates required by the College of
Snrgeons of Edinburgh, the Faculty of Physicians of Glasgow,
and the College of Snrgeons in Ireland, together with a certi¬
ficate in Vaccination, and evidence of four years’ professional
study.
Members or licentiates of a College of Surgeons, and
graduates in Surgery or Medicine of a university will be ad¬
mitted to examination on producing their diploma, licence,
or degree, together with proof of being twenty-one years of
age, a certificate in Vaccination, and evidence of at least four
yean’ professional study.
The Professional Examination
Is divided into two parts. The first or Primary Examination,
on Anatomy and Physiology, is partly written, and partly
demonstrative on the recently dissected subject, and on pre¬
pared parts of the human body. The second or Pass Exami¬
nation, on Pathology, Surgery, and Surgical Anatomy, is partly
written and Partly oral, and partly on the use of Surgical
apparatus. The Primary Examinations are held in January,
April, May, July, and November; and the Pass Examinations
generally in the ensuing week respectively. Candidates will
not be admitted to the Primary Examination until after the
termination of their second winter at a recognised school; nor
to the Pass Examination until after the fourth year. The fee
of five guineas paid by each candidate prior to his Primary
Examination will not be returned, but will be allowed on his
admission as a member. A candidate having entered his name
for either examination, who shall fail to attend the meeting of
the court for which he shall have received a card, will not be
allowed to present himself within three months from the date.
A candidate referred on the Primary Examination is required,
prior to re-examination, to produce a certificate of the perfor¬
mance of dissections during not less than three months subse¬
quently. A candidate referred on the Pass Examination is
required to produce a certificate of six months' surgical practice
of a recognised hospital, together with lectures on clinical
•urgery.
N.B—On and after the 1st of October, 1868, all candidates
presenting themselves for the final examination for the diploma
of Member or Fellow of the college, will be required to pass
m examination in Medicine at the college, or to produce a
recognised degree, diploma, or licence in Medicine, before re¬
dwing the diploma.
• i*4The Winter Session comprises a period of six months, and, in
“ ******** on the 1st of October, and terminates on the 31st
0nmttier Session comprises a period of three months, and, in
flUTniw on the 1st of May, and terminates on the 81st of
APOTHECARIES’ SOCIETY OF LONDON.
The Licence of the Worshipful Society of Apothecaries is
perhaps the most useful medical diploma for the general
practitioner in England. The monopoly enjoyed by this
body for many years, in this respect, is not easily to be dis¬
turbed. The laws of many institutions require their me¬
dical officers to hold this aiploma, and these laws are not
readily altered. Though other medical qualifications are
recognised by the Poor-law Board, there is no doubt that
the guardians throughout the country—and they elect the
medical officers—are familiar with the diploma of the
Apothecaries’ Society, and it is to them more of a guar¬
antee than other qualifications, of the value of which they
are ignorant. The drawback to many a student is that,
constrained by the Act of Parliament, the Society requires
apprenticeship. This clause has, however, received a very
liberal interpretation, and every pupil of a licentiate, who
is certified to have served after the manner of an ap¬
prentice, is considered to have fulfilled the requirement.
During this term he may also have carried on his hospital
studies. Everyone, therefore, who can show this certificate,
intending to settle in England as a general practitioner—
even if he take other diplomas, would probably consult
his own interest by becoming a Licentiate of the Apothe¬
caries’ Society j and as the fee is only six guineas, a very
large number of young men will, we doubt not, secure this
possible avenue to appointments.
Every candidate for a certificate of qualification to prac¬
tise as an Apothecary must produce testimonials—
1. Of having passed in general education.
2. Of apprenticeship of five years to a practitioner qualified
by the Act of 1815. This period may include the time spent
at lectures and hospital.
3. Of being of the age of twenty-one.
4. Of good moral conduct.
5. And of the required course of study.
COUBSE OF STUDY.—FIB8T YEAB.
Winter Session —Chemistry, Anatomy and Physiology, and
Dissections.
Summer Session —Botany, Materia Medica and Therapeutics,
Practical Chemistry.l
SECOND YEAR.
Winter Session —Anatomy and Physiology, including Dis¬
sections and Demonstrations, Principles and Practice of Medi¬
cine, Clinical Medical Practice.
Summer Session —Midwifery and Diseases of Women and
Children, 2 Forensic Medicine and Toxicology, Clinical Medical
Practice.
THIRD YEAR.
Winter Session —Principles and Practice of Medicine, Clini¬
cal Medical Lectures, Morbid Anatomy, Clinical Medical
Practice.
Summer Session —Practical Midwifery and Vaccination* 8
Morbid Anatomy, Clinical Medical Practice.
All students are required personally to register the several
tickets of admission to lectures and medical practice within
the first fifteen days of the months of October and May.
PROFESSIONAL EXAMINATIONS.
The Examiners meet every Thursday at a quarter before
Four. Candidates must give notice before the Monday pre¬
vious, and deposit the required testimonials, with the fee. The
examination is divided into two parts, partly in writing, and
partly viva voce .
FIRST EXAMINATION,
Which may be passed after the second winter, embraces the
following subjects:—
Prescriptions.
Anatomy and Physiology.
General and Practical Chemistry.
Botany and Materia Medica.
1 A specific course of instruction in the laboratory, with an opportu*
nity of personal manipulation, and a knowledge of the various re*
agents for poisons.
9 A certificate of attendance, on not less than 20 cases, will be rq*
©rived from a legally qualified practitioner.
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256 The Medical Press and Circular.
UNIVERSITY OF DUBLIN.
September 16 , 18 *
SECOND EXAMINATION,
At the termination of studies :—
Principles and Praotice of Medioine.
Pathology and Therapeutics.
Midwifery, including the Diseases of Women and Children.
Forensic Medicine and Toxicology.
EXAMINATION IN ARTS.
The Examination in Arts will be held on January 29th and
80th, April 23rd and 24th, September 24th and 25th, by
means of printed papers. Candidates will be examined in—
1. English ; 2. Latin; 3. Mathematics ; 4. One of the fol¬
lowing optional subjects :— (a) Greek, ( b ) French, (c) German,
( d) Natural Philosophy.
The examinations will take place in the following order :—
Friday morning, 10 to 11—English. 11 to 1—Latin.
Friday afternoon, 2 to 4—Mathematics.
Saturday morning—The fourth, or optional branch.
Fee, one guinea, not to be returned to him.
The examination for certificate as assistant, will be—
In Translating Prescriptions.
In the British Pharmacopceia.
In Pharmacy and Materia Medica.
FEES.
For a certificate of qualification to practise, six guineas (the
half to be paid at the first examination); for an assistant’s
certificate, two guineas.
SYLLABUS OF SUBJECTS FOR EXAMINATION, 1869.
1. The English Language.—History, Structure and Grammar.
English Composition. (The books recommended are
Adam’s “ English Language,” and Trench’s “ Study of
Words.”)
2. The Latin Language.—January Examination—Cicero, De
Amicitia. April Examination—Ovid, Metamorph.
Books I. and II. September Examination—Horace,
Odes, Books III. and IV. Re-translation of easy sen¬
tences. Grammatical Questions.
8. Mathematics.—Arithmetic. Vulgar and Decimal Fractions.
Addition, Subtraction, Multiplication, and Division of
Algebra. Simple Equations. The First Two Books of
Euclid.
4. (a) Greek—Xenophon, Anabasis, Books I. and II. (6)
French—Paul and Virginia. Translation from English
into French, (c) German—Schiller’s Wilhelm Tell.
Translation of English into German, (d) Natural Phil¬
osophy—Mechanics. Hydrostatics and Pneumatics.
(The book recommended is Lund’s “ Cambridge Course
of Natural Philosophy.”)
NF.—The examination after 1869 will comprise five
branches, Greek being made compulsory.
Gentlemen must send name and address, with the fee, to
Mr. Sargeant, Beadle's Office, at least one week previously.
FRIZES IN BOTANY.
The Society of Apothecaries annually offer two prizes in
Botany (systematic, descriptive, and physiological), for stu¬
dents in their second summer.
The prizes consist of a gold medal and of a silver medal,
and books to the second candidate. Examination on the
second Wednesday in August.
PRIZES IN MATERIA MEDICA AND PHARMACEUTICAL CHEMISTRY.
The Society of Apothecaries annually offer two prizes for
proficiency in Materia Medica and Pharmaceutical Chemistry,
for students in their third winter. The prizes consist of a
§ old medal and a silver medal, and books to the second candi-
ate.
The examinations will be held on the third Wednesday in
October, and on the following Friday. Competitors must send
Written notice before the 7 th October.
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UNIVERSITY OF DUBLIN.
The following Degrees and Licences in Medicine and Sur¬
gery are granted by the University of Dublin :—
1. Bachelor in Medicine. 2. Doctor in Medicine. 3. Mas¬
ter in Surgery. 4. Licentiate in Medicine. 5. Licentiate in
Surgery.
Matriculation .
Every student must be matriculated by the senior lecturer,
for which a fee of five shillings is payable; but he need not
have his name on the College books, or attend any of the
academical duties, unless he desire to obtain a licence or De¬
gree in Medicine or Surgery. No student can be admitted for
the Winter Courses after the 25th of November.
QUALIFICATIONS FOR DEGREES AND LICENCES.
Bachelor in Medicine.
Candidates must be graduates in Arts, and may obtain the
degree at the same commencements as the B.A., or at any
subsequent one. The medical education of a Bachelor in
Medicine is of four years’ duration, and comprises the following
lectures :—
Winter Count *.—Anatomy and Physiology—Practical Ana¬
tomy with Dissections—Surgery—Chemistry—Practice of
Medicine—Midwifery.
Summer Courses.—Botany—Materia Medica and Pharmacy
—Institutes of Medicine—Medical Jurisprudence.
Hospital attendance on St. Patrick Dun’s during nine
months, with three consecutive courses of clinioal lectures.
Also nine months’ additional attendance on a recognised
hospital, and Practical Midwifery.
Any of the courses may be attended at any recognised medi¬
cal Bchool, and three of them at Edinburgh University, pro¬
vided the candidates have kept an Annus Medicus in the
School of Physic.
The schools recognised are—1. The School of the Royal
College of Surgeons in Ireland. 2. The Carmichael School
3. The School of Steevens’ Hospital 4. The Ledwich School
5. The Cecilia-street School.
An Annus Medicus may be kept in three way#—1. By
attending two winter courses. 2. Or one winter and two sum¬
mer courses. 3. By nine months* attendance on Sir Patrick
Dun’s Hospital and Clinical Lectures : together with one
winter course or two summer courses of three months* duration.
The fee for nine months’ attendance at Sir Patrick Don’s
Hospital is twelve guineas.
The fee for the Liceat ad Examinandum is £5.
The fee for the degree of M.B. is £11.
Doctor in Medicine .
A doctor in medicine must be M.B. of at least three yean’
standing, and requires no other qualification.
Total fees for this degree, £13.
Master in Surgery .
This degree can only be obtained by Bachelors of Arts. The
curriculum is the same as that for the Licentiate in Surgery, si
given below.
Candidates will also be required to perform surgical opera¬
tions on the dead subject.
Total amount of fees for the degree of Ch. M., £16.
Licentiate in Medicine.
Candidates for the licence in Medicine and Surgery must b«
matriculated in Medicine, and must have completed four yean
in medical studies, and must pass an examination in Arts, in*
eluding Greek, Latin, English, and Mathematics, unless they
be students in the Senior Freshman, or some higher class. The
medical course necessary for a Licence in Medicine is the santt
as for the degree of M.B. A fee of £5 is charged on taking
the Licence. Licentiates in Surgery of the Royal College of
Surgeons in Ireland, on passing the Art examination, will be
admitted to examination for the Licence in Medicine. 8ucfc
candidates will be exempted from examination in Anatomy
Surgery : and candidates who have also the Licence in Mid¬
wifery of the said college will be exempted from examination
in Midwifery. Fee for the Liceat ad Examinandum, £5.
for the Licence in Medicine, £5.
Licentiate in Surgery .
Candidates must have kept one full year in Arts, -and will bo
required to perform surgical operations on the dead subji^
The curriculum extends over four years, and is as follow*£--
Two courses each of Anatomy and Physiology, and Tkect y w
Practice of Surgery ; three courses of Demonstration! *»»
Dissections; and one course each of Practice of Medirioe,
Digitized by VjiOOv l\~
The Medical Prom and Circular.
QUEEN'S UNIVERSITY IN IRELAND.
September 16,1888. 257
Chemistry, Materia Medica, Midwifery, Laboratory Chemistry,
Botany, and Medical Jurisprudence. Also attendance for
three Sessions, each of nine months, on a recognised hospital.
Of the courses of lectures, which are of six months* duration,
not more than three can be attended during any one session.
Any of the above-named courses may be attended at any of
the medical schools of Dublin, provided the candidate has kept
an Annua Medicua A fee of £5 is charged for the licence,
and £6 for the Liceat,
SESSIONAL EXAMINATIONS.
Candidates for degrees and licences will be subjected to two
examinations, one of them preliminary, which will be held at
the close of the second year, and the other, after the full curri¬
culum has been completed. The subjects of the preliminary
examination are the following: Descriptive Anatomy, Botany,
and Materia Medica, Pharmacy, Chemistry, theoretical and
practical, with Chemical Physics. The best answers at the
preliminary examination will* be elected to the scholarships,
provided they are in the Senior Freshman, or some higher
class, and have kept one Annua Medicua,
PRIVILEGES OF MEDICAL STUDENTS.
Medical or surgical Btudents, being junior or senior sophis-
ters, and in attendance on the full courses necessary for an
A nnua Medicua are exempted from the classics of the junior
aophister year, and from one of the three optional courses
(Mathematical Physics, Experimental Physics, or Classics) of
the senior aophister year. To obtain this privilege the student
must be matriculated, and the certificate of his attendance on
lectures be submitted to the senior lecturer.
FREE COURSE8.
Students in arts having their names on the college-books
will be permitted to attend one course free of expense with
each of the university professors. Should the student who ha*,
had the privilege of free attendance desire to obtain an official
testimonium, he must, on obtaining it, pay to the professor the
usual fee.
MEDICAL SCHOLARSHIPS.
Two medical scholarships are given annually, value £20 per
annum each, tenable for two yean, the examinations for which
are held each year in June, in the following subjects:—
Anatomy, Physiology, Chemistry, Materia Medica, and Botany.
Medical School Exhibition.
The professors of the university school give three exhibitions
annually; two senior, value £15 and £10, open to all students
who have been three yean attending the school. The subjects
being—Practioe of Medicine, Surgery, Pathology, and Forensic
Medicine.
One junior, value £15—the time and subjects of examina¬
tion being the same as those for the medical soholanhips.
Expense of obtaining the degrees of Bachelor in Medicine
and Master in Surgery in the University of Dublin:—
Lectures.* £49 7 0
Hospitals. 28 7 0
Degree Fees. 32 0 0
£109 14 0
Private Tuition, say . • . 20 0 0
£129 14 0
N.B.—As no degrees in Medicine or Surgery are conferred
except upon graduates in Arts, the expense of the degree of
Bachelor in Arts, amounting altogether to £83, 4s., should be
added to the foregoing, making the total cost something over
£ 200 .
The board of Trinity College have recently passed orders:—
1. That three-fourths of the courses of lectures must be in all
m sos attended. 2. That the system of perpetual pupilB be
abolished. 3. That a dally roll be called by each Professor.
4. Students in Arts shall be entitled to attend one course in
Botany, and to receive a certificate free of charge. 5. Candi¬
dates lor degrees and licences in Surgery shall be required to
attend one course only on Anatomy, for which he shall be charged
guineas* The two courses delivered by the Professor
-'flCjbtfgtey shall include practical instruction in Operative Sur¬
gery on toe dead subject; and for each the Professor shall
ofcarge four guineas. 7. The Professor shall charge three
guineas far the winter lectures in Chemistry. 8. Laboratory
instruction shall be substituted for the second course of chem¬
istry, hitherto delivered, for which the Professor of Chemistry
shall charge five guineas. 9. Students in Arts may attend the
Professors of Surgery and Chemistry, and to receive certifi¬
cates on payment of half the fees. 10. That after Shrovetide,
1868, all candidates in Medicine shall produce certificates in
practical Midwifery, including at least six deliveries.
See advertisements of School of Physic and Sir Patrick
Dun’s Hospital
THE QUEEN’S UNIVERSITY IN IRELAND.
FACULTY OF MEDICINE.
DEGREE OF DOCTOR OF MEDICINE.
Each Candidate for the Degree is required—
1. To have passed in one of the Queen’s Colleges the exami¬
nation for Matriculation in Arts, and to have been Matricu¬
lated in Medicine. 2. To have attended in one of the Queen’s
Colleges, Lectures on one Continental Language for six
I months, and on Natural Philosophy for six months. 3. To
have attended, in Borne one of the Queen’s Colleges, two
courses. For the remainder of the courses, certificates will
be received from the Lecturers in Schools, recognised by
the Senate. 4. To pass two University Examinations —>
the First University Examination and the Degree Examina¬
tion.
The curriculum of Medical study extends over four years,
and is divided into two periods of two years each.
The first period comprises attendance on Chemistry, Natural
History, Anatomy and Physiology, Practical Anatomy, Materia
Medica, and Pharmacy. Practical Chemistry in a recognised
Laboratory is also to be attended during the first period, and
the practice during six months of a Medico-Chirurgical Hos¬
pital, containing at least sixty beds, together with the Clinical
Lectures delivered therein.
The second period comprises attendance on Anatomy and
Physiology, Practical Anatomy, Theory and Practice of Sur¬
gery, Midwifery and 'Diseases of Women and Children, Theoiy
and Practice of Medicine, Medical Jurisprudence. During
this period Students attended Practical Midwifery, and eighteen
months’ practioe of a Medico-Chirurgical Hospital, containing
at least sixty beds, and in which Clinical Instruction is de¬
livered.
At least two of the above Courses of Lectures must be
attended in some one of the Queen’s Colleges ; the remainder
may be taken At the option of the Candidate, in any Univer¬
sity, College, or School recognised by the Senate of the
Queen’s University.
The University Examinations are held twice in each year, in
June and September.
The June Examinations are Pass Examinations, and com¬
mence on the Tuesday following the second Saturday in June.
The Honour Examinations oommence on the last Tuesday
in September, 'and are followed by Pass Examinations.
Each Candidate for Examination in ’June must forward to
the Secretary, before the 1st of June, notice of his inten¬
tion to offer himself, along with his certificates; and each
Candidate for Examination in September or October must for¬
ward similar notice, along with his certificates, before the 1st
of September.
THE FIRST UNIVERSITY EXAMINATION IN MEDICINE.
The First Examination may be passed either in June or
September.
Students may present themselves for this Examination at
the termination of the first period of the Curriculum, or at
any subsequent period.
Before being examined, each Candidate must produce evi¬
dence of having completed the course recommended for study
during the first period.
The First University Examination comprises the subjects
recommended for study during the first period, along with
which any Candidate may present himself for Examination
in Experimental Physics and Modern Languages, if he has
attended in one of the Queen’s Colleges the courses on these
subjects.
English Composition forms a part of all University Ex¬
aminations.
HONOURS.
Competitors for Honours will be examined in all the sub-
$58 tte Medical Press and Circular. COLLEGE OF SURGEONS, IRELAND,
September 16, ltt&
jocts of the First Medical Examination, including Experimental
Physics and Modern Languages.
Two Exhibitions, one consisting of two instalments of £20
each, the other of two instalments of £15 each, are awarded
under certain conditions at this examination.
The Candidates who pass with Honours will be arranged
in three classes.
Candidates who defer passing their First Medical Examina¬
tion until they present themselves at the degree are not eli¬
gible for Honours with the First Examination.
The Honour and Pass Examinations will be held in Sep¬
tember. The Examination held in June is a Pass Examina¬
tion.
DEGREE EXAMINATIONS IN MEDICINE.
Examinations (for the M.D. will be held in June and Sep¬
tember. The fee is £5.
Each Candidate must produce—
1. A Certificate from the Secretary of the Queen’s Univer¬
sity, that he has passed the previous examination, unless he
presents himself for both examinations simultaneously.
9. From the Council of his College that he has passed a full
Examination for Matriculation in Arts, and has been admitted
a Matriculated Student in the Faculty of Medicine.
3. That he has attended in the College lectures on one
Modem Language, on Experimental Physics, and two other
courses.
4. That he has completed all other prescribed courses.
The Degree Examination comprises the subjects recom¬
mended for study during the second period, along with Experi¬
mental Physics and one Modem Language, unless an Exami¬
nation in these subjects have been already passed at the pre¬
vious Medical Examination.
The Examination for the Degree of M.Ch. comprises in
addition an examination in Operative Surgery.
Candidates who graduated with Honours will be arranged
in three classes. Candidates who take a first class will receive
a medal and prize. Candidates who take a second class will
reoeive a prize. Candidates who take a third class will re¬
ceive a certificate of honour.
The Examination for the Degree with Honours will com¬
mence on the last Tuesday in September, and will be followed
by the examination of those candidates who seek to graduate
without honours.
See advertisements of Queen’s Colleges, Belfast and Cork.
ROYAL COLLEGE OF SURGEONS IN IRELAND.
The Royal College of Surgeons is the principal Surgical
Licensing Corporation of Ireland, and confers the great
majority of the surgical Qualifications granted in that divi¬
sion of the United Kingdom. Although there is a medical
. school attached to it, the college receives and grants its
diplomas on certificates from all medical schools of stand¬
ing. The letters testimonial confers the title of licentiate,
with full qualification to practise; but the exercise of the
privileges of attending and voting as a member of the col¬
lege is reserved for fellows. The medical school of the
college is under the superintendence of the council, by
whom the professors are elected. Important modifications
have been recently made in the system of examination,
quarterly sessions of the court having been established,
and voting by numbers instead of “ Yes” and “ No” in¬
troduced. Full information as to these changes will be
found in the appended regulations.
Court of Examiner *.—Christopher Fleming, B. W. Richard¬
son, Edward A. Stoker, George H. Porter, T. J. Tufnell, J.
Barker, E. S. O’Grady, M. H. Collia.
Examiners in Midwifery .—E. J. Quin an, G. Cronyn, James
IsdelL
Examiners in General Education .—T. Byrne, A.B., M.B.;
John Murray, AJd., LL.D.; G. F. Shaw, LL.D., F.T.C.D.
REGISTRATION OF PUPILS.
Every person shall be registered as a pupil on the college
books on payment of five guineas.
Registered pupils can study in the museum on two days in
each week, and to read in the library every day, from ten to
one. They may also attend the Lectures on Comparative
- - ■ -
Anatomy, and obtain the certificate without payment No
student is admitted to the sessional or final examination for
letters testimonial until he becomes a registered pupil.
CLASSICAL EXAMINATION.
Registered pupils are admitted to examination at any period
previous to the final examination for letters testimonial
Students not registered pupils are also admitted upon pay¬
ment of ten shillings; but they are not enrolled as registered
pupils, until they have paid the five guineas.
Candidates may select any of the following Greek works:—
The Gospel of St. John, the Menippus of Lucian, or a
book of Xenophon’s Anabasia; also, in Latin, First and
Second Books of the ^Eneid of Virgil, the Jugurthine War o!
Sallust, or Third Book of Livy. Candidates will also be
required to write English from dictation, and to give evidence
of proficiency in arithmetic.
THE FELLOWSHIP.
Candidates must be twenty-five years of age, have studied
six years, and have attended a course on Comparative Anatomy,
on Botany, and Natural Philosophy. The fee is thirty guineas
for a resident in Dublin, and twenty for a non-resident, having
been previously a licentiate.
LETTERS TESTIMONIAL.
Every registered pupil shall be admitted to an examination
if he shall have laid before the council—a. A receipt showing
that he has lodged twenty guineas, b. A certificate of an
examination in Greek and Latin, c. Certificates of four yean’
study, d. Certificates of three years hospital attendance. 1
e. Certificates of attendance on the following lectures :—
Three Courses. —Anatomy and Physiology; Theory and
Practice of Surgery ; Dissections, with Demonstrations.
Two Courses .—Chemistry (or one on general and one on
practical Chemistry.)
One Course .—Midwifery ; Medical Jurisprudence; Botany;
Materia Medica ; Practice of Medicine.
DIPLOMA IN MIDWIFERY.
Any fellow or licentiate shall be admitted to an examina¬
tion upon the following documents :—
a. Certificates of one course of lectures on Midwifery and
Diseases of Women and Children.
b. That he has attended a recognised lying-in hospital for
six months ; or a recognised dispensary for lying-in-women and
children, devoted to this branch of surgery alone.
c. That he has conducted thirty labour cases. Candidates
for the Midwifery Diploma shall do examined on the organisa¬
tion of the female ; the growth and peculiarities of the f©tus;
the practice of Midwifery, and the diseases of women and chil¬
dren.
REGULATIONS'AS TO EXAMINATIONS.
Letters Testimonial .
Five examiners at least are present. Each candidate shall bs
examined upon Anatomy, Physiology, the Theory and Prac¬
tice of Medicine and Surgery, Materia Medica and the form
of prescription, and shall perform such Surgical operations or
dissections, or explain such anatomical and pathological pre¬
parations as the examiners may require.
Licentiates of a college of physicians or graduates in medi¬
cine of a university, shall be exalnined in general and descrip¬
tive Anatomy, Physiology, the Theory and Practice of Sim
gery, and Operative Surgery. Rejected candidates cannot
present themselves until after six months. In addition to the
oral examinations, candidates are required to give written
answers to written questions.
FELLOWSHIP EXAMINATION.
Five examiners at least, together with the president, or vice-
president, and two members of the council, shall be present
Each candidate shall be examined on two days. The subjeds
of the first examination shall be Anatomy and Physiology
(human and comparative); those of the second, Pathology,
Therapeutics, the Theory and Practice of Medicine and Sor*
1 Attbndavck ox Pbovixcial Hospitals.— Candidates who htf
have attended recognized hospitals during three Winters, ahaH t*
admitted, if they shall produce certificates of attendance da ti ng s
like number of months at a County Infirmary, or Provinci al BgF"
cal Hospital, containing at least fifty beds .provided the aUigtp*
shall make returns, in the months of May and November of
| of students so attending. - * '
e
the Median Press And Circular.
COLLEGE OF PHYSICIANS, IRELAND.
September 16, 1868. 259
gory. In addition to the oral examinations, candidates shall
be required to give written answers to written questions. The
candidates shall also perform dissections and operations on the
dead body. Rejected candidates cannot present themselves
until after one year.
ORDER OF QUABTEBLY EXAMINATIONS.
1st. Candidates shall return their names to the registrar,
and lodge their fees and certificates one week before examina¬
tion.
2nd. Candidates shall be examined in alphabetical order.
4th. The candidates assemble at three o'clock P.M.,
when twelve, selected according to alphabetical order, will
each (for the junior class) receive three written questions on
Anatomy and Physiology, and one on Materia Medica, and
(for the senior) four written questions on Surgery and Practice
of Medicine, which they will be required to answer within
one hour; at the end of the hour each candidate shall en¬
close his questions and answers in an envelope, with his name
on the back, and hand same to the examiner superintending.
5th. The seven examiners shall attend on each day at four
o'clock, to commence the Oral Examinations, and four of them
shall examine for a quarter of an hour, at four separate tables
in the junior class—viz., three on Anatomy and Physiology,
and one on Materia Medica, and in the senior class, three on
Surgery and Practice of Medicine, and one on the Form of
Prescription.
6th. Two councillors shall be summoned to witness the ex¬
amination of each candidate, and shall accompany him from
table to table till his examination be completed, when the
voting papers having been examined, and the result declared,
the name of each successful candidate shall be enrolled in a
book kept for that purpose in the college.
Examinations shall be held on the second Tuesday in
February, May, August, and November, at which Candi¬
dates shall be divided into two classes—junior and senior.
The Junior Class shall produce certificates of three
courses of Lectures on Anatomy and Physiology, three courses
on Practical Anatomy, with dissections ; two courses on Che¬
mistry, one course on Materia Medica, one course on Botany,
and one course on Forensic Medicine.
This class shall be examined in Anatomy, Physiology,
and Materia Medica.
The fee for this examination shall be five guineas ; not
to be returned in case of rejection, but to be allowed in the fee
for the second examination.
The Senior Class shall produce certificates of three courses
on the Theory and Practice of Surgery, one course on
the Practice of Medicine, and one course on Midwifery ; also
of attendance on a recognised hospital for three Winter and
three Summer Sessions.
This class shall be examined in Surgery, Operative Sur¬
gery, the Practice of Medicine, and form of prescription.
Both these examinations shall be partly written and partly
oral.
The fee for this examination shall be fifteen guineas.
Fees to be paid by Candidates for Letters Testimonial.
1st. The candidate pays ten shillings for his preliminary
examination.
2nd. Five guineas as registered pupil of the college.
3rd. Five guineas for the Jonior Class examination, which
is not returned in case of rejection, but is allowed in the fee
for his second examination.
4th. Fifteen guineas for the Senior Class examination—total,
£2«, 15s.
5th. Every candidate rejected at the quarterly examinations
shall be required to pay to the college the sum of two guineas
on applying for re-examination.
See advertisement of School in connection with College.
KING AND QUEEN’S COLLEGE OF PHYSICIANS
IN IRELAND.
BEGtJLATI0X8 RESPECTING THE LICENTIATESHIP.
Candidates must make application according to the form
supplied, and lodge the admission fee.
Candidates must give proof of having attained the age of
twe n t y- one, of four years’ study; ana of having studied
^ptfiWT. Physiology, Practical Anatomy, Chemistry; Frac¬
tal Chemistry Materia Medica and Botany, Medical
Jvhpniaeace, Practice of Medicine and Pathology, Surgery,
MMwifrty.
Of having attended a Medico-Chirurgical Hospital, with
Clinical Lectures, for twenty-seven months (or for eighteen
months with nine months at a Medical Hospital), both
hospitals not being taken ont in the same year.
Of six months’ Practical Midwifery at a hospital, or other
evidence of having attended Practical Midwifery.
Candidates not personally known to a Fellow of the College
must transmit Testimonials of character from registered Phy¬
sicians and Surgeons. Those of public hospitals or infirmaries
are preferred. ’ '
SESSIONAL EXAMINATIONS.
Students are recommended to divide their study into two
Periods, of two years each ; the first, Anatomy and Physio¬
logy, Surgery, Chemistry, Botany, and Hospital Attendance.
The second to comprise Practice of Medicine, Materia
Medica, Medical Jurisprudence, Midwifery, and Hospital At¬
tendance. \
The Examination is divided into two parts:—
First Part.—Anatomy, Physiology, Botany and Chemistry.
Second Part.—Materia Medica, Practice of Medicine, Medi¬
cal Jurisprudence, and Midwifery.
Students may be examined in the first part at the termina¬
tion of the first period of study; or in all the subjects on the
completion of their studies.
Candidates must have passed a Preliminary Examination in
Arts within the first two years of their studies.
Students in Arts of one year’s standing, of a University;
Graduates or Licentiates in Medicine or Surgery of any Uni¬
versity or College will be exempted.
Candidates qualified as follows are required to undergo the
second part of the professional Examination only—viz., 1.
Graduates in medicine of a University. 2. Fellows, Mem¬
bers, or Licentiates, of the Colleges of Physicians of London
or Edinburgh, admitted upon Examination. 3. Graduates or
Licentiates in Surgery.
An objected Candidate may be admitted to re-examination
after two months.
Every candidate must subscribe a declaration that he
authorises the cancelling of his diploma should he at any time
keep open shop for Bale of medicines.
REGULATIONS RESPECTING THE LICENCE IN MIDWIFERY.
Members of the College must undergo a special Examina¬
tion, and shall be distinguished as Practitioners in Midwifery
in the Lists of the College.
Candidates not being Licentiates, will be admitted on the
following qualifications:—The Degree or Licence in Medicine
or Surgery with a Certificate of six months’ Lectures ou
Midwifery, with six months at a recognized Lying-in Hospital,
or of having attended Practical Midwifery for six months
at a recognised Lying-in Hospital, or other evidence of
having attended Practical Midwifery.
FEES FOR LICENCE AND EXAMINATIONS.
The Fee for the Licence is £15, 15s.; which may be divided
as follows:—
For Examination at the termination of the first period of
Study, £5, 5s.
For final Examination for the Licence, £10,10s,
Fee for the Midwifery Diploma, £3, 3s.
The following Regulations relative to the Licence in Mid¬
wifery were adopted by the College on the 10th of March,
1865 ; Fee for the Licence in Medicine and Midwifery, if
taken out at the same time, £16.
The Admission Fee, with the exception of £2,2s., is returned
to any rejected Candidate ; and the Admission Fee, with the
exception of £1, Is., is returned to any rejected Candidate for
the Licence in Midwifery ; but in the case of a rejected Candi¬
date afterwards passing within twelve months, the sum pre¬
viously deducted is allowed in the fee paid for such second Ex¬
amination.
Beside the ordinary separate examination for each candi¬
date, Quarterly Class Examinations are now held at the King
and Queen’s College of Physicians, Dublin, according to the
regulations given below. In every case the examinations of
this College are open to that portion of the public who are
best qualified to judge the Licentiates, and due notice is
given according to a printed form, which is put up in the read¬
ing-room two days before each separate examination, and by
advertisement in the medical and daily papers, as regards the
Digitized by v joogle
260 The Medical Press and Circular.
UNIVERSITY OF EDINBURGH.
September 16, 1868.
Quarterly Class Examinations. The examinations are emi¬
nently fair and practical, due regard ^being had to the bona fide
knowledge of the candidate ; and to the interests of the public
who may be confided to his professional care. This College
has recently discontinued preliminary examinations in Arts,
leaving that duty to be performed by the Universities, and by
other public bodies, having the care of general, rather than
professional education.
The quarterly examinations are partly written and partly
viva voce; and after 18th October, 1868, all examinations will
be conducted in like manner.
See advertisement of School of Physic.
THE APOTHECARIES’ HALL OF IRELAND.
REGULATIONS REGARDING THE LICENCE.
Every candidate is required to undergo a preliminary and a
professional examination.
THE PRELIMINARY EDUCATION AND EXAMINATION
Include—1. English; 2. Mathematics; 3. French; 4. Latin;
5. Greek; 6. Natural Philosophy; 7. Natural History.
A preliminary examination will be held at the 11 all four
times in the year—viz., on the third Friday in the months of
January, April, July, and October, at two o’clock p.m. This
examination will be conducted by graduates in arts of the
University of Dublin, with assessors from the court of the
Hall.
Unsuccessful candidates will not be re-admitted to examina¬
tion until after six months.
Certificates in arts granted by any of the bodies named in
the Medical Act, or by any educational institution approved
of by the Medical Council, will be recognised.
THE PROFESSIONAL EDUCATION.
Every candidate for the licence to practice must produce
certificates—1. Of having passed an examination in arts pre¬
vious to professional study. 2. Of being registered as a student
in medicine by one of the bodies named in Medical Act. 3.
Of being twenty-one years of age, and of good moral character.
4. Of apprenticeship to a qualified apothecary, or of having
been engaged at practical pharmacy with an apothecary for
three years subsequent to having passed the examination in
arts. 5. Of having spent four years in professional study. 6.
Of having attended the following courses, viz.:—Chemistry,
one winter session; Anatomy and Physiology, two winter ses¬
sions; Demonstrations and Dissections, two winter sessions;
Botany and Natural History, one summer session; Materia
Medica and Therapeutics, one summer session; Practical Che¬
mistry, three months; Principles and Practice of Medicine,
one winter session; Midwifery and Diseases of Women and
Children, six months; Practical Midwifery at a recognised
hospital (attendance upon twenty cases); Surgery, one winter
session; Medical Jurisprudence, one summer session; Instruc¬
tion in the Practice of Vaccination. 7. Of having attended
at a recognised hospital the Practice of Medicine and Clinical
Lectures during two winter and two summer sessions; also the
Practice of Surgery and Clinical Lectures, one winter and one
summer session.
tEBTIFICATE OF ASSISTANT.
Candidates for the certificate of assistant to an apothecary
must have completed at least three years of his apprenticeship
or have a Certificate from an apothecary of having been en¬
gaged at Practical Pharmacy for three years, together with a
certificate of good moral character.
The examination of the intended assistant will be restricted
to the British Pharmacopoeia and to Pharmacy, scientific and
practical, including the history and character of Medicines,
their preparations, combination, and doses, and the translation
of Latin Prescriptions.
THE PROFESSIONAL EXAMINATION
Will be held on the first Uco Fridays in each' month, with
the exception of the month of August, and will commence at
Twelve o’clock Noon, by means of printed or written questions,
to which written answers will be required. Each Candidate
must have his paper completed (with his name affixed thereto)
by the hour of Two o’clock, P.M., when the candidates will be
examined orally.
Candidates who fail to pass the First Part of the Professi on a l
Examination will be remitted to their studies for three month.
Numerical values will be assigned to the Answers, both
■written and oral, in the several Examinations, and only Can¬
didates who possess a certain proficiency of Medical knowledge
in all the subjects will obtain “ The Licence to Practise .”
Unsuccessful Candidates at the Pass Examination will not
be re-admitted until after the expiration of six months.
Doctors of Medicine of any of the Universities in the United
Kingdom, or Surgeons of any of the Royal Colleges of Surgeons
whose qualifications as such appear in the Medical Registrar,
and who, having first passed an Examination in Arts, have
also served an Apprenticeship, or the required term at practical
Pharmacy, to a qualified Apothecary, may obtain the Licence
of the Hall by undergoing an Examination—the former in
Pharmacy and the latter in Medicine and Pharmacy ; in either
case the Candidate will be subjected only to one day’s Exami¬
nation.
Candidates for the Licence must lodge their Testimonials
and enrol their names and address with the Clerk at the Hall,
in Dublin, a week prior to the day of Examination.
-+■■ -
gUpIatas aitir
uf §tasiit0 §0te in ^uatlarir.
UNIVERSITY OF EDINBURGH.
This is a teaching as well as a qualifying body, and the
other faculties are as complete as that of medicine. The
University confers the degree of M.D., and M.B., as well
as that of C.M., and so affords its graduates the oppor¬
tunity of obtaining, at the same time, a Surgical, in ad¬
dition to the Medical diploma. The C.M. is not conferred
on any one who does not take at the same time the M.B.
For the degrees of M.B. and C.M., four years of profes¬
sional study must be completed after passing a preliminaiy
examination recognised by the Medical Council. A degree
in arts in any British University exempts from the pre¬
liminary examination. Of these four years, one must be
passed in the University of Edinburgh, and one other
either in that or some other University entitled to confer
the degree of M.D.
The University recognises the courses of lectures of extra-
academical teachers in Edinburgh subject to certain regula¬
tions.
The following regulations respecting the examinations
for the degrees of M.B. and C.M. are now in force
Every candidate must deliver, before the 31st March:—
1. A declaration, in his own handwriting, that he has com¬
pleted hia twenty-first year, and that he will not be, on the day
of graduation, under apprenticeship. 2. A statement of hi
studies, as well in Literature and Philosophy as in Medicine,
accompanied with certificates.
2. Each candidate is examined, both in writing and rim row,
—1st, on Chemistry, Botany, and Natural History ; 2ndly, on
Anatomy, Institutes of Medicine, Materia Medica. Pathology;
3rdly, on Surgery, Practice of Medicine, Midwifery, end
Medical Jurisprudence ; 4thly, clinically on Medicine, and on
Surgery in an hospital.
3. Students are admitted to an examination on tbefint
division of these subjects at the end of their second year.
4. Students who have passed their examination on the tint
division may be admitted to examination on the second divi¬
sion at the end of their third year.
5. The examination on the third and fourth divisions cannot
take place until the candidate has completed his fourth annul
medicos.
6. Candidates may be admitted to examination on the first
two of these divisions at the end of their third year, or to the
four examinations at the end of their fourth year.
7. A candidate found unqualified cannot be again admitted
to examination unless he has studied during another year two
of the prescribed subjects.
8. After the candidate has satisfied the examiners, he wiH
be summoned, on the 31st day of July, to defend his thesk;
and finally, if the Senate think fit, he will be admitted on ft*
1st of August,
Digitized by CjOOQie
The Medleal Press and Circular.
COLLEGE OF SURGEONS, EDINBURGH.
September It, IMS. 261
DEGREE OF M.D.
9. The degree of Doctor of Medicine may be conferred on
any candidate who has obtained the degree of Bachelor of
Medicine, and is of the age of twenty-four years, and has been
engaged, subsequently to the degree of Bachelor of Medicine,
for two years at an hospital, or in the Military or Naval Me¬
dical Service, or in medical and surgical practice : the Doctor
of Medicine must be a graduate in Arts of a University, or
ahall, in addition to the preliminary branches of extra profes¬
sional education required for M.B., have passed a satisfactory
examination in Greek, and in Logic or Moral Philosophy, and
in one at least of the following subjects—namely, French,
German, Higher Mathematics, and Natural Philosophy.
_ 10. Persons who began medical studies before 1861, are en¬
titled to graduate under the system in force before or after
that date.
N. B.—No candidate can appear for his final examination
for M.D., who has not deposited his thesis with the Dean on
the 81st of March. This statute will be rigidly enforced.
CANDIDATES FOR GRADUATION WHO COMMENCED BEFORE 1861.
Total Fee for M.B. Diploma, . , . £15 15 0
Additional Fee for C.M. Diploma, . , 5 5 0
Additional Fee for M.D. Diploma, . . 5 5 0
Government Stamp-duty for M.D. only, . 10 0 0
bvte .—Total Fees and Stamp for graduating as M.D. only,
by Regulations for Students commencing before February,
1861, £25. In conformity with the desire expressed by the Privy
Council, it has been resolved that any candidate for a degree
in Medicine, must produce, at his final examination, a certificate
from a dispensary or other public institution where vaccination
is practised, attesting that he has been practically instructed in
the operation, and is acquainted with the appearances which
follow its performance.
N.B.—These are only required for the degree of M.D., and
none are now required for the degree of M.B. Those who
have, under former regulations, given in Theses when taking
the degree of M.B. require no Theses for M.D.
Preliminary Examinations in Arts, . 20th and 21st Oct. 1868.
» i, . 23rd and 24th March,
1869.
First Professional Examination, . 24th October, 1868.
»» „ . 1st April, 1869.
Second Professional Examination, . 7th and 8th July, 1868.
» „ . 8th and 9th April, 1869.
Final Professional Examination, . 2nd and 3rd June, 1868.
Defence of Theses, . . . 31st July.
Graduation, . . , . 1st August.
For further particulars see advertisement.
UNIVERSITY OF GLASGOW.
This is a large teaching as well as examining body. The
same degrees are conferred as in the Universities of Edin¬
burgh and St. Andrews. The course of study regulations
to be observed by candidates are the same as those of the
university of Edinburgh (which see), the Dean’s compul¬
sory residence at the University of Glasgow being required
instead of at Edinburgh. The examinations are conducted
by the Professors of Mediciiie, together with the three
•lessors appointed by the University Court. The pre¬
sent Assessors are Dr. John Coats, Dr. J. G. Fleming, and
Dr. Andrew Anderson. The term for conferring degrees
18 °n the first day of May. Fees for degrees :—M.B.,
^15, 15s. (being £ 5, 5s. at each of the three examinations);
C.M., £5 f 5 g. (in addition to the fees for M.B.) ; M.D.,
*3) 5s. (in addition to the fees for M.B.) ; and ilO, 3s.
for Government stamp. The lectures qualifying for the
degrees are delivered by the Professors in the University,
nnd the hospital practice is attended at the Glasgow Royal
Infirmary.
- Winter Session.
Anatomy—Demonstrations, &c.—Dr. A. Thompson, 11 o’clock.
uhemUtry—Dr. T. Anderson, at 10 o’clock.
Materia Medica—Dr. Cowan, at 11 o’clock.
Institution of Medicine—Dr. Buchanan, at 4 o’clock.
Medicine—Dr. Gairdnfer, at 12 o’clock.
Surgery—Mr. Lister, at 1 o’clock.
Midwifery, &c.—Dr. Leishman, at 3 o’clock.
Medical J urisprudence —Dr. Rainy, at 4 o’clock.
Lectures on the Eye—[vacant] (in summer).
Summer Session.
Practical Anatomy and Demonstrations—Dr. Thomson, at 11.
Botany—Dr. Alex. Dickson* at 2, and half-past 6 o’clock.
Practical Chemistry—Dr. Anderson, at 10 ; Lab. 9 4 A.M, to
44 p.m.
Natural History—Dr. Young, at 10 o’clock.
HOSPITAL PRACTICE—GLASGOW ROYAL INFIRMARY.
Physicians—Drs. Gairdner, Leishman, Steven, and Perry, at
half-past 8 o’clock.
Surgeons—Drs. E. Watson, Dewar, Macleod, and Mr. Lister,
at half-past 8 o’clock.
Assistant-Surgeons—Dr. Dunlop (one vacant).
PRIZES, SCHOLARSHIPS, AND EXHIBITIONS.
Brisbane Bursary, value £50 per annum ; Logan Bursary,
value £15 per annum ; Walton Bursary, value £20 per
annum ; three Armagh Bursaries, value £25 per annum.
The Introductory Lecture will be delivered on the 27th
October, 1868, by Professor Lister.
TERMS OP EXAMINATION AND GRADUATION, FEES, &C.
The examinations in general education take place twice
yearly—viz., in October and April. Those who intend to pre¬
sent themselves for either of these examinations are required
to send in their names to the Registrar on or before the 13th
October, or the 6th of April. The professional examina¬
tions arc held at the following periods—viz., the first in Octo¬
ber ; the second and third in April.
UNIVERSITY OF ABERDEEN.
This is a large teaching body, as well as o^e entitled to
confer degrees in all the faculties. The curriculum required
for medical degrees is the same as that of the University
of Edinburgh (which see). Thus, four years of professional
study, after passing a preliminary examination, is essential.
One year must be passed at Aberdeen. The lectures quali¬
fying for this and other examining bodies are delivered by
the professors in the university.
Winter Session.
Anatomy, Dissections, &c.—Dr. Struthers, 11 and 9 to 4.
Chemistry—Mr. Brazier, at 3.
Materia Medica—In summer.
Physiology (Inst, of Medicine)—Dr. Ogilvie, at 4.
Medicine—Dr. Macrobin, at 3.
Surgery—Dr. Pirrie, at 10.
Midwifery, &c.—Dr. Dyce, at 4.
Medical Jurisprudence—Dr. Ogston, at 9.
Natural History—Mr. Nicol, at 2.
Natural Philosophy—Mr. Thomson, at 9.
Summer Session.
Practical Anatomy and Demonstrations— Dr. Struthers, 9 to 4.
Botany—Dr. Dickie, at 9 A.M.
Histology—Dr. Struthers, at 2 P M.
Comparative Anatomy—Mr. Nicol, at 11.
Practical Chemistry—Mr. Brazier, 10 A.M.
Materia Medica, &c.—Dr. Harvey, at 3.
HOSPITAL PRACTICE—ABERDEEN ROYAL INFIRMARY.
Physicians—Drs. Harvey, J. F. Smith, A. Reith, daily at 12.
Surgeons—Drs. Keith, Pirrie. Kerr, Fiddes, Wolfe (ophth.),
Mr. Williamson (dental), daily at 12.
Clinical Medicine—Drs. Harvey and J. F. Smith, at 1.
Clinical Surgery—Drs. Keith and Pirrie, at 1.
For further particulars see advertisement.
ROYAL COLLEGE OF SURGEONS OP
EDINBURGH.
THE FELLOWSHIP
Is conferred only on persons who have obtained a diploma
from this or one of the Colleges of Surgeons of England
or Ireland, or the Faculty of Physicians and Surgeons of
Glasgow, and who are 25 years of age. At the election,
three-fourths of the votes are required to be in the candi¬
date's favour, and he has to promise to maintain the privi-
262 The Medical Press and Circular. THE SCOTCH DOUBLE QUALIFICATIONS.
September 16 , 1666 .
leges of the College and obey its laws. Fellows are for¬
bidden to keep open shops, to be connected with secret
remedies, or to suffer their names to be used in indelicate
advertisements or publications.
THE LICENCE.
The regulations are the same as those for the Joint Exami¬
nation, given below, by the Colleges of Physicians and Sur¬
geons, with the following exceptions : Botany is not required.
A second course of Medicine is not required.
The first Professional Examination embraces Anatomy,
Physiology, and Chemistry. The second Surgery and Surgi¬
cal Anatomy, also Medicine, Midwifery, Materia Medica,
Medical Jurisprudence, and Clinical Surgery.
Registered medical practitioners, whose degree or licence in
Medicine dates prior to October 1st, 1861, are exempt from
the first Professional Examination.
Fee for the diploma, £10.
For further particulars see advertisement.
ROYAL COLLEGE OF PHYSICIANS OF
EDINBURGH.
This, like its London sister, is exclusively a licensing body,
though, since the arrangement for the double qualification
has been carried out, it may possess some additional con¬
trol over the teaching at Surgeons’ Hall. By this arrange¬
ment students who have fulfilled the prescribed curriculum
may pass the joint examination of this college and the
Royal College of Surgeons, and obtain the two diplomas.
They can thus at once register both a medical and surgical
qualification.
THE FELLOWSHIP.
Thisis conferred only by election, and no one can be baltotted
for until he has been a member for one year.
THE MEMBERSHIP
Is conferred on licentiates of a college of physicians, or gra¬
duates of a University, who are 24 years of age and satisfy the
College of their knowledge of medical and general science.
THE LICENCE.
months' attendance on the practice of a public general hospital,
containing on the average at least eighty patients.
A certificate of proficiency in Vaccination, from a Vaccine
Institution, will be required of every candidate.
Candidates commencing professional study prior to 1st Oct,
1S65, are admitted to the final examination alter four sessions,
or three winter and two summer sessions’ attendance at a
regular medical school.
Candidates commencing professional study on, or subse¬
quent to the above date, must have been engaged in profes¬
sional study during four years, which shall embrace four
winter sessions or three winter and two summer sessions at a
medical school.
Candidates are required to be registered in the form pre¬
scribed by the General Medical Council at the commencement
of their professional study.
Candidates are subjected to two professional examinations;
the first embraces Anatomy, Physiology, and Chemistry, and
cannot be undergone before the end of the second winter ses¬
sion of study.
The second embraces Surgery and Surgical Anatomy,
Medicine, Midwifery, Materia Medica, and Medical Juris¬
prudence, and cannot be undergone before the termination of
the full period of study.
Intending candidates for the second examination must pro¬
duce evidence—1. Of being 21 years of age.—2. Of having
passed the first examination.—3. Class and hospital certificates.
They will also write out a tabular statement of their whole
course of study, for which the secretary, on application, will
supply candidates with printed forms.
The fee for the diploma is £10; £4 payable at the first, and
£6 at the second examination.
First examinations will be held on the second Tuesday of
each month. Second examinations will take place, the written
and Clinical parts, on each of the above days, and the oral part
on the succeeding day.
Candidates who possess a Qualification to practise, are ad¬
missible to the Second Professional Examination at the full
fee.
In every case of rejection, £2 of the fee is retained, and
the remainder is returned.
A candidate may be admitted to examination on a day
specially arranged, on paying an extra fee of £3, which will
be forfeited in the event of rejeotion.
' The regulations are the same as those for the joint examina¬
tion. For the Scotch Double Qualification, see below, with
the following exceptions :—Anatomy, Practical Anatomy, and
Surgery, six months ; Clinical Surgery, three months.
Candidates for the Licence of the College who already pos¬
sess a qualification from a recognised licensing body, or who
have passed the first Professional Examination before a quali¬
fying body, will not be required to be re-examined in Anatomy,
Physiology, and Chemistry.
The following are the Fees, payable in all cases in ad¬
vance :—
By a Licentiate, Ten Guineas. By a Member, Thirty
Guineas.
When a Licentiate shall be raised to the rank of Member,
Twenty Guineas.
See advertisement of Colleges of Physicians and Surgeons.
FACULTY OF PHYSICIANS AND SURGEONS OF
GLASGOW.
ABSTRACT OF REGULATIONS FOR THE LICENCE.
Course of Study.—1. Anatomy, two courses, six months
each. 2. Practical Anatomy, twelve monthB. 3. Chemistry,
one course, six months. 4. Practical or Analytical Chemistry,
one course, three months. 5. Physiology, not less than fifty
lectures. 6. Practice of Medicine, one course, six months.
7. Clinical Medicine, one course, six months. 8. Principles
and Practice of Surgery, one course, six months. 9. Clinical
Surgery, one course, six months. 10. In addition to the
above courses of Surgery and Clinical Surgery, one six
months’ course of either of these at the option of the candi¬
date. 11. Materia Medica, one course, three months. 12.
Midwifery, &c., one course, three months. 13. Medical Juris¬
prudence, one course, three months. 14. Practical Midwifery, I
attendance on at least six cases of labour. 15. Pathological l
Anatomy, three months’ instructions in the post-mortem room
of a recognised hospital. 16. Hospital Practice, twenty-four
DOUBLE QUALIFICATION.
The Faculty of Physicians and Surgeons of Glasgow, and
the Royal College of Physicians of Edinburgh, while they
still continue to give their diplomas separately, under separ¬
ate regulations, have made arrangements by which, after one
series of examinations, the student may obtain two separate
licences ; one in Medicine and one in Surgery. (See “ The
Scotch Double Qualification ” below.)
The “ Dr. James Watson Prize,” of the annual value of
ten guineas, is open to all students who have passed the First
Examination of the Faculty, and who are not qualified at the
date at which the pay is due.
Preliminary Examinations.—23rd October, 6th November,
1868 ; 1st April, and 23rd July, 1869. Subjects.—English,
Latin, Arithmetic, Algebra, Geometry, and one of the follow¬
ing, at the option of the candidate, Natural Philosophy,
Greek, French, and German.
First Professional Examination for the Diploma of the
Faculty, on the second Tuesday of every month. Subjects.
—Anatomy, Physiology, and Chemistry.
Second Professional Examination for the Diploma of the
Faculty, on the second Tuesday and Wednesday of each
month. Subjects.—Surgery and Surgical Anatomy, Medi¬
cine, Midwifery, Materia Medica, and Medical Jurisprudence.
First Professional Examination for the Double Qualifica¬
tion, granted conjointly with the Royal College of Physicians
of Edinburgh, on the second Thursday of October, January,
April, May, July, and August. Second Examination on the
sam e days.
For full particulars see advertisement.
THE SCOTCH DOUBLE QUALIFICATIONS.
As already stated the Royal College of Physicians of Edin¬
burgh have made arrangements with the Royal College of
Surgeons of Edinburgh, and the Faculty of Physicians and
Surgeons of Glasgow, by which, after one series of exami-
Digitized by
Google
11* Medical Pttm and Circular. UNIVERSITY OF ST. ANDREWS. September 16,1868. 263
nations, the successful candidate receives two diplomas,
and is thus able to register a medical and a surgical quali¬
fication under the Medical Act, thus :—
Lie. Roy. Coll, of Phys. Ed., and Lie. R. C. S. Edin., or
Lie. R. Col. of Phy. Ed., and L. Fac. Phys. and Surg.
Glas., as the case may be.
The principle on which the joint examinations are conducted
is a simple compromise by which the College of Physicians
takes exclusive charge of the examination in medicine ; the
College of Surgeons or the Glasgow Faculty, as the case may
be. of the examination in surgery ; while the examination in
subjects common to both medicine and surgery is conducted by
a board, in which each of the bodies is represented.
It is proper to state that such arrangements as those were
contemplated by the Medical Act and authorized by Section
XIX., while thesh under consideration were sanctioned by the
Medical Council on the 7th August, 1859. •
Candidates for the double qualification having fulfilled the
prescribed curriculum are subjected to two professional exa¬
minations. The preliminary examination for future students
must be passed before commencing professional study, and in
other respects be in accordance with the recommendations of
the Medical Council.
The following courses of lectures must be attended :—Ana¬
tomy, two courses, Bix months each ; Practical Anatomy,
twelve months ; Chemistry, six months ; Practical or Analy¬
tical Chemistry, three months; Materia Medica, three months;
Physiology, fifty lectures ; Practice of Medicine, six months;
Clinical Medicine, six months (in addition to the above
courses of Practice of Medicine and Clinical Medicine, one
course of either, at the option of the student); Principles and
Practice of Surgery, six months ; Clinical Surgery, six months
(in addition to the above courses of Surgery and Clinical
Surgery, one course of either at the option of the Btudent);
Midwtfery and Diseases of Women and Children, three
months; Medical Jurisprudence, three months ; Pathological
Anatomy, three months (or attendance on post-mortem exami¬
nations at a hospital). Candidates must have attended six
cases of labour, either in a maternity hospital, or a dispensary
where midwifery cases are admitted, or in private practice, and
must produce a certificate to that effect. Also three months
practical pharmacy under an apothecary or a member of the
Pharmaceutical Society, or a chemist and druggist recognised
by either college, or in a hospital or dispensary, or as assistant
to a registered practitioner.
The candidate must have also attended, for twenty-four
months, a public general hospital, and for six months a public
dispensary, recognised by the college ; or for six months as
visiting assistant to a registered practitioner.
A certificate in vaccination, signed by a registered practi¬
tioner will be required.
Candidates for the first professional examination must apply
on or before the Saturday preceding the examination, and
produce certificates of all those courses of study which have
reference to the subjects of that; examination, and also a certi¬
ficate of having passed the preliminary examination. Fee £6.
In case of a candidate being unsuccessful, £4 will be returned
to him, the remaining £2 being retained.
BECOND EXAMINATION.
Candidates who have passed the first professional examina¬
tion of any licensing board will be admissable to the second
examination on producing certificates of the whole course of
study, and paying the fee of £16. In conducting the exa¬
mination, none of the subjects will be omitted. Unsuccessful
Candidates will receive back £14.
The second examination shall embrace Medicine, Surgery,
and Surgical Anatomy. Midwifery, Pathological Anatomy,
Materia Medica and Pharmacy, and Medical Jurisprudence;
and shall not take place before the termination of the last year
of atudy. These examinations will take place immediately
after the conclusion of the first professional examinations.
Every candidate must produce—1st. Evidence of his having
attained the age of twenty-one; 2nd. The tickets and certificates
of his classes; 3rd. The certificate of the first professional exa¬
mination ; and 4th. A tabular statement (for which a printed
form will be furnished by the Inspector) exhibiting the full
amount of his education. The tabular statment must be
attested by his signature, and will L© preserved as a record.
Unsuccess fnl candidates at either examination shall be
remitted to their studies for a period, not in any case less than
three months. Fee £10. In case of a candidate being
unsuccessful, £8 will be returned.
Dissections and Anatomical Specimens, articles of the
Materia Medica, Chemical Tests, the Microscope, Surgical
Apparatus, and Pathological Specimens, will be employed
during the examinations; and every candidate will be required
to write prescriptions. The examination may also consist in
part of the actual examination of persons labouring under
disease.
Candidates who have been rejected by any examining board
may not be admitted within three months.
The inspector and treasurer of the double qualifications is
Dr. Gairdner, of 45, Northumberland street, Edinburgh, to
whom all communications should be addressed, and who will
furnish any further information.
UNIVERSITY OF ST. ANDREWS.
This University confers the Deg?ee of Master in Surgery
(C.M.), as well as the Degrees of Bachelor and Doctor of
Medicine. For many years the University did not require
residence, and large numbers of medical men resorted to it
in order to obtain the Doctorship by examination only.
In this the University closely assimilated itself to the
University of London, which is exclusively an examining
body. The large number of practitioners who obtained
the Degree after an examination extending over three or
four days, attests the wisdom of a policy which was almost
reversed by the University Commissioners. Only ten per¬
sons per annum can now obtain the St. Andrews Degree
without residence. There are not a few of the old gra¬
duates who look upon this policy as retrogade and illiberal.
The University of London maintains its position without
requiring academical residence, and no one can doubt that
the University of St. Andrews might have pursued the
same course with great success, and by so doing conferred
a benefit on the profession. Those who have not now ful¬
filled their course in a University, must either go to the
University of London or ferego a decree. The London
University compels matriculation before commencing Hos¬
pital study. Only a relaxation of this rule can secure to
all who desire it the opportunity of being examined for a
degree. The following are the regulations actually in
force:—
1. No one shall be admitted to the Bachelor of Medicine or
Master in Surgery lyho has not been engaged in Medical and
Surgical study for four years—the annus mediate , being con¬
stituted by two courses of one hundred lectures each, or by one
such course, and two courses of fifty lectures each; but, in the
case of the clinical courses, it shall be sufficient that the lec¬
tures be given at least twice a-week.
2. Candidates for the Bachelor of Medicine and Master in
Surgery must produce certificates similar to those required by
the University of Edinburgh.
3. No one shall be received as a Bachelor of Medicine or
Master in Surgery unless two of his four years shall have been
in one of the following, viz.,—the University of St. Andrews,
of Glasgow, of Aberdeen, of Edinburgh, of Oxford, of Cam¬
bridge, Trinity College, Dublin ; Queen's College, Belfast ;
Cork and Galway.
4. Every candidate for M.B. and C.M. shall lodge with the
Senatus—A declaration, in his own handwriting, that he has
completed his twenty-first year, and is not under articles of
apprenticeship. A state of his studies in literature, philo¬
sophy and medicine with certificates. A dissertation, composed
by himself, and shall be examined, both in writing and orally
—first, on Chemistry, Botany, Elementary, Anatomy, and
Materia Medica ; secondly on advanced Anatomy, Zoology,
with Comparative Anatomy, Physiology, and Surgery; and
thirdly, on Practice of Medicine, Clinical Medicine, Clinical
Surgery, Midwifery, General Pathology, and Medical Juris¬
prudence.
5. Students who offer themselves for examination on the
first division of these subjects, at the end of their second year
may be admitted.
6. Students who have passed on the first division may be
admitted to examination on the second division at the end of
their third year.
7. The examination of the third division shall not take place
until the fourth.year.
Digitized by Google
264 The Medical Press and Circular.
GUY’S HOSPITAL.
September 16,1666.
8. Candidates may be admitted to examination on the first
two of these divisions at the end of their third year ; or to the
three at the end of their fourth year.
9. Rejected candidates shall not be admitted unless they
shall have completed another year of study, or such portion of
another year as may be prescribed by the Examiners.
10. Masters in Surgery must at the same time obtain the
degree of Bachelor of Medicine.
11. There shall be paid for the degree of Bachelor five
guineas for each of the three divisions, each such fee being pay¬
able when the candidate is examined in that division, and if
the candidate desires to be admitted to the degree of Bachelor
only, he shall not be required to pay any further fee to the
fifteen guineas ; but if he desires the degree of Master in
Surgery he shall pay a further fee of five guineas ; and every
candidate for the degree of Doctor, being a Bachelor of
Medicine, shall bay, in addition to the fees paid by him for the
degree of Bachelor of Medicine, a fee of five guineas, exclusive
of stamp duties.
ANDERSON’S UNIVERSITY, GLASGOW.
This is exclusively a teaching body. It offers excellent
opportunities for acquiring a complete medical education,
and the expenses are very much below those of any other
institution. The fame of Glasgow as a place for clinical
instruction lias long been known, and this school affords
the means of dissection, and the pursuit of other practical
knowledge throughout the year. Hospital practice at the
Glasgow Royal Infirmary. Every information will be given
on application to Dr. George Buchanan, 193, Bath-street,
Glasgow, both as to the University, the Hospital, and
Diplomas.
Winter Session.
Anatomy—Dr. George Buchanan, at 5 o’clock.
Practical Anatomy—Dr. George Buchanan, at 1 o’clock.
Physiology—Dr. E. Watson, at 12 o’clock.
Suigery—Dr. G. H. B. Macleod, at 11 o’clock.
Chemistry—Dr. Penny, at 10 o’clock.
Practice of Medicine—Dr. M‘Call Anderson, at 4 o’clock.
Dissection—Dr. George Buchanan, daily.
Materia Medica—Dr. Morton, at 3 o’clock.
Summer Session.
Surgical Anatomy—Dr. George Buchanan, at 12 o’clock.
Operative Surgery—Dr. G. H. B. Macleod, at 5 o’clock.
Midwifery—Dr. J. G. Wilson, at 3 o’clock
Practical Chemistry—Dr. Penny, at 1 o’clock.
Botany—Mr. Hennedy, at 10 o ? clock.
Medical Jurisprudence—Dr. Leishman, at 4 o’clock.
Glasgow Royal Infirmary. —See above.
Glasgow Eye Infirmary .
This Hospital contains 24 beds for in-patients, of whom 200
were treated during last year ; 3000 out-patients were pre¬
scribed for at the dispensary ; 197 operations were performed.
Consulting Surgeons.—Dr. H. Rainy and Dr. A. Anderson.
Surgeons.—Dr. Mackenzie, Dr. Anderson, and Dr. W. Brown.
Assistant-Surgeon.—Dr. George Rainy.
Junior Assistant-Surgeon.—Dr. Thomas Reid.
Glasgow Lying-in Hospital and Dispensary,
This Hospital contains 24 beds for in-patients. The average
number of women delivered yearly is 800.
Consulting Surgeon.—Dr. George Buchanan.
Consulting Physician.—Dr. A. Anderson.
Visiting Physicians.—Dr. Tannahill and Dr. J. G. Wilson.
Physicians to Out-Patients.—Dr. Yeaman and Dr. Dewar.
Dispensary for Skin Diseases , 63, John-strect.
Physician.—Dr. M'Call Anderson.
Number of patients annually, about 1200.
Practical Courses are held during the months of May, June,
and July.
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ST. BARTHOLOMEW’S HOSPITAL.
The great city hospital has always attracted large num¬
bers of students from all parts of the country, so that the
school is very flourishing. The loss of Dr. Martin made
a change in the staff duly noticed in our columns during
the year. Dr. Gee is the new Assistant-Physician. Speeial
departments have been organised during the last year.
H.R.H. the Prince of Wales is the President of the
hospital, which receives within its walls upwards of 5000
in-patients annually, and its out-patients and casualties
amount to more than 100,000 annually. It contains
650 beds, of which 403 are allotted to surgical, including
ophthalmic, orthopaedic, aural, and syphilitic cases, and 241
to medical cases and diseases of women and children. One
of the Assistant-Physicians sees the medical out-patients
daily, between eleven and two ; and one of the Assistant-
Surgeons sees the surgical patients daily, between twelve
and two.
Accommodation is provided for residence of students in
the college connected with the institution, for which an
entrance fe#bf £2, 2s., and a further payment of caution
money, £3, 3s. are required. 'The cost of maintenance
varies from 30s. to 33s. per week, payable in each term;
and the term of residence is unlimited.
The introductory lecture will be delivered on October
1st at two p.m. by Mr. Thomas Smith.
PRIZES, SCHOLARSHIPS, OB EXHIBITIONS.
Jeafferson Exhibition, £20, tenable for two years. Scholar¬
ships, three of £50 each ; one of £30; two of £25 ; one of
£20 ; all for general proficiency in Medicine and Surgery and
Midwifery, or Anatomy and Physiology and Chemistry; and
the following foundation prizes—Kirkes' Medal; Bentley
Prize ; Hitchin’s Prize; Wix Prize ; Foster Prize ; Treasurer's
Prize.
For further information see Advertisement.
ST. THOMAS’S HOSPITAL.
This is the borough hospital which was removed for the
Charing-cross Railway. The Surrey Hall affords temporary
accommodation until the new hospital on the site at Stan-
gate shall have been erected, when, we doubt not, a new
impetus will be given to the charity and the school. Dar¬
ing the year we nave furnished our readers with an aocount
of laying the foundation-stone (by H.M. the Queen) of the
noble pile of buildings now rising so rapidly on the banks
of the Thames. It is hoped by many that the new insti¬
tution may be ready to open with the session of 1869.
Dr. Barnes will give the introductory address this year
on the 1st of October.
There is accommodation for residence and free mainte¬
nance in the College-house for the two house-smgeons,
resident accoucheurs, one dresser, one obstetric clerk, and
assistant obstetric clerk, which appointments are awarded
by competition. Very good lodgings are to be obtained at
a reasonable rate all round the hospital.
PRIZK8 AND APPOINTMENTS FOB THE SESSION.
First year’s students—College prizes of £30, £20, and £10.
Second year’s students.—Prizes of £30, £20, and £10. The
dresserships and the clinical and obstetric clerkship.
Third year’s students—Prizes of £30, £20, and £10. The
two house surgeoncies, the resident accoucheurship, two hos¬
pital redstrarships at a salary of £40 each, or one at £80, are
awarded to third and fourth years’ students, according to
merit.
The William Tite Scholarship, founded by William Tite,
Esq., M.P., F.R.S., the proceeds of £1000 consols, tenable for
three years, is awarded every third year.
The dressers are provided with rooms and commons free of
expense. The Granger Testimonial Prize of £20, awarded
biennially to third or fourth year’s students, for the best phy¬
siological essay, to be illustrated by preparations and dissec¬
tions. The Cheselden Medal, for Surgery and Surgical
Anatomy. The Treasurer’s Gold Medal, for general proficiency
and good conduct.
FEES.
The hospital practice and lectures for the first and second
year, each, £40; and £10 for each succeeding year; or £90
perpetual. For further particulars see advertisement.
GUY’S HOSPITAL.
This old favourite borough school still attracts as many
students as ever. The hospital is, we believe, the largest
e
the Medical Pre* and Circular.
WESTMINSTER HOSPITAL.
September 16,1868. 265
but one in the metropolis, and from the excellence of its
appointments, its situation, and superior staff, it still keeps
np its old renown. In special departments, Guy’s is the
most advanced. This hospital has set tne example of
giving the appointments to its special departments to
gentlemen not on the staff. This liberality has enabled it
to secure the leading specialists of the country in its ser¬
vice, and has done more than all the other hospitals to¬
gether to put down all improper coquetting with specialism.
Guy's is situated close to the London Bridge Railways.
Hence, great facilities for getting to any part of London or
the country. It is quite practicable for students to reside
a little distance down either of the lines that converge at
this point, and thus enjoy the benefit of country air during
their hospital career. For those who wish to live close to
the hospital, there are many lodgings to be had at a
moderate price.
The Resident House Physician is appointed every six
months.
House-Burgeons are appointed every four months from
those students who have obtained the College diploma.
PRIZES.
Prises, varying in value from £25 to £40 each, will be
awarded at the dose of each Summer Session for general pro*
fidency—three at entrance ; three at end of first year ; two
at end of second ; two at end of third.
Two Gold Medals—one in Medicine, the other in Surgery—
are given annually by the Treasurer at the end of third year.
A Voluntary Examination will take place at entrance, in
Elementary Classics and Mathematics. The three first candi¬
dates will receive respectively £25, £20, £15.
The Introductory Lecture will be delivered on Thursday,
October 1st, at 2 p.m., by Dr. Moxon.
For further particulars see advertisement.
THE LONDON HOSPITAL.
This large hospital is situated at the east end of London,
in a district where accidents are of frequent occurrence,
and as a field for the study of surgery has always been pre¬
eminent. It contains upwards of 500 beds ; of these 160
are devoted to medical cases, and the remainder to surgery.
About 200 are reserved for cases of accidents. The in¬
patients last year numbered 4334; the out-patients, 34,442.
During the year special departments have been organised
for diseases of the eye, ear, and skin. Special wards are
also set apart for venereal and obstetric cases.
In our last Students’ Number we noticed the changes
consequent on the resignation of Dr. Raiusbotham, who
has lately died, as noticed in our columns—viz., the election
of Dr. Head (Obstetric Physician to the Hospital) to the
chair of Midwifery in the College, for a second year, and
of Dr. Prosser James to the chair of Forensic Medicine,
also for a second year. These gentlemen have since been
permanently appointed to their respective Professor¬
ships.
Mr. John Adams, Senior Surgeon of the Hospital,
having, during the year, become an examiner at the Royal
College of Surgeons of England, has resigned his Lecture¬
ship on Anatomy, which he had held for about 37 years,
being, we believe, the oldest and most popular teacher of
anatomy in the metropolis, if not in the Kingdom. He is
succeeded by Mr. Walter Rivington, in consequence of
which Mr. James Adams, son of the new college examiner,
is in future to be assisted in the demonstrations by Mr.
Waren Tay.
Dr. Tidy will continue to share the Chemical Course
with Dr. Letheby.
An additional Assistant Physician and Surgeon have
just been appointed to tho Hospital.
PRIZES AND APPOINTMENTS.
The following prizes and appointments are open to pupils:—
1. Two Scholarships will be awarded during the next winter
to first year’s students. The first, value £20, to the best stu¬
dent in Human Osteology, kc. The second, value £25, to the
best student in Anatomy, Physiology, add Chemistry.
2* The Duckworth-Nelson Prize, value £10,10s., will be
awarded in May, 1869, and is open to all students. The sub¬
jects will be Practical Medicine and Surgery.
3. A Hospital Scholarship, value £20, for zeal and profi¬
ciency in Clinical Medicine, and similar Scholarships in Surgery
and Obstetrics.
4. A Resident Medical Officer, who resides and boards in
the hospital, and receives £75, is appointed for twelve months.
He is eligible for the further period of twelve months, and
then receives £100.
5. Medical and Surgical Registrars are appointed annually,
and receive £25 and £35 respectively.
6. Three House-Surgeons are elected every six months,
without expense ; they reside and are provided with commons.
The house-surgeons are eligible for re-election for three
months.
7. A Resident Accoucheur is appointed for six months, free
of all expense, with residence and board. He is the assistant
to the obstetric physician and the assistant-physician.
8. An Assistant Medical Officer is chosen from among the
medical pupils. He remains in the hospital day and night,
and is provided with board.
9. Prizes to the value of £60 are awarded to the most meri¬
torious of the dressers.
10. Two Clinical Assistants are appointed for the medical
out-patients, and receive salaries of £40.
11. Two Assistants are appointed for the surgical out¬
patients at £40.
12. Two Surgical Dressing Pupils, in rotation, remain in the
hospital for a week, and are provided with board.
13. Special Certificates are given.
For further particulars see advertisement.
MIDDLESEX HOSPITAL.
The hospital contains upwards of 300 beds, of which 185
are for surgical, and 120 for medical cases. There is a
special department for cancer cases affording accommoda¬
tion for thirty-three in-patients, whose period of residence
in the hospital is unlimited. Wards are also appropriated
for the reception of cases of uterine disease and .of syphilis,
and beds are set apart for patients suffering from diseases
of the eye.
Special attention is bestowed on the clinical instruction
of the students both in the wards and out-patients’ rooms.
Three clinical prizes, including the governors’ prize of
twenty guineas, are annually awarded to those students
who pass the most satisfactory examination at the bedside,
and in the post-mortem room. Class prizes are also given,
and six resident clinical appointments are annually awarded
after competitive examination, to students who have com¬
pleted their education and complied with the regulations
of the school. The officers thus appointed reside and
board in the hospital free of expense.
The college tutor assists all general students free of
charge, especially those who are preparing for examination,
and his daily instruction is arranged wiui a view to avoid
the necessity of students obtaining any private teaching
apart from that of the medical school.
The fee for attendance on the hospital practice and lec¬
tures required by the Colleges of Physicians and Surgeons,
and by the Society of Apothecaries is £90, which may be
paid by instalments. Tne introductory address will be
delivered by Dr. Burdon Sanderson, F.R.S., on Thursday,
October 1st, at three o’clock p.m.
For further particulars see advertisement.
WESTMINSTER HOSPITAL.
This is near the Abbey and the Houses of Parliament,
and will be found convenient for all in that neighbourhood.
It is well appointed in every respect, and one of the most
moderate in respect to fees. The whole course of study
for the usual examinations may here be completed for
seventy-five guineas, payable in instalments. The perpe¬
tual fee is only eighty guineas. Resident appointments,
clerkships, and dresserships are all conferred without extra
payments. Suitable lodgings may be obtained in the neigh¬
bourhood, and at not more than a quarter of au hour's walk
from the Hospital
Digitized by
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266 The Medical Press and Circular. MANCHESTER SCHOOL OF MEDICINE.
September 16, I860;
PRIZES.
Resident appointments of House Physician and House
Surgeon free of charge.
The Assistant House Surgeon receives his commons at the
Hospital free of charge.
Clinical Clerks and Dressers are appointed from the students
free of all extra fee ; and the Clerk and Dresser for the week
have lunch at the Hospital table.
A prize of books or instruments for each winter and summer
course. Prizes of five guineas for Clinical Medicine and
Surgery.
Chadwick prize of twenty guineas for general proficiency.
The examinations are held at the end of each winter and
summer session.
Public distribution at the commencement of the summer
session.
The introductory lecture will be delivered on Thursday,
October 1st, at eight P.M., by Francis Mason, Esq., F.R.C.S. ;
after which a conversazione will be held in the board room.
The students are enabled to attend the practice at the
National Hospital for Epilepsy and Paralysis, and also that at
the Royal Westminster Ophthalmic Hospital. A certain
number of beds are set apart for special diseases of the akin,
eye, &c.
For further particulars see advertisement.
UNIVERSITY COLLEGE AND HOSPITAL.
This is situated in a very central position, near the Gower-
street Station of the Underground Railway, affording
facilities for gentlemen residing in many parts of London.
The College gives instruction in every department of
knowledge, and specially prepares students for degrees in
all the Faculties at the University of London. There is,
however, no theological faculty, the College, like the
University with which it is in intimate connection, being
founded on the non-sectarian principle. The Medical
Faculty and the Hospital are very complete and nourish¬
ing as educational institutions. The University College
School specially prepares boys to be ready at a proper
age to enter the College.
PRIZES.
Liston Gold Medal for Clinical Surgery. Dr. Fellowes’
Medals for Clinical Medicine, two gold and two silver.
Filliter Exhibition for Proficiency in Pathological Anatomy,
£ 30 .
An Atkinson Morley Scholarship for the promotion of the
study of Surgery, £45 per annum, tenable for three years.
Entrance Exhibitions—Three Entrance Exhibitions of the
respective value of £30, £20, and £10 per annum, tenable for
two years, are awarded, upon examination, to gentlemen who
are about to commence their first winter's attendance in a
Medical School.
The Examination, by written papers, will be in Classics,
Elementary Mathematics, Natural Philosophy, and in either
French or German, at the option of the candidate, and will
take place at the College on Wednesday and Thursday, the
24th and 25th September.
There are numerous private boarding residencies and lodg¬
ing-houses in the neighbourhood of the College, and a register
of them is kept in the office of the College, which gives full
information as to terms, &c.
The Introductory Lecture will be delivered on Thursday,
1st October, 1868, by Professor Erichsen.
For further particulars see advertisement.
CHARING-CROSS HOSPITAL.
This hospital, though one of the smaller ones, derives
from its situation great advantages. It is in one of the
most central positions in London, where there is constant
communication with every part. In connection with it
the practice of the Royal Western Ophthalmic Hospital,
close by, affords an excellent opportunity for the study of
that branch of tbe profession. Other special departments
have been established, and the authorities seem to have
the courage to establish them on a liberal basis, the hospi¬
tal staff not monopolizing these appointments.
APPOINTMENTS OPEN TO STUDENTS.
The office of Registrar and Pathological Registrar, tenable
for two or three years, for which the Council award an annual
stipend, is open to all matriculated students who have obtained
their qualifications.
The offices of resident medical officer, resident surgical
officer, and Physician Accoucheur’s Assistant, with six months’
residence at the hospital, are awarded to senior matriculated
students after a competitive examination.
A feature of this school deserving of particular notice is the
existence of free scholarships. These candidates are sons of
professional men, of reduced circumstances and position, or of
gentlemen, and are to have had a classical education, who
have already commenced study, and, from unforseen circum¬
stances, be unable to complete their professional education
with such assistance.
Application must be accompanied by the official certificate
of the candidates having passed the preliminary classical exa¬
mination either of the London University, of the College of
Physicians, the College of Surgeons, or of the Society of
Apothecaries.
The Llewellyn Scholarship of £25 is open to all matriculated
students who have just completed their second academical
year.
The Golden Scholarship of £15 a-year, tenable for two
years, is open to all matriculated students who have just com¬
pleted their first academical year.
The following medals are awarded annually :—
The Gold Medal, for general proficiency.
The Governors’ Clinical Silver Medal.
Silver Class Medals, on all the subjects of the lectures.
Bronze Class Medals, on all the subjects of the lectures.
For further particulars see advertisement.
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p’oMitcM Scfywrlg iff gptrtaiic.
MANCHESTER ROYAL SCHOOL OF MEDICINE.
The Winter Session will commence on Thursday, October
1st, at 12 o’clock, when an Introductory Address will be
delivered by Dr. Simpson, after which the Scholarships
and Prizes for the past session will be distributed.
SCHOLARSHIPS AND PRIZES.
In addition to three Scholarships, of the value, respectively,
of £20, £15, and £10, for Perpetual Students, Prizes for
General Proficiency have been substituted for Class Prizes, in
accordance with the suggestions issued by the Royal College
of Surgeons. At the end of the Sessions, Certificates of
Honour will be awarded for regularity of attendance upon
Lectures, and general good conduct.
Winter Session.
Anatomy and Physiology.—Mr. Smith, Tus. Wed. Thur. at 12.
Anatomy, Descriptive.—Mr. Lund, Tu. Wed. Th. Fri. at 8'45.
Anatomical Demonstrations.—Mr. S. M. Bradley.
Chemistry.—Mr. D. Stone, Tues. at 1, Wed. at 11, Fri. at 1.
Medicine.—Drs. Roberts and Morgan, Mon. at 1, Wed. at 2,
Fri. at 1 o’clock.
Surgery.—Mr. G. Southam, Mon. Tues. Thur. at 2 o’clock.
Summer Session.
Materia Medica.—-Mr. A. Somers, Tues. Wed. Fri. at 12.
Midwifery, &c.—Dr. Thorburn, Mon. Wed. Thur. Fri. at 9.
Botany.—Mr. Grindon, Mon. Wed. Thur. at 2 o’clock.
Med. Jurisprudence.—Mr. Harrison, Mon. Wed. at 1, Fri. at
1*30.
Practical Chemistry.—Mr. D. Stone, Tues. Thur. at 1 o’clock
Comparative Anatomy.—Mr. Bradley.
Pathology and Morbid Anatomy.—Dr. Simpson, Mon. Thur.
at 12 o’clock.
Ophthalmic Surgery—Mr. Hunt, Mon. Sat. at 8*45.
HOSPITAL PRACTICE—MANCHESTER ROYAL IN FIRM ART.
Daily, 10 to 12 o’clock.
Physicians.—Drs. E. Wilkinson, Watts, Browne, Robflf br
Simpson and Morgan. Dresserships, full period, £21.
Surgeons.—Messrs. Beever, Smith, Dumville, Southam, r.
Heath, and Lund. Dresserships, full period, £31,10*
Fee for all the Lectures required by the College and Hall*
£42. Ditto and for Hospital, Medical and Surguad Prwtooc*
—For further particulars see advertisement.
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The Medical Press and Circular.
BRISTOL MEDICAL SCHOOL.
September 16,1668. 267
LIVERPOOL ROYAL INFIRMARY SCHOOL OF
MEDICINE.
This School is in connection with the Royal Infirmary, a
very large and important institution, containing nearly
300 beds, in which the opportunities for obtaining practical
knowledge are very extensive.
The introductonr lecture will be delivered by Dr.
Roberts, on Thurscuiy, October 1st, at 3 r.M.
PRIZES.
Scholarship, value £42, consisting of a gold medal, value
£10, 10s., and six months' free board and residence, with
dressership and clerkship in the Royal Infirmary. In case
the scholarship is gained by a resident pupil, six months’ pay¬
ment (£31, 10s.) will be returned to him.
Four exhibitions, value £41, 10s. each, consisting of free
board and residence in the Royal Infirmary for six months,
with dressership on award of* the Medical Board.
FEES.
For Six months* medical and surgical practice, £10, 10s.;
twelvemonths, do., do., £12, 12s.; perpetual, £31, 10s. Stu¬
dents are admitted to the practice of the Lock Hospital at
tached to the Royal Infirmary ; fee, £3, 3s. per annum ; six
months, £2, 2s. Fee for all the lectures required by the Col¬
lege and Hall, £42.
A prospectus may be obtained from the registrar, Mr.
Harmon, 51, Rodney-street.
For further particulars see advertisement.
BIRMINGHAM.
SYDENHAM COLLEGE.
Sydenham College was established for the purpose of
affording a complete Medical education. It is governed
by a Council composed of seventy eminent practitioners in
the Midland Counties, and affords every facility for the
study of medicine. A Classical and Mathematical De¬
partment has also been added, with special reference to the
preparation of students for their preliminary examination.
PRIZES.
The Wameford Scholarships : four scholarships of £10 each,
held for two years, conferred for diligence and good conduct!
The Warneford Gold and Silver Medals for essays of a religious
as well as a scientific nature. The Founder’s Scholarship,
conferred on a first year's resident student after examination
at the end of the summer session. Honorary medals and
certificates of honour are annually given. The Percy and Clay
Prizes of five guinea* each, in books, for proficiency in the
German and French languages respectively.
THE QUEEN’S HOSPITAL.
The hospital has lately obtained, by Act of Parliament,
separation from the Queen’s College, and will now be open on
equal terms to the students of both the medical schools. Each
physician and surgeon visits his wards with the students on an
appointed day in each week, and special courses of lectures are
given by each of the officers in succession. By these arrange¬
ments the students can follow the practice of each physician
and surgeon during the whole of the Winter and Summer
Sessions and in the same periods attend the special courses de¬
livered by each clinical professor.
HOSPITAL PRACTICE—QUEEN’S HOSPITAL.
Physicians.—Dr. A. Fleming and Dr. Foster.
Surgeons.—Messrs. West, Gamgee, and F. Jordan, Mr.
Wilders (oast.) Dr. Suckling and Dr. Earl (obst).
lees for all the lectures required by the College and Hall.
Bitto, and for Hospital Medical and Surgical Practice, £68, 5s #
BIRMINGHAM GENERAL HOSPITAL.
Physicians.—Dr. G. F. Evans, Dr. Bell Fletcher, Dr. James
Russell, and Dr. W. F. Wade.
Surgeons.—Mr. D. W. Crompton, Mr. Alfred Baker, Mr. O.
Pemberton, and Mr. T. H. Bartleet.
Resident Physician and Tutor.—Dr. Wyllie.
Resident Surgeon.—Mr. Addenbrooke.
For farther particulars see advertisement.
SHEFFIELD SCHOOL OF MEDICINE.
The next Session will commence on October 1st, when the
Introductory Lecture will be delivered by H. Clifton Gorley,
Esq., F.R.S.
Winter Session.
Anatomy.—Mr. Skinner and Mr. W. J. Le Tall.
Demonstrations of Anatomy.—Messrs, Skinner, Jackson, and
Wool house.
Physiology.—Mr. Thomas Leeds,
Medicine.—Dr. Frank-Smith.
Surgery.—Mr. W. F. Favell and Mr. Parker.
Chemistry.—Mr. Allen.
Clinical Medicine.—Dr. de Bartolomd, Dr. Elam, and Dr.
Law.
Clinical Surgery.—Mr. Barber, Mr. Favell, and Mr. Parker.
Summer Session.
Midwifery and Dis. of Women.—Drs. Keeling and Hime.
Materia Medina.—Dr. Young.
Medical Jurisprudence.—Mr. A. Jackson and Mr. Baker.
Botany.—Mr. Birks and Dr. Mason.
Practical Chemistry.—Mr. Allen.
Dental Surgery.—Mr. Merryweather.
Pathology and Microscopy.— Mr. Hardy Smith (at the In¬
firmary).
Operative Surgery.—Mr. Favell and Mr. Parker.
SHEFFIELD ‘GENERAL INFIRMARY.
Physicians.—Dr. De Bartolome, I)r. Elam, and Dr. Law.
Surgeons.—Mr. Barber, Mr. Favell, and Air. Parker.
House Surgeon.—^Mr. G. A. Brown.
SHEFFIELD PUBLIC HOSPITAL AND DISPENSARY.
Physicians.—Dr. J. C. Hall, Dr. Law, and Dr. Frank-Smith
Surgeons.—Mr. Chesman, Air. A. Jackson, and Dr. Keeling.
For further particulars see advertisement.
BRISTOL MEDICAL SCHOOL.
In this town there is ample opportunity of completing a
medical education, and the western counties have long
availed themselves of the instruction there to be obtained.
The Bristol Medical School educates the students who
receive their Clinical instruction in either of the two large
hospitals of the city—the Bristol General Hospital and
the Bristol Royal Infirmary.
Prizes and certificates of honour are given after competitive
examinations-amongst students of the first, second, and third
years respectively. The interest of £500 will be given to the
prizeman of the third year who shall have been educated at
the infirmary, and can produce certificates of good conduct and
moral character. The prizeman of the third year who shall
have been educated at the General Hospital will receive, in
addition to the school prize, the sum of twenty guineas, given
by the committee of that institution.
HOSPITAL PRACTICE.
The General Hospital, founded in 1832, is situated in a
populous district near the docks, coileries, manufactories, and
railway stations, from which sources the wards are supplied
with a great variety of important cases.
The present building was completed and occupied in 1858,
It contains 130 beds.
FEES.
Six months, £6 ; one year, £10 ; perpetual, £20. Library,
£1, Is. per annum. Dressership or clinical clerkship, £5, 5s.,
for six months. Two scholarships of £15 each are awarded
annually, and a prize of twenty guineas is given to the hospi¬
tal student who is successful in the third year’s competition at
the school. Dressers reside in the hospital in weekly rotation
free of expense.
THE ROYAL INFIRMARY.
This infirmary was founded in the year 1735, and is there¬
fore one of the oldest provincial hospitals. It contains 242
beds.
FEES.
Surgeon’s pupil, first year, £12, 12s. ; two years, £21 ; three
years, £26, 5s. Dresser (extra free), one year. £12, 12s. ; two
years, £21 ; three years, £26, 5s. Physician’s pupil, six
months, £8 ; one year, £15 ; eighteen months, £20 j perpetual,
~ioCK !
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CATHOLIC UNIVEBSITY.
September 16 t 1316.
£25. E ft^h pupil is required to pay an entrance fee to the
infirmary of £5, and a subscription of £1, Is. per annum to
the library, which numbers about 2700 volumes. The dressers
reside in the infirmary in weekly rotation.
Fees for all the Lectures required by the College and Hall,
£47, 58. Ditto, and for hospital practice, £87, 5s.
PRIZES.
Suple Prize.—AJ gold medal, value’£5, 5s., with £7, 7s. in
money is given annually to each of the two successful candi¬
dates in each of the medical and surgical examinations. Clark's
Prize. See advertisement.
HULL AND EAST-RIDING SCHOOL OF MEDICINE
AND ANATOMY, KINGSTON-SQUARE, SESSION
1868-69.
The Winter Session will commence on Thursday, October 1,
1868. Anatomy, Physiology, and Pathology, by Mr.
R. M. Craven and Mr. Rudd. Anatomy and Anatomical
Demonstrations, by Mr. Nicholson. Principles and Practice
of Medicine, by Dr. Elliott. Principles and Practice of
Surgery, by Dr. King. Chemistry, by Mr. Walton.
The Summer Session commences May 1, 1869. Midwifery
and Diseases of Women and Children, by Mr. Henry Gibson.
Materia Medica and Therapeutics, by Mr. Holden and Mr.
Henson. Forensic Medicine, by Dr. Munroe, F.L.S. Botany,
by Mr. Niven. Chemistry, by Mr. Walton. Perpetual fee to
all the Lectures except Chemistry, £42.
The Hospital contains 152 beds, and is recognised by all
the Examining Boards. Clinical Lectures are given at the
Hospital twice a week : on Medicine, by Sir H. Cooper, Dr.
Daly, and Dr. Elliott; on Surgery, by Dr. Lunn, Mr. Craven,
and Dr. King. Perpetual fee for attendance on the Medical
and Surgical Practice, £21. Clinical Lectures, £1, Is.
Application for tickets may be made to Mr. R. M. Craven.
For further particulars see advertisement.
-♦-
grijijr sf IpMritw.
SCHOOL OF PHYSIC, UNIVERSITY OF DUBLIN.
This School was established by Act of Parliament 40th George
III., and is under the joint government of the Board of Trinity
College and the King’s and Queen's College of Physicians.
Institutes of Medicine, Professor Law. Materia Medica
and Pharmacy, Professor A. Smith. Surgery, Professor R.
Smith. Anatomy and Chirurgery, Professor MacDowel.
Its Medical School is at Trinity College, where a spacious
Dissecting-room has recently been erected. Information as to
the Medical Scholarships and Exhibitions in this School will
be found amongst the regulations of the University of Dublin.
SCHOOL OF SURGERY, ROYAL COLLEGE OF
SURGEONS.
This school is under the superintendence of the Council of the
College, who appoint the professors. The Introductory Ad¬
dress will be given on Monday, October 26, by Mr. Hargrave.
The Professor of Physiology will commence his course with a
series of twelve lectures on Comparative Anatomy—free to the
public. The dissecting rooms have been recently much en¬
larged. Arrangements have been made to give increased faci¬
lities for instruction in Operative Surgery and Chemical
Analysis. Prizes in Anatomy and Physiology, and Surgery,
will be awarded at the end of the Winter Session. The
Junior Surgical Society meets fortnightly in the school, and
several prizes have been offered for the best essays read during
the Session.
Winter Session.
Anatomy and Physiology, and Comparative Anatomy.—Dr.
E. D. Mapother—Daily, 2 o’clock.
Descriptive Anatomy.—Dr. Bevan and Mr. Morgan—Daily
12 o'clock.
Demonstrations.—Dre. Croly,Stoney,M , Allister, Hewitt, Roe,
S. Hewitt, Stoker, Kelly, and Scott—Daily, 8 to 4
o'clock.
Surgery.—Mr. Hargrave and Mr. Hughes—Tuesday, Thurs¬
day, and Saturday, 3 o’clock.
Practical Medicine.—Dr. Benson—Mon., Wed., and Fri., at 3.
Chemistry.—Dr. W. Barker—Mon., Wed., and Fri., at 1.
Summer Session.
Materia Medica.—Mr. Macnamara.
Medical Jurisprudence,—Dr. Geoghegan.
Midwifery.—Dr. Sawyer.
Botany.—Dr. H. Minchin.
Hygiene.—Dr. Cameron.
Fees.—£3, 3s. Od., for each Course—Comparative Anatomy
and Hygiene, Free.
For further particulars see advertisement.
THE LEDWICH SCHOOL OF MEDICINE,
PETER-STREET.
This school, claiming priority of foundation before any of
its kindred unchartered institutions were projected, was
established in 1810 by J. Kirby, and has, since then, under
the energetic administration of the Messrs. Ledwich Mid Dr.
Mason, maintained a very high prestige as an educational in¬
stitution. It is situated next doqy to the Adelaide Hospital in
Peter-street, about five minutes' walk from the Meath Hospi¬
tal, Royal College of Surgeons, and Mercer's Hospital, and
the Coombe Lying-in Hospital, and ten minutes from the
Catholic University School, the University and the City of
Dublin Hospital. The hospital in most immediate connexion
with it is Mercer’s.
For further particulars see advertisement.
STEEVENS' HOSPITAL SCHOOL.
This hospital is conducted on the plan of the London Hospital
Schools, combining, in one establishment, all the department*
of medical education. Situated in the centre of a district,
occupied by some of the largest manufacturing concerns, its
beds are constantly filled with accidents of a serious nature.
Immediately adjoining is St. Patrick’s (Swift’s)Asylum for the
Insane, Dr. Croker, consulting physician, being one of the
medical attendants. All morbid specimens are most carefully
examined and preserved by the curator, who is an officer re¬
gularly appointed and paid by the Board of Governors.
There is accommodation for residence of seven surgical and
four medical residents; besides whom the Resident-Surgeon
receives house pupils. The fees payable for the privilege of
residence are 21 guineas, winter; 15 guineas, summer, nx
months ; including hospital ticket; students have apartments,
coal, gas, and furniture. . .
Accommodation outside the hospital, in the neighbourhood,
is arranged by the hospital authorities.
PRIZES.
3 Cusack Medal and Exhibition, of £8, £5, £3; 2 Midwifery
Assistants, £30 each ; 1 Medical Clinical prize, £10, 10a; l
Surgical prize, £10, 10s.
The session opens with distribution of prizes in the first week
in November. For further particulars see advertisement.
THE CARMICHAEL SCHOOL OF MEDICINE.
The various lectures are now delivered, and the dissection*
carried on in the new building, which the munificence of the
late Surgeon Carmichael has given to the Proprietors. ^ As the
building was designed with special reference to the requirement*
of a large medical class, every convenience is afforded to the
student in the prosecution of his studies.
The proximity of the School with the House of Industry
Hospitals, and its connection with these Institutions as well **
with the Mater Miserioordise, Meath and Jervis-street Hospi¬
tals, through its teachers, insures equal opportunities to the
pupils of becoming thoroughly acquainted with the more im¬
mediately practical part of their profession.
Arrangements have now been completed for rendering more
available the Carmichael premium bequest, which will hence¬
forth enable the Proprietors to distribute prizes to tile amount
of £60 yearly ; and the Scholarship, value £16 yearly, which
the friends of the late Dr. M&yne have founded in his name,
will be allotted at the termination of the Winter Session.
For further particulars see advertisement.
THE MEDICAL SCHOOL OF THE CATHOLIC
UNIVERSITY
Occupies a central position, and is within a short distance of
the principal hospitals of the city; it possesses a oomplet®
Laboratory for the study of practical and expenmental
chemistry ; the dissecting room is lighted with gas for the con¬
venience of industrious students; there are class rooms for
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COOMBB LYING-IN HOSPITAL.
September 16,1868. 269
private tuition on the premises, likewise a reading-room, and a
college for the residence of medical students has been specially
provided, containing a library of the most approved class,
books. Two exhibitions, each of the value of £20, are offered
for competition in the ensuing year—viz., one in the combined
subjects of chemistry, physiology, miscrosoopic anatomy, and
botany ; and one in surgery, medicine, and midwifery. A gold
medal of the value of £7 is likewise offered in materia medica,
medical jurisprudence, and practical chemistry in the ensuing
summer session. The students of the physiological and botanical
classes are instructed in the use of the microscope, and how to
recognise the various animal and vegetable tissues, and fluids.
There is accommodation for residence of students fin con¬
nection with the institution which will accommodate at least
40 students.
The fees payable for the privilege of residence are from £7 to
£10 the academic year.
The arrangements and cost of maintenance are by a club,
voluntarily constituted, and the officers of which are annually
elected by the students.
The term of residence is nine months.
Prizes and Exhibitions.—Two Exhibitions of £20 each, and
one gold medal of the value of £7, besides two class prizes in
each class of the respective value of £3 and £2, for which the
exa min ation takes place on the first week in April and the first
week of July.
The introductory lecture will be delivered on the 2nd of
November, at 3 p.m., by Dr. Lyons.
For further particulars see advertisement.
THE CITY OF DUBLIN HOSPITAL.
This hospital is situated in Upper Baggot-street, about ten
minutes’ walk from the Royal College of Surgeons and the
medical school of Trinity College, and twelve from the Led-
wich Schools and the School of the Catholic University.
Physicians, surgeons, and assistant-physicians are, with three
exceptions, either Professors or Demonstrators in the School of
the Royal College of Surgeons in Ireland. The hospital con¬
tains 104 beds and accommodates about 800 intern patients
annually. There are special wards for ophthalmic diseases,
on which subject a special course of lectures is delivered by
Dr. Jacob, and for diseases of children. A new wing has been
lately opened for the reception of fever and other infectious
diseases. The “Purser” Studentship of £20 per annum (with
apartments) is obtainable by competitive examinations by all
students, and a special certificate is granted. The fees for
hospital attendanoe are—Nine months, £8, 8. Six months, £6,
0s. Summer 8 months, £3, 3s. Perpetual, £21.
For further particulars see advertisement.
THE MEATH HOSPITAL AND COUNTY DUBLIN
INFIRMARY.
Sqtge our last Students’ Number, Mr. William Stokes has re
tired from this hospital, and James W. Stronge, A.M., M.B.
Univ., Dublin, L.R.C.S.I., has been elected in his place.
This hospital is situated about a quarter of an hour’s walk
from the University, and within a few minutes of the College
of Surgeons and the Ledwich Schools of Medicine ; affords
every facility for the treatment and study of disease. Its salu¬
brious position and long established character call for constant
admission to its accident, chronic, fever, surgical, and children’s
wards, which are thus constantly occupied with cases illustra¬
tive of medicine and surgery.
Four prizes will be given at the termination of the Winter
Course to the best answerers in their respective classes.
The office of Resident Pupil is open to pupils as well as
apprentices.
Further particulars, with complete list of physicians and
surgeons, will be found in our advertising columns.
ST. VINCENT'S HOSPITAL.
This Hospital was established in 1834 by the Sisters of
Charity, some of whom had studied the system of the
Parisian Hospitals, after which it was modelled. Dr.
O'Femdl was the original medical officer. The ward for
" Enfant Malades” is an interesting feature. The hospital
has over a hundred beds constantly full, and each sister
has charge of about twelve patients. In connection with
it a Convalescent Home was established two years since at
BtiUorgan, and the greatest benefit in the way of rapid
recoveries and convalescence after acute attacks has fol¬
lowed. These institutions are wholly supported by volun¬
tary contributions. The clinical instruction in medicine
and surgery is given by Dr. O'Ferrall, Dr. Quinlan, Dr.
Mapother, Mr. O’Leary, and Dr. Cryan. Prizes are
awarded at the end of the Winter Session.
For further particulars see advertisement.
THE ADELAIDE HOSPITAL
Is in Peter-street, next door to the Ledwich School From
the 1st of October, the Physicians and Surgeons will visit the
Wards, and give instruction at the bed-side, at the advertised
hours, and the course of Clinical Lectures will be commenced
in the beginning of November.
For further particulars see advertisement.
SIR PATRICK DUN’S HOSPITAL,
Founded on the endowment of Sir Patrick Dun, and for
many years receiving nothing but purely medical cases, has
been lately reconstituted as aMedico-Chirurgical Hospital.
It is in immediate connection with the School of Physic,
and its physicians and surgeons are all professors in that
school. The university requires nine months' attendance
at this hospital from candidates for the M.B.
Hospital fee for twelve months, including nine months (
clinical lectures:—First year, 12 guineas; second year, 9
guineas; third year, 6 guineas.
For further particulars see advertisement.
THE MATER MISERICORDLE HOSPITAL,
Situated in Eccles-street, is a new and handsome building,
and, when it is completed, will be one of the finest charitable
institutions in Dublin.
Fees. —Nine months, £8 8s.; six months, £6 6s.; three
months, £3 3s.
For further particulars see advertisement.
MERCER’S HOSPITAL
Is situated within a few minutes’ walk of the Royal College of
Surgeons, Ledwich School, Trinity College, and Catholic
University School.
Two new wards for the reception of Fever and Contagious
Diseases, are now open, in addition to the previous accommo¬
dation of the Hospital.
Terms of A ttendance .—Six months, Six Guineas ; Nine
months, Eight Guineas ; Perpetual Pupils, £21.
For further particulars see advertisement.
JERVIS-STREET HOSPITAL.
This Hospital is situated in the neighbourhood of the Car¬
michael and Catholic University Schools, and in a part of the
city not otherwise provided with Hospital relief.
For further particulars see advertisement.
ROTUNDO LYING-IN HOSPITAL.
This well-known institution is the largest and oldest maternity
hospital in the United Kingdom, and the repute in which it is
held, attracts students from all parts of the world. It accom¬
modates an average of 1500 intern patients, and is under the
care of the master, who is elected every seven years, and two
assistant masters, who hold these appointments for three years.
The mastership is at present held by Dr. Denham, and the
assistant masterships by Dr. T. More Madden and Dr. Beatty.
A student entering for the practice of the hospital pays a fee
of £10, 10s. for six months’ practice. During that period he is
required to attend at least thirty cases, either within the walls
of the hospital or at the homes of patients who may apply for
assistance. For this course of study a certificate is given,
which is received as a qualification in Midwifery in the public
services.
Students are admitted to reside in the hospital, for which
they pay a fee of 20 guineas for six months.
THE COOMBE LYING-IN HOSPITAL.
This hospital was founded in 1820, but it was not until 1867
that it was incorporated by Royal Charter, which enables its
medica] officers to issue Diplomas qualifying the holders to
practice Midwifery. By a clause in the charter the Diplomas
issued antecedent to its date have been made of equal force and
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QUEEN’S COLLEGE, GALWAY.
September 10, 1808.
value with those issued subsequent thereto. This hospital divides
with the Rotundo, almost the entire of the obstetric hospital
practice of Dublin. It is situated in the centre of a district
densely populated by the lower orders, and thus affords the
amplest opportunities for practice. It accommodates about
600 labour cases within its walls, while those attended as ex-
terns amount to nearly double that number. Moreover, the
chronic ward for the reception of cases of the diseases of females,
gives admission to about eighty patients annually. Its wards
are in the charge of Dr. Ringland and Dr. Sawyer, as Mas¬
ters, and Dr. Roe, as Assistant-master, whilst the chronic
ward for the diseases of females is under the charge of Dr.
Kidd, the obstetric surgeon of the institution. The fee for
attendance is £4, 4s. for six months as extern, and £10, 10s.
as intern pupil. During that period the student attends on a
given night in each week, or oftener, if circumstances permit,
and takes charge in his turn of any cases which may be
admitted to the Labour wards, or may call for his assistance
outside. In difficult cases he has the superintendence of the
resident-medical officer, and of the' Masters when necessary.
An annual examination is held in May and November, at
which prizes of considerable amount are awarded, and certifi¬
cates of good answering granted. Two paid resident Pupil
Midwifery Assistantships are obtainable annually by competi¬
tive examination, for which all pupils who have obtained their
Midwifery Diploma are eligible.
For further particulars see advertisement.
- ♦ -
^rnbrnrial Colleges of grclanlr.
QUEEN’S COLLEGE, BELFAST.
The first Matriculation examination will commence on the
22nd October. There will be additional Matriculation
Examinations on the 14th November for those who have
not been able to present themselves at the first. Lectures
will commence on 1st November. No student can be per¬
mitted to enter after the 14th November. Two junior
scholarships, value £25 each, are awarded to matriculated
students commencing the first year of their study. The
examination for these will take place immediately after the
first Matriculation Examination. Two of similar value to
students of the second year, two to students of the third
year, and two to students of the fourth year.
For subjects of examination and other information see
Queen’s College Calendar for 1865. At the termination of
the session prizes will be awarded for proficiency in the
several classes.
The trustees of the “ Charters’ Educational Fund” grant
annually, for ten years, a sum of £50, for the purpose of
establishing an exhibition in connection with the Belfast
School of Medicine. The competitive examination for
this exhibition will be held at the end of the session, at
which all medical students can compete.
Pees.—Practical Chemistry, £3. Anatomy and Physiology,
first course, £3; subsequent course, £2. Anatomical Demon¬
strations and Practical Anatomy, each course, £3; for subjects
each session, 15s. Other medical lectures, first course, £2;
each subsequent course, £1.
BELFAST GENERAL HOSPITAL.
This Institution is the only Hospital for the reception of
Injuries and Surgical Diseases in Belfast, and contains 150
beds.
For further particulars see advertisement.
QUEEN’S COLLEGE, CORK.
MEDICAL SCHOLARSHIPS.
First Year —One to the candidate who shall have most dis¬
tinguished himself at the examination for science scholarships
of the first year in Arts, and one to the candidate who shall
have most distinguished himself at the examination for literary
scholarships of the first year in Arts. Candidates for these
scholarships shall have previously declared themselves, and
have matriculated as medical students.
Subjects for the Second Year—Anatomy and Physiology,
Chemistry, General Physics, Zoology and Botany, the French-
language.
Subjects for Third Year—Anatomy and Physiology, Prac¬
tical Anatomy, Materia Medica, Practical Chemistry.
Subjects for Fourth Year—Anatomy and Physiology, Prac¬
tical Anatomy, Therapeutics, Pathology and Morbid Anatomy,
Surgery, Midwifery.
The fees, whether matriculated or non-matnculated, for
attendance on lectures, are £1 for each course, when attended
for the first time, and £1 for each re-attendance on the same;
except that the fee for Anatomy and Physiology shall be £3
when attended for the first time, and £2 for every subsequent
attendance ; and that for Practical Anatomy or Practical
Chemistry shall be £3 for each attendance.
H08PITAL ATTENDANCE.
South Charitable Infirmary and County of Cork General Hospital.
Physicians.—W. K. Townsend, M.D.; E. R. Townsend, Jun.
A.B.M.D.
Surgeons.—W. K. Tanner, M.D.; T. Gregg, M.D.; T. Curtiss,
L. R.C.S.r.
North Charitable Infirmary and City of Cork General Hospital.
Physicians.—E. Finn, A.M., M.D.; John Popham, AM.,
M. B.; P. Godding, M.D.
Surgeons.—Samuel Hobart, M.D., T. C. Shinkwin, MJ).; A
Y. Hobart, M.D.
Fees for six months, £5, 5s., and for twelve months, £8,8s.
For further particulars see advertisement
QUEEN’S COLLEGE, GALWAY.
FACULTY OF MEDICINE.
The College Session.
The College Session is divided into three Terms. The First
Term commences October 15, and ends December 23, 1867.
Matriculation.
The Matriculation Examination is held at the commence¬
ment of the first Term ; but additional Examinations are held
before the close of the Term. The last Matriculation Exami¬
nation is held on the 15th November. Each candidate before
being admitted to Examination, must pay a fee of ten shilling 9 *
which will be returned to such as fail to pass.
A ttendance on Lectures.
All Students shall pay the College Fee, and a moiety of
their Class Fees, and enter their names with the Registrar*
before they are admitted to the classes of the several Pro¬
fessors. No Student shall have his name replaced on the roUs
at the second Term who has not paid the second moiety of hi»
Class Fees. No Student shall be regarded as having kept a
Course of Lectures who has not attended two-thirds of tn p
entire number.
Examinations.
A Sessional Examination is held at the close of each Session
in the subjects of Lectures. There is also a Supplementary
Examination on the same subjects at the commencement of tbe
following Session.
Scholarships.
Eight Junior Scholarships, of the value of £25 each, are
awarded to Students pursuing the Course for the Dog 1 **
M.D. The Examinations for Junior Scholarships are held a
the commencement of the First Term. Junior Scholars are ex
empted from one moiety of the Class Fees. The College
empowered to award Exhibitions, varying in value from*
to £18, at the same Examinations as the Scholarships, and
be held upon the same terras.
For further particulars see advertisement.
MEDICAL EDUCATION.
We are reluctantly compelled to omit from our Student 4
Number extracts from the Carmichael Prize Essays °f~p r '
Mapother and Dr. Ashe, which we had hoped to hay® *1
before our student readers. In their absence we can hut a
vise our readers to refer to the Essays themselves, ^ ec0D ?^.
of which will be found advertised in another part of our
Those Gentlemen who have so kindly forwarded us information
corrections, will please receive our best thanks. v*tii**
Several Original Papers, Correspondence, Hospital Deports, Now**
of Books, and other matter, must unavoidably stand over.
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8be §xm & tfimlxt.
il SALUS POPULI SUPPvEMA LEX.”
WEDNESDAY, SEPTEMBER 23, 1 868.
CONTENTS.
LECTURE.
Lectures cm Venereal Diseases Delivered
in Dr. Steevens* Hospital. No. IV.
By Robert McDonnell, M.D., F.R.S.,
one of the Burgeons to Steevens* Hos¬
pital... page 271
ORIGINAL COMMUNICATIONS.
Morbid Conditions of the Throat in their
Relation to Pulmonary Consumption :
their Diagnosis and Treatment. No.
VII. By 8. 8cott Alison, M.D. Edin... 275
Artificial Restraints on Population. By
Henry Mao Cormac, M.D. 277
HOSPITAL REPORTS.
Da. Steevexs’ Hospital—
Chronic Laryngitis: Tracheotomy: Re-
PAGE
eovery. Under the care of R. L. Swan,
F.R.C.8.I., Resident Burgeon Dr.
Steevens* Hospital. 277
8t. Groroe’b Hospital—
Dr. J. W. Ogle’s cases of Abdominal
Tumours. 278
FOREIGN MEDICAL LITERA¬
TURE.
Recent Contributions to the Theory of
the Innervation of the Heart and
Blood-Vessels. Translated by W. D.
Moore, M.D., Dub. et Cantab.,
M.R.I.A., L.K.aC.P.1. 279
LEADING ARTICLE.
The Puboatory or London Hospitals... 281
PAOjg
NOTES ON CURRENT TOPICS,
University of Cambridge.—Lord Amberley
and the Fenians.—An Insulted Coroner.
—Full Dress and Disease.—Register,—
Lodgers and Graduates.—The Coming
Medical Session in London.—Coombe
Lying-in Hospital, Dublin....,.282-85
CORRESPONDENCE,
Davey on the Title of Doctor.. 225
Madden on Compound and Comminuted
Fracture of the Patella. 285
Armstrong on the Representation of the
Universities of Glasgow and Aberdeen. 2£6
Medical News, Notices to Correspondents,
.. 285
°§,ttiXLXL
LECTURES ON VENEREAL DISEASES
DELIVERED IN
DR. STEEVENS' HOSPITAL.
LECTURE IV.
By ROBERT McDONNELL, M.D., F.R.S.,
OMR OF TIIE SURGEONS TO STEEVENS* HOSPITAL.
(Continued from page 287.)
I approach the subject of the use of mercury with some
diffidence, not because I have not made up my mind upon
this point, but because I feel that I cannot convey to you
my convictions upon this important subject. My convic¬
tions are founded upon facts and observations witnessed
by myself. You have merely my testimony, and you have
on the other side the testimony of persons cjuite as trust¬
worthy, and as anxious to teach what they believe to be true.
You are placed in the centre of a dilemma ; you can only
get out of it by keeping your eyes open and observing for
yourselves : observing cases not for a few weeks or months
as you usually see them in hospital, but for years ; observ¬
ing in short such cases (as everyone has some opportunity
of watching) as are likely to come in your way again and
again through life, and noting whether those treated by
mercury are, after two, three, four, or five years, better men
than those treated without it.
My experience has led me to assume these two proposi¬
tions as true—
1st. Upon most men mercury acts in a way very detri¬
mental to the constitution.
2nd. In the majority of cases true syphilis can be cured
without it.
Hence it follows that I have recourse to mercurials as
little as possible.
Now, gentlemen, as regards the first of these propositions,
I am aware that you will find many persons, who have
used mercury a good deal in their practice, who will assure
yon that it does no harm. That is not my experience.
Lot me call some witnesses, whose evidence will weigh
with you as though it were given on oath from the witness-
box:—
Sir Astley Cooper — u It is lamentable to think on the
number of lives which must have been destroyed by
phthisis and otherwise in consequence of the imprudent
administration of mercury which prevailed among the
older surgeons. The health of a patient is perhaps
irremediably destroyed by this treatment.”
“ Q. Have you ever been able to trace any connection
between the excessive use of mercury and those symptoms
which are generally designated tertiary syphilis ?
A. (Mr. Hilton)—I have; and I think it is the deterior¬
ation of the health by the medicine, and not by the
disease : that is my belief.
Q. Have you seen bad effects from pushing the mercurial
course too far ?
A. (Mr. Paget)—Yes; and I believe the worst thing
syphilis can produce is produced with the help of mercury.
Wnen the latter is carried too far, or so given as to injure
severely the system of the patient, the effects are much
worse than would be produced by syphilis if left alone.
Professor Syme, of Edinburgh—I regard mercury, not
in all constitutions, but in many, as a poison. A very
small quantity may be sufficient for the purpose. I believe
that the modified use of mercury has perhaps done more, or
as much, harm as the profuse administration of it.
Q. Have you noticed the effects of syphilis on persons in
after life, and do you believe, that it tends to depreciate
the health in after life ?
A. That is a question, I think, of whether it is syphilis
or mercury. I shall not say which, but undoubtedly people
who have suffered from these two retain through life a
peculiarity in appearance and a proclivity to disease very
different from tneir neighbours.
Q. You used mercurials in your practice in early life.
Having tested it fairly, were you induced to forego it as
an anti*syphilitic agent, and to rely upon simple remedies ?
A. Yes. I think that mercury frequently relieves the
existing symptoms of the disease, but it seems to have an
effect upon the constitution which exposes the patient to
some subsequent attack in a more aggravated form.”—
Vide Report of Venereal Committee .
I think, gentlemen of the jury, I need call no more wit¬
nesses to prove that mercury is a rather dangerous weapon
to handle : that he who would not “ push it too far” had
better not use it at all in cases of “v4role faible”—in cases
which can certainly be cured without it.
Mercurials used in the treatment of syphilitic, as well
as other maladies, are sometimes given as alteratives—-that
is, in the hope of putting the patient in a better condition
of health, but without producing any marked mercurial
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272 Tha Medical Proas Mid Circular.
McDONNELL’S LECTURE.
September 88,1868.
effects. Sometimes they are given with the intention of second day they are increased by two, until it becomes
producing in a more or less decided degree the peculiar thirty a day.
effects known as mercurialization. Of Zittman’s decoction the mercurial action is certainly
Besides these effects, it appears to me that some mercu- nothing more than alterative. Although it is calomel
rial applications are only local in their effects. These which is used in making it, yet the prolonged boiling with
actions of different mercurials, or of mercurials used in dif- the other ingredients causes a small quantity of this to be
ferent methods, must be carefully discriminated from each dissolved in the form—as I am told by Dr. E. Davy, who
other. To one of them only can we assign any of that examined it for me—of corrosive sublimate,
influence which has been called, and is stul regarded by I have seen very good effects from the so-called Zittman
many, as specific. treatment. Mr. Erasmus Wilson speaks very highly of it
I have stated in a former lecture that I have never known His evidence, in answer to the Venereal Committee, is as
anything like constitutional mercurial action from the use follows :—
of calomel ointment; yet this is a very useful ointment in “ Q. Have you any experience of the Zittman treat-
many skin affections—syphilitic and other ; its action ment ?
seems to be local. Citrine ointment may also be used, A. Yes.
more or less diluted, and rubbed extensively over the body. Q- What is the result of your observations upon that?
I think it is of real service in clearing away various erup- A. The result is that a patient with the very worst form of
tions, but I have never known it produce any affection of syphilis, the most irritable form in which mercury cannot
the gums. The ointment of the red iodide of mercury, so be given, seems to be entirely cured at the end of ten
useful in lupoid ulcerations, also appears to have only a days.
local action.
Extensive condylomata, by cleanliness and dusting the
surface with powdered calomel, are quickly cured; yet,
here also, there seems to be nothing more than a local
effect. Possibly the sublimed calomel of the calomel
vapour-bath, on which I have already given my opinion,
may have some similar local effect.
Administered as an alterative, many mercurials are given
internally at considerable intervals, sometimes combined
with aperients, or more frequently and in small doses.
Corrosive sublimate is much used in this way. It forms
the mercurial ingredient in the pill of Dupuytren, 1 the
liquor of Van-Swieten, 2 and the decoction of Zittman. 3 In
the treatment known in Germany as the Dzondi method,
the same preparation is used, but is rapidly increased in
quantity. Thus, twelve grains of the sublimate are made
into 240 pil ls. Four pills are given the first day, and every
1 Formula for Dupuytren’s pill:—
B. Corrosivi sublimati, gr. l-5th or
Extracti opii aquosi, gr. $ or &.
Ouiad rosin os, gr. iv.
M. Fiat pilula.
2 Formula for the liquor of Tan Swieten
B. Corrosivi aublimati, gr. viij.
Bpiritus rectiflcati, 3iss.
Aqute distill atm, Jxivss.
M. From two to four drachms daily, divided into three or four doses,
and given in milk or decoction of sarsaparilla, with some syrup of
poppies, if it causes any pain in the bowels.
3. Formula for “Zittman’s decoction”
dicoctiox so. 1.
R. Radicis Barts ip, SxiJ.
Aqute, lb. xxiv.
Boil for a quarter of an hour, and add the three following substances
tied up in a muslin bag:—
Aluminis, Jiss.
Calomelanos, Jss.
Hydraigyri sulphurcti, 3i.
(Cinnabar.)
Boll until the whole is reduced one-third, and add—
Fol. sennce, Siij.
Rad. glycerrhizee, Jj.
Anisi seminum.
_ Emmettli fructus, aa., Jss.
Infuse for a few minutes, and strain.
This decoction is called die “ strong decoction.”
DKCOCTIOX xo. 2.
.Add to the residue of No. 1 decoction—
Radicis sarsco, 3ij.
Aquae, lbs. xxiv.
Boil and add-
Limoni® cort.
CannellsB albee cort.
Cardamomi seminum.
Rad. glycerrhizee, aa., 3iij.
Infuse for a few minutes, and strain.
This is called the 41 weak decoction.”
. ^ £? Ue , nt t*kes a purge ; every morning he takes half
apintof decoction No. 1; he drinks it hot and remains in bed. In
Oie afternoon he takes a pint of decoction No. 2, and in the evening
half a pint of decoction No. 1; these doses are taken cold emng
He continues this for four days, and on the fifth takes another mire* •
trs to have only a days.
Q. You say “ seems to be ?”
5S and dusting the A. I would say cured, because I have known instances io
[uickly cured; yet, which the disease has never returned. Sometimes it is
more than a local necessary to repeat the Zittman treatment a second or
el of the calomel third time after an interval of some months.”
given my opinion, The exact decoctions, according to Zittman’s formulae,
are so troublesome to prepare that I have adopted the fol-
aercurials are given lowing, in imitation, as being more convenient:—
metimes combined R Extracti sarsae liquidi, §ij.
id in small doses. Syrupi sennae, £i.
bis way. It forms Amisi essentire, Jij*
f Dupuytren, 1 the Extracti glycerrhizae, ^i.
on of Zittman. 3 In Aquae foeniculi, ad. 3viij.
e Dzondi method, M. Bene, fiat mistura.
pidly increased in Mark No. 1.
ublimate are made R Aluminis, ^ss.
irst day, and every Corrosivi sublimati, gr. ij.
—- Glycerini, |j.
Aqurc, ad. Siij.
M. et solve.
Mark No. 2.
We begin on the first day with a purge of compound
colocynth pill.
Every morning the patient takes, in half a pint of hot
Lto three or four doses, water > one tablespoonful of No. 1 and one teaspoonful
, with some syrup of of No. 2 bottle.
In the afternoon he takes, in one pint of cold water,
half a tablespoonful of No. 1 and one teaspoonful of No.
2 bottle.
In the evening he takes the same dose as in the morning,
e following substances hut cold.
He keeps his bed and continues this treatment for four
days ; on the fifth he takes only another purge ; then re¬
commences for four days more as at first, and again on the
fifth another purge.
Treatment is then stopped for one week, at the end of
which time it is again resumed, if necessary.
The patient should, during treatment, remain in bed,
and make no unnecessary exertion. He is allowed a cup
” of tea and dry toast for breakfast ; the same in the evening;
a cutlet or mutton chop, with a little vegetable and bread,
for dinner.
Mr. Erasmus Wilson says that he has found persons so
fascinated by this mode of treatment that they have put
themselves under it without his knowing anything about
it, and that in very bad cases indeed.
It owes its merits to its sweating, purging, and diuretic
action; and certainly does not debilitate at all so much aa
one expect.
remain!* in be<L in . As regards the administration of mercury given with the
and in the evening intention of producing marked mercurial effects on the
takeaaaotherpurge • 8 y? te . m > the world has seen divers methods. In the good
rs, and follows on the 01 d times there was “ the great mercurial unction,” and
oonun ' lea * or *°ur davs, and on the fifth takes another minre • i . ’ WWIU uivers metnoas. in tne gwu
fifth !S^other d pur Cti ° n811,1 “ fore for four dayB ' an <i f°Uows on the old times there was “the great mercurial unction,” and
Alter a week ofre^.e thi. treatment ie again resumed if neees. “ tH<5 "“H T r0Urirtl . unctiou -” You should read Astruc’s
■“7* iv a * account of these, written something more than a century
During the treatment a strict regimen is enforced. ago. He says—“ 1st. Of the great mercurial unction.”
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The Medical and Circular.
McDonnell’s lecture.
September 23,1868. 273
“A full regular spitting being once raised, the second
stage of the cure commences, of which we shall now speak.
“We call that a full regular spitting in which a thick,
tenacious, viscid, and pituitary saliva flows out of the
mouth to the quantity of five or six pints in twenty-four
hours. But I would not be understood to mean this at the
beginning or at the end of a salivation, when the spitting
is not in so great plenty, but at the height of the ptyalism,
when I think the regular discharge ought to be from three
to six pints. If the discharge is less than three pints it will
be too small and not conquer the disease, unless it be con¬
tinued beyond the usual number of days. If it exceeds the
bounds of six pints it will be too violent, and not to be borne
by the patient for a sufficient time to get the better of the
distemper. If the ptyalism keeps within due bounds it is
neither to be encouraged or restrained, but to be kept to
the same height for fifteen, eighteen, twenty or twenty-five
days, as it shall be more or less plentiful.”
2ndly, of the gentler method of mercurial unction:—
“ Whereby the disease is cured by a very gentle salivation;
you should proceed slowly and cautiously through the whole
course of the cure, with gentle unctions used at due intervals,
taking care that no bad accident may happen by the bring¬
ing on a violent andjtoo precipitate ptyalism. But if you
find it necessary the dose of ointment may be increased, or
the intervals between the frictions shortened in such a man¬
ner that after the fourth or fifth friction a salivation may
be raised, not a precipitate tumultuous one, bringing on a
sudden swelling upon the face, head, and neck, inflamma¬
tory, burning, ulcerous, irrestrainable, immoderate, in
which the discharge of saliva amounts every day to eight,
nine, or t ten pints—such a one as is frequently produced by
the greater method of unction, by which many patients are
suffocated, and most are brought into manifest danger of
their lives ; but, on the contrary, a slow, gentle spitting,
easy to be managed, attended with no swelling of the head,
a very gentle inflammation, and a moderate discharge,
which never exceeds the quantity of a pint or two in every
four-and-twenty hours. The spitting is kept up to the same
height during the whole course of the cure.”
Some highly esteemed practitioners in the present day
have recourse to treatment which is virtually the same as
Astruc’s milder unction; they would hesitate to use such plain
and vigorous language in describing it, but, effectively, it is
the same. The system of Ricord is, however, now-a-days,
more the fashion.
Ricord adopts a less severe but much more prolonged
method of exhub it ing mercury. When th e chancre is indurated
he gives it from the first, and prefers its internal adminis¬
tration; when this is inadmissible he employs inunction or
fumigation. He does not desire to salivate, but continues
the mercurial treatment for months, stopping it for a time
if salivation comes on, and arresting this with chlorate of
potash, given in doses of from 40 to 60 grains a-day. The
mercurial course is. followed by one not quite so long of
iodide of potassium, in doses of from 20 to 60 grains a-day.
Some persons agree with Mr. Syme in thinking that the
tedious process of introducing mercury into the system
adopted by Ricord and his followers injures the constitu¬
tion as much, if not more, than the short, sharp, and de¬
cisive salivation of As true and his school.
I have myself seen several cases in which, unintention¬
ally or by accident, a “ full regular spitting was raised,”
producing a marvellous effect upon symptoms which seemed
only aggravated by the milder method.
A female convict, under the care of the late Dr. Banon,
was a victim to aggravated syphilis. She had, among
other symptoms, an extensive and painful ulceration of the
perinseum, engaging the fourchette and verge of the anus.
During three weeks she had taken iodide of mercury with
opium ; her gums were sore. When she came under my
care she had mercurial diarrhoea, and the sore was very
irritable ; she shrieked with pain when the dressing was
removed from the ulcer, so exquisitely sensitive werefsome
portions of its edge ; it showed no sign of healing. In short,
as Dr. Banon admitted, it had made no progress for some
weeks. This patient was ordered an enema of starch and
laudanum, and black-wash for the sore. By a mistake on
the part of the attendant, the black-wash was thrown into
the rectum along with the enema. The result was a pro¬
fuse hvper-salivation, and as if by magic the ulcer healed,
and remained healed.
I have said that I have seen several cases like this. I
recollect M. Paget mentioning to me a case like the fore¬
going, which by a somewhat similar accident had occurred
in his practice ; I have also seen cases in which there was
no reason to suspect any syphilitic taint where an unin¬
tentional hyper-salivation produced great and prompt
benefit.
A woman was extensively scalded in the back and
shoulder, after the sloughs had separated, a large and
exquisitely irritable ulcer remained; exuberant flabby
granulations rose from its surface ; it was directed to bo
dressed with black-wash ; after some days of this appli¬
cation, to so large a surface, the patient was found to be
profusely salivated. At once the entire character of the
granulations altered, the sensibility diminished, and the
ulcer healed rapidly.
I learned that some months before, this patient had
been mercurialized for an injury to her eye ; she denied
ever having had syphilis ; was married to a respectable
man, and was the mother of three healthy children..
Such cases are instructive ; yet we should not think, of
adopting the practice of salivation for ulcers resulting
from burns ; no more should I advocate a return to the
method of Astruc for treating venereal ulcers.
Some one of you has asked me this very practical ques¬
tion : how do the bulk of practitioners in the present day
treat venereal ulcers on the genital organs ? Now, this
question embraces all sorts of sores, both simple and
syphilitic, and I think I may answer it in a double
fashion.
1st. I may speak for the mass of practitioners spread
over the length and breadth of the land. 2nd. For those
who, in large cities, connected possibly with medical
schools and hospitals, or as spcialists, may be supposed to be
on the whole more intimately acquainted with the subject.
From my own experience, I unhesitatingly say that the
first class, as a rule, give mercury in some form in the
treatment of all venereal ulcers. This is not to be
wondered at; the great mass of practitioners carry through
life much of what they picked up as students ; they fol¬
low the dicta of their most respected masters, hence we
see the practice of such a man as Colles living long after
him ; lasting in fact longer than it would, had he lived to
modify it according as advancing science shed more light
upon the subject. Even the illustrious Colles could not
know what was not known in his time ; viz.—that the
simple and syphilitic sore are quite distinct ; that the
former is much the commonest, and does not need mercury
either to cure it or to prevent the secondary affections,
which under no circumstances woiild succeed to it. He, aa
a rule, gave mercury to all, so do his pupils, and they still
fancy that they are in many cases preventing the occur¬
rence of constitutional symptoms, when in reality it is the
nature of the disease that no such symptoms ever follow it.
They do what we are all prone to do, they attribute to the
action of their mercurial course what is really simply due
to the non-infecting character of the complaint. But,
gentlemen (setting aside my own personal views), I think
that it is to the practice of the second class that you
should look for the real answer to the question ; to the
practice of those whose position makes it, in fact, necessary
for them to be acquainted with the teachings of modem
science on this subject. Now, perhaps, the best reply I
can give to this question is again to call some witnesses
from among those examined before the Venereal Com¬
mittee, and letting them speak to you for themselves.
Let me first call Thomas Byrne, Esq., F.R.C.S.I., a gen¬
tleman whose name is well-known to you, and who has had
the vast experience, arising from over 32 years connec¬
tion with the Westmoreland Lock Hospital in this city.
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274 The Medical Press and Circular.
McDONNELL’S LECTURE.
September 23,1866.
“ Q. Do you employ mercury in the treatment of both
sores ?
A. I never use it for the soft sore.
Q. Do you give mercury in every case of indurated
chancre*?
A. I do. , „
2nd. William Acton, Esq., formerly extern to the Vene¬
real Hospital in Paris, and who may be taken as repre¬
senting the views of the school of M. Ricord.
Q. Do you give mercury for primary sores ?
A. When I have well ascertained that a sore is an in¬
durated chancre I do immediately.
3rd. George Busk, Esq., F.R.S., surgeon to the Dread¬
nought hospital ship.
Q. Do you ever treat the primary sore with mercury ?
A. Yes ; at any rate, all indurated sores.
4th. Victor De Meric, Esq., Surgeon to the Royal Free
Hospital.
Q. Do you treat the primary sore with mercury ?
A. I treat the primary indurated sore with mercury. I
do not wait until the so-called secondaries have appeared.
5th. Langston Parker, Esq., Surgeon to the Queen's Hos¬
pital, Birmingham:—
I should abolish the treatment of a soft chancre by mer¬
cury altogether as a rule. In a sore specifically indurated I
should give mercury with one object, not to prevent the
secondary taint which should follow, but to heal the ulcer
itself, which will not heal sometimes without mercury.
6th. Jonathan Hutchinson, Esq., Surgeon to the London
Hospital.
Q. I believe you do not treat the primary sores with
mercury ?
A. The indurated sores I do.
Q. But not the soft sores ?
A. No.
Q. Do you treat the indurated sore invariably with mer¬
cury ?
A. I do. I may state that I treated for two years, at the
Metropolitan Free Hospital, all indurated sores without
mercury ; for the sake of the experiment I systematically
desisted from the use of it, but I have now gone back to the
use of mercury. I now always prescribe it for a primary
Indurated sore.
7th. Sir William Ferguson, Bart,, F.R.S., Professor of
Surgery and Surgeon to King's College Hospital.
Q. How do you treat the common soft sore ?
A. With plain water, a bit of lint and water locally
applied, a little attention to the general health, keeping
the bowels regular, and the skin in correct condition, also
paying attention to the habits of the patient and the
diet.
Q. How do you treat the primary hard sore which we
should all deem to be syphilitic ?
A. I would still, whatever sore it might be, go on with
the water dressing, until I saw that the hardness was fairly
developed; after that, if I had not already used any specific
remedy (that is to say, a remedy to have a specific effect on
the constitution, such as blue pill in moderate quantities,
or iodide of potassium), I woujd then begin one or other
of these. I should very likely start with a little blue pill,
thinkin g that it would probably put the patient into a
better state of health, and I should proceed moderately
with that, using it as an alterative and not with a view of
producing any very marked effects of mercury. If I were
satisfied that the patient were in a better condition and in
good health, with the exception of the sore, I should not
use this remedy long, but very likely administer iodide of
potassium, sarsaparilla, or some other agent that would
nave a beneficial effect on the system.
8th. James Paget, Esq., F.R.S., Surgeon to St. Bartholo¬
mew's Hospital.
Q. Do you use mercury largely in the treatment of pri¬
mary sores, taking first the soft sore ?
A. Never in the soft sore, unless I found after a long
time that all other means failed, and I thought that I had
made a mistake with a primary hard sore; then, assuming
the condition of the patient to be such as would fairly bear
a careful use of mercury, I should always give it."
You will naturally attribute much weight to the testi¬
mony of such witnesses. You perceive that there is con¬
siderable unanimity among them ; they all attach great
importance to the hardness—this symptom is that which
determines mercurial treatment. The simple venereal sore
they cure without it. Syphilitic sores, without hardness,
they deal with on expectant principles.
A few practitioners of note, as Mr. Erichsen, give mer¬
cury for both sores. He says, “ Both in the soft and hard
sores I give mercury.” But we have to set against such
persons the highly valuable testimony of some of the most
distinguished of our military surgeons, whose peculiarly
extensive opportunities of studying accurately these com¬
plaints, gives much authority to their evidence.
9th. ‘‘Thomas Longmore, Esq., Professor of Military
Surgery at the Army Medical School, Netley.
Q. Including the entire class of cases based on deposit
more or less hard, do you, as a rule, employ mercury,
either local or through the constitution, for the primary
treatment of the sores ?
A. Not for the primary treatment; I have given up
that for years.
Q. What is your reason for relinquishing it ?
A. It is, that I have been taught by experience not to
believe that the development of secondary symptoms is
prevented by giving mercury, and my impression is that
the secondary symptoms are more tractable, if it be not
given for the treatment of the primary sore.
10th. George E. Blenkins, Esq., Surgeon-Major Grena¬
dier Guards.
Q. I think you stated that you did not treat either the
primary or secondary manifestations of the disease with
mercury ?
A. For the last 26 years I have not done so. For the
first year of my experience in the Guards I adopted the
same practice that I found every one else pursuing to a
large extent, but I saw so many bad forms of the so-
called tertiary syphilis where the bones became carious,
that I was inclined to follow the treatment that I heard
had been pursued in the army before Sir James
M‘Gregor’s cases were made known. Ever since that
period, 26 years ago, I have adopted that plan rigidly,
and have never swerved from it, although it has been
attempted to laugh me out of it, and I have been almost
told that I have been doing what was incorrect. But I
have invariably pursued one system of treatment, and I
am perfectly satisfied that in the long run I have been the
gainer, and the patient too.
11th. Dr. Jelfery Marston, Assistant-Surgeon Royal
Artillery, Portsmouth.
Q. Do you consider it necessary to give mercury in all
cases of primary sores based on tlpckening or induration ?
A. No.
Q. Do you observe that the administration of mercury
has an effect on the period required for the healing of the
primary sore ?
A. In some cases it has, but sores often heal by local
remedies only.
Q. Y ou cannot lay down a rule as to the administra¬
tion of mercury ?
A. No. There are many things to be taken into
consideration. I do not now commonly give mercury in
the primary stage unless the induration be dense or large.*
I feel justified, therefore, upon the whole, in stating
in answer to the question which I have been asked, that
the vast majority of well-informed practitioners in the
present day do not give mercury until they are certain
that the case is one of true constitutional syphilis.
All doubtful cases are watched ; they are treated with
simple measures and surveillance.
I have already said that the hardness is an important but
by no means absolutely constant symptom of a syphilitic
sore ; when it does occur it is regarded by most practi¬
tioners as the first proof that the case is one of constitu-
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tfhfi Medical Press and Circular.
ALISON ON CONSUMPTION.
September 23, I860. 2 15
tional syphilis. They wait, however, until this or some
other unmistakable symptom leaves no doubt that the |
case is one of constitutional disease ; then, and not till
then, do they give mercury. To use a homely phrase, they
do not take off their hats to the devil, until they are quite
certain that he has come in sight. A few like M. Diday,
and I may say myself, if his highness keeps at a distance
(only appearing in the form of a “ verole faible”), forego the
honour of saluting him, even although we may catch a
glimpse of his formidable person. While one or two
staunch heroes like Mr. Blenkins sternly refuse to pay their
homage under any circumstances.
Such is, I believe, a true statement of the actual practice
of the present time as regards the use of mercury.
You will perceive, gentlemen, at a glance, that since
the close of the last century, king mercury has lost
much of his temporal power. He then with the aid
of a great Lieutenant-General John Hunter ruled despoti¬
cally over three races. A great territory, a land flowing—
but not with milk and honey—the land of gonorrhoea was
beneath his sway. The rest of his people, although as
different in race as the Christian from the Jew, dwelt to¬
gether, as we may say, in the same cities and bowed beneath
nis sceptre. “ Chancrelles” and “ chancres” alike submitted
to him.
The first revolution deprived him for ever of gonorrhoea-
land. The second was the revolt of the chancrelles ; this
was headed by the Garibaldi of venereal revolutions, the
illustrious Ricord, who in his earlier days had struck the
last blows which had liberated gonorrhoea from the yoke
of the tyrant. This second revolution may now be said to
be accomplished. Ricord has won the freedom of the
chancrelles. The mercurial despot of former times is now
reduced to the condition (pardon me for saying it) of a
c mititutional sovereign ; he reigns only over the true
chancres ; even among these there is an agitation going on,
and a popular demagogue with wonderful powers as a
“ mob orator,” named Paul Diday, bids fair to gain great
privileges if not absolute manumission for the section
known as the “ V^roles Faibles.”
In medicine, as in politics, there are party struggles,
defeats, and victories ; we have our conservatives and our
reformers, those who look always back to the “ good old
times,” fearing changes and shaking their heads at any
departure from ancient rules of practice, those who are
prone, too prone, perhaps, to adopt new ideas, and turn
their backs on what time and experience has sanctified.
Between the two we make progress. Syphilis is a
subject which has drawn to itself the attention and study
of some of the greatest minds the world has ever produced :
that our knowledge of it has advanced so slowly is the
surest proof of what difficulties and obscurities surroimd
it. He who has done ought to penetrate this obscurity ;
to let into the darkened chamber one ray of light, so as to
give the physician armed with a club a better chance of
striking the disease and avoiding nature, has achieved
touch for mankind. Among these it is with pardonable
national vanity, that I point to Colles, Carmichael, and
Wallace.
-+-
Original CuMMttttkrfiuits.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION : THEIR
DIAGNOSIS AND TREATMENT.
By S. SCOTT ALISON, M.D. Edin.,
WtLLOW OF TDK ROYAL COLLKOK OK PHYSICIANS, LONDON, AND
fSYSIClAS TO THE HOSPITAL FOR CONSUMPTION AND DIBKA6E8 OF TUB
CUK8T, BROMPTON, AND TUB SCOTTISH UOSP1TAL.
No. VII.
The treatment of throat disorders simulating pulmonary
consumption, although properly a secondary object in a
paper more particularly devoted to diagnosis, deserves some
notice here. It may be observed generally that the treat¬
ment of cases of simulated consumption when judiciously
suited to the various conditions, both local and constitu¬
tional, which are present, is remarkable for its very happy
results. The general health is restored, and the local suffer¬
ings are, in the majority of cases, speedily mitigated and
ultimately abated.
The plan of treatment, or ratio medendi , may be divi¬
ded in most cases into three parts—1st., that directed to
the remedying of the general effects of the local disease
upon the body ; 2nd, that directed to the correction of the
associated morbid habits of body, or cachexiae, which fre¬
quently prevail in such cases, and play an important part
in the origin of the local disorders, and in their persistence;
and 3rd, that pointed to the local management of the
throat disorders.
On all these heads a few words may be usefully expended.
Local treatment alone in some cases is nearly all that is
required ; treatment directed to the correction of taint is
the paramount consideration in some cases, such as the
scrofulous and the syphilitic, and the constitutional treat¬
ment for the correction of grave injuries of the general
health is a leading demand in cases of throat diseases of
long standing, that have been misunderstood, and that
have given rise in the mind of the patient to grave alarm
lest the loss of life should be the result.
The local treatment which I have found useful in dis¬
orders of the throat simulating pulmonary consumption,
includes surgical means, the direct application of various
agents in the solid form, in the liquid form, in the form of
vapour and spray, the application of galvanism, of heat
and cold, and the external use of liniments and fomenta¬
tions and other means.
The surgical interference which I have found to be
most useful has included the excision of the enlarged and
over-active tonsil by the scalpel or the guillotine; the
scarification of the tonsils in minor cases ; the scarification
of the pharynx and the amputation of the over-vascular
and elongated uvula. These operations have frequently
proved the effective means of at once bringing about a
cure of the suspected disease of the lungs, and a total and
immediate removal of all the symptoms which have annoyed
aud alarmed the patient.
The application of solids to the morbid parts of the
upper air-tube apparatus has been most useful in the treat¬
ment of the cases of throat disorders simulating pulmonary
consumption. In old standing cases of enlarged tonsil,
in chronic pharyngitis with enlarged glandules, associated
with morbid and excessive secretions, the application of
the solid nitrate of silver has proved of immense service.
It has also proved of great value when the uvula has been
found long, large, and flabby.
The exhibition of troches, cdhtaining respectively
tannic acid, bismuth, and chlorate of potash has been found
very serviceable. In cases of relaxation, with flabby con¬
ditions and with excessive secretion, thetannic acid lozenge
has done great service. When there has been a fair amount
of secretion, or a little excess, with nervous irritation and
tickling sensation, the bismuth lozenge has given good re¬
sults ; and when there has been hypertrophy, with con¬
gestive action, over-vascularity, and reduced secretions,
the chlorate of potash lozenge has rendered pre-eminent
service. Morphia and opium, which are frequently pre¬
scribed in throat disorders, I have not employed in the
cases under consideration, for these agents are calculated to
impair digestion and the nutritive functions already fre¬
quently in fault, and when given in the shape of lozenge
are liable to be taken in dangerous excess. I deprecate
the use of such important medicines in so familiar a form
as a lozenge. The gum and the tragacanth lozenge are safe,
and may be given almost ad libitum in cases marked with
constant irritative hemming ; they are perfectly safe in the
hands of the patient. Perhaps it is not trifling to say that,
the various preparations of cnocolate have been at once
grateful to the patient, sedative und nutritious. The
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ALISON ON CONSUMPTION.
September £3,18&
lozenge of the French Company, to be obtained of Fortnam
and Mason, Piccadilly, is worthy of recommendation.
Agents in the liquid form hare been found very service-
'able. These have been employed, firstly, in the form of
gargle ; secondly, they have been taken into the mouth
and slowly swallowed ; and, thirdly, they have been ap¬
plied by means of brushes and sponges. Gargles of
chlorate of potash and borate of soda have proved of
great use. They have imparted a healthy action to weakly
congested tonsils and to the pharynx, and have promoted
the healthy secretions of these parts. Gargles of tannic
acid, of oak-bark decoction, of hydrochloric, and of sul¬
phuric acid, have given tone to the parts affected with
old standing congestion, with over secretion, and with
varicose veins. Gargles of honey and acetic acid, and of
honey and citric acid, or lemon juice, have also proved of
use in promoting, tone and healthy secretion, as well as in
allaying over sensibility, and they have this negative ad¬
vantage, that they may be used pretty largely without any
injury or the risk of injury even with young patients. I
have found them perfectly innocent.
Lincti, usually composed of medical agents of an
innocent nature, and of treacle, or honey, or sugar, are fre¬
quently found of use ; they have proved of decided ser¬
vice in many cases treated by myself. In this form the
agent is applied for some time to the parts and ultmately
allowed to pass down the oesophagus. The most useful has
been composed of nitric acid, sulphuric acid, acetic acid,
and phosphoric acid.
Glycerin, used after this fashion, has proved of great use
in many cases marked with sense of dryness and tickling.
Oil, employed in the same manner, is useful, and it may
be sometimes advantageously conjoined with honey.
Solutions of many agents, and liquids have been largely
and beneficially employed by myself in cases of throat
disease, simulating pulmonary consumption, applied by
means of sponges and brashes. The sponge has been fixed,
as usual, to the end of a whalebone-stem, variously bent,
and the brushes have been of various sizes, generally
large, and having handles bent so as to reach, conveniently,
the parts most affected. The brushes have been gene¬
rally composed of camel-hair, but a very useful brush, re¬
markable for cleanliness, is made of spun-glass, and may
be procured of our best chemists.
The familiar solution of nitrate of silver, long applied
in this manner by the profession, has afforded to my
patients great alleviation of irritation and congestive
action, and has imparted a healthier condition to the
morbid parts. In the same manner, the solution of
bichloride of mercury has been used, especially in syphi¬
litic cases. In my little work on the Medication of the
Larynx and Trachea, published in 1853, I recommended
the application, in this fashion, of oil, glycerin, cod liver
oil, mucilage, and some active agents, and I have found
their employment, in the class of cases under consider¬
ation, very useful.
Inhalations have been largely employed in the treatment
of cases of throat disease simulating pulmonary consump¬
tion coming under my care, and they have proved of great
service when the disorder has been seated low down in
the trachea.
The vapour of hot water, perhaps, has been the most
generally useful of all the inhalations which I have em¬
ployed. It has been in cases of constriction or coarcta¬
tion of the trachea, deficient secretions and moderate spas¬
modic action, that this form of application has been most
serviceable. The vapour has been clearly inhaled through
various inhalers, such as those of Nelson, Edwards, and
Maw, but 1 have found excellent results from the employ¬
ment of a common earthenware jug with a narrow mouth
covered with a handkerchief of muslin or cambric.
The inhalations of chloric ether, conium, hops, as pre¬
scribed in the Pharmacopeia of the Consumption Hospi¬
tal, Brompton, have been most useful when irritant spas¬
modic action has suggested the use of sedatives. The in¬
halation of camphor with the vapour of hot water has been
found of use when moderate stimulation has been indi¬
cated.
The inhalation of the vapour of some hot mineral
waters chiefly sulphureous, is calculated to be useful in some
cases. Sprays have also proved of great use in cases of
disease situated low down. The agents I have employed
have been solutions of nitrate of silver, tannic acid and
acetate of lead. The instruments employed have been
those of Biegele.
The spray of sea-water, as naturally found in the
atmosphere of the coast in stormy weather, has proved of
use in some cases of throat disease marked by atony in
debilitated and scrofulous patients. The spray of mineral
waters has likewise proved of use in some cases. The sul¬
phureous waters have been useful in this way.
Galvanism applied to the larynx and trachea has proved
of some advantage, but chiefly in cases of atony of the
muscles of the larynx, and attended with moderate
aphonia, and free from ulceration, in hysterical girls.
I cannot say that the results have in general been
equal to the expectations of patients, but sudden cases do
occasionally occur.
The instruments best suited for the application of gal¬
vanism, are those of Dr. Morell Mackenzie ; it is with his
instruments that I am most conversant.
The management Qf the trachea and larynx in vocal and
respiratory exertions is not to be disregarded in the treat¬
ment of throat affections. Hurried respiratory efforts are
generally to be avoided, loud and protracted and rapid
speaking is usually hurtful, and singing particularly at a
high pitch is often highly injurious.
Besides the application of agents directly made to the
interior of the throat, &c., I have largely employed agents
addressed to the exterior, and this branch of treatment is
one of very considerable importance, and will in practice
prove a valuable co-operative agency in the treatment, and
should not be lost sight of by the practitioners.
When the disorder of the throat has given signs of
activity with congestion and swelling, together with a re¬
duced amount of secretion, the local application of fomen¬
tations prove [useful. I have largely employed, them in
such affections, more particularly when developed in the
larynx, the narrows, or angustiae of the trachea, and at its
bifurcation. The linseed cataplasm has given relief, and
this may sometimes be the most available means, but it
has the disadvantage of weight, and unless covered up
with flannel is, in this climate, particularly in winter, liable
to become soon cold. The fomentation of sporigo piline
made to fit to the front of the neck, and it may be to the
upper part of the chest at the sternum, is more convenient,
and may be kept applied for almost any length of time. I
have found tho very greatest advantage from this applica¬
tion. When a little stimulation of the skin is desired, the
hot water in which thesporigo piline is to be soakedmay be
faintly coloured with mustard flour, a small teaspoonful of
the flour being added, say to half a pint of water. With
children such a stimulant must notjbe applied too strong or
for a length of time, and diligent attention is necessary with
this as with everything relating to the medical treatment of
young subjects.
Blisters applied to tbe throat have been generally con¬
demned by the profession on account of the danger of in¬
flammatory action caused by the application spreading to
the interior of the air-tube. I have not employed them
nearer than the upper part of the sternum. At that part
a small blister, the size of a crown piece, in the case of
adults, and of a shilling in tbe case of children, applied for
an hour or two, has done good service in obstinate cases of
vascular over-action of the narrows of the trachea.
Some degree of counter-irritation of the neck and of the
upper sternal region, I generally employ in all cases of
serious implication of the throat, whether merely simulating
consumption or accompanying it, except in the dying
state. I generally paint with iodine on either side of the
trachea to the extent, in the adult, of an inch in length,
and half an inch in breadth, and over a space about
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HOSPITAL REPORTS.
September 23,1338. 27?
the, size of a florin at the upper part of the sternum.
I avoid painting over the larynx lest chaffing should
give rise to sores, which I have sometimes seen pro¬
duced to a troublesome extent. When the pharynx
and tonsils are affected I sometimes paint the nape
of the neck to the extent of a florin. The strength
of the iodine paint I have employed for adults has been
twenty grains to half an ounce of rectified spirits of wine.
This produces a sense of heat, a blush around, and a weakly
state of the skin some hours after, which continues for
days, from a quickened production of the epidermis. The
application is renewed in a day or two, according to the
effects produced.
For children, the paint should be weaker, and it is de¬
sirable to bear in mind that the skin at the front of the
neck is more sensitive than the skin at the nape, or at the
upper part of the chest.
Liniments, in cases of throat disease, render good ser¬
vice. In cases of general tenderness of the throat, the
patient attains relief by the general aid and gentle application
of such liniments as those of chloroform and of soap. It
is necessary to apply them gently; but they may be freely
used as regards space, back and front, and also over the
upper part of the chest.
I have found exhausted and dying patients suffering
from dysphagia to experience great relief from the chloro¬
form liniment, and indeed it has in some such cases proved
the only external breast application that the patient could
tolerate.
The mustard liniment of the British Pharmacopoeia, ap¬
plied to the lower part of the neck and over the upper part
of the sternum, has produced in some cases immediate
and beneficial stimulation of the skin.
The abstraction of blood to a limited extent from the
neck ot upper part of the chest will only seldom be desi¬
rable; but I have met with cases of active congestion of
the larynx and trachea simulating, and also accom¬
panying pulmonary consumption, in which the application
of leeches has not only appeared to be indicated, but in
which the loss of blood through their means has been very
useful. It has relieved symptoms immediately, and has
appeared to produce that local state of things necessary
for the early and full beneficial effect of other means. This
application of brushes will be found admissible in cases
marked with urgent dyspnoea, hot skin, and full, quickened
pulse. I have known the best results to follow the appli¬
cation of one or two leeches to the lower part of the neck
or upper part of the chest. A point at the upper part
of the sternum is a good one; no risk of inflammatory
action of the skin need be apprehended, and the sternum
offers a good means of resistance should pressure be re¬
quired to bring excessive oozing of blood to an end.
The amemic and scorbutic habit, and the morbid condi¬
tion, offer, of course, difficulties to this practice; but the
sanguine and full habits, on the other hand, give facilities
for its adoption.
ARTIFICIAL RESTRAINTS ON POPULATION.
By HENRY MAC CORMAC, M.D.
I cannot enough commend your remarks on this sub¬
ject in The Medical Press and Circular, of September
2. Until mankind reach a certain pitch of moral elevation
and refinement, they seek enjoyment without counting the
cost. Nothing, I believe, can be had for which a price has
not been paid. If we do not pay the price we must, as
defaulting debtors, incur the penalty. Nature, in other
Words the providence of God, will not remit our indebted¬
ness. The gospel of moral obligation is one which cannot
have too many teachers. It extends to all things. It is
just as peremptory now as it was in all past times, and will
be in all times to come. The world is not over-peopled, and
probably will never be so. But many places are relatively
over-peopled. Universal self-denial, as adjusted to times
and places and circumstances, is incumbent on every oue.
It is incumbent in thought as it is incumbent in deed. We
have only to look around to be made aware of the evils
that flow from the violation of the principle. It is con¬
spicuous in others, it is only too obvious among ourselves.
I was talking one day, some years back, to a German mar¬
ried lady, who had resided for some time in France.
“ French women,” said she, “ have small families.”
“ Comment” said I. “ Elies prennent des precautions” was
the reply. I did not ask her what the precautions were.
But any precautions that impugn the Divine law—the law
of purity and truth—will be productive of evil. There
can be no violation of this law which is attended with im¬
punity. We might as well, as some one has said, try to
cut one end off a stick, as hope for it. There is an im¬
mense amount of insane speculation among all classes.
There are books extant replete with doctrines, with incul¬
cations which, could they only be carried out, would mul¬
tiply current disorders a thousand fold. Man is the god
of woman’s idolatry. And, yet, she should look to a higher
worship. When this is realised, woman will cease to be
the victim and the plaything of man. She will prove the
incitement and the incentive to pure and holy action, in¬
stead of its violation. I do not for a moment presume to
level imputations against the species at large of either
sex. I only desire to advert to infractions when they subsist,
I only wish to be understood as speaking of those—whether
ourselves or others—who are capable of perpetrating them.
And I look upon it as one of the duties of the profession to
stand up for nonest, truthful speculation, and action con¬
formable.
- ♦— -
krsgiM §bprk
DR. STEEYENS’ HOSPITAL.
CnRONIC LARYNGITIS I TRACHEOTOMY : RECOVER^.
Under the care of R. L. SWAN, F.R.C.S.I.,
RESIDENT SURGEON, DE STKEVKNS’ HOSPITAL.
R. P., aged 47, was admitted into hospital, July, 1868.
He had been a considerable time suffering from disease of
the larynx, presumptively of syphilitic origin, which
affection he had contracted ten years ago. He had lately
been under the observation of Mr. Wilpiot, and during
that time coughed up small pieces of cartilage on a few
occasions, after which he experienced relief.
On admission, he presented the following symptoms :—
General debility indicated by pallor and emaciation ; voice
hoarse, or sometimes complete aphonia ; respiration loud
and embarrassed, amounting occasionally to orthopncca,
influenced by changes of weather, and more difficult at
night; pain on manipulating the laryngeal 'region. Parox¬
ysmal attacks of cough frequent, with expectoration of
sanguinolent mucus. Lungs healthy, as far as could be
determined from the confusion of sounds heard through
the stethoscope ; percussion natural ; no pain in degluti¬
tion. Appetite bad ; pulse 100 ; tongue tremulous and
furred.
He states that he suffered on one occasion from en¬
largement and induration of the cervical glands, and
nodes on the frontal bone, which subsided under treatment.
The neck is short, the shoulders elevated, the cicatrix of
an old abscess is visible above the sternum.
Ordered—A small blister on each side of the larynx ;
bromide of potassium internally. Nutritious diet.
August 10th.—No improvement. Breathing more
difficult; nights are spent in a sitting posture without
sleep. Ordered mercurial fumigation.
15th.—The fumigation has been repeated, the gums are
now slightly affected, but the disease lias remained un¬
checked. It was at this period intended to have a consul¬
tation ou the following day, as to the propriety of opening
the trachea, and giving the larynx rest.
11.30 F.ii.—The nurse on duty in the ward came to my
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HOSPITAL REPORTS.
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residence stating that he was much worse. I then found
him in the following alarming condition:—Respiration
gasping, loud, and resembling an indistinct whistle ; face
and trunk covered with a cold sweat ; extremities frigid ;
posture, sitting erect; countenance indicative of the utmost
distress. Having made those observations, I determined
that relief must be afforded without delay, and so informed
him. He immediately acquiesced, and with difficulty
stated that as he then was he could not exist ten minutes.
Having obtained the assistance of Dr. L’Estrange, Army
Medical Staff, now residing in the hospital, and Mr. Rath-
borne, the diligent dresser on duty, and surrounded the bed
with a large screen, I made an incision through the integu¬
ments, an inch long, just above the sternum. I here found
that owing to the old abscess in this situation, the skin and
subcutaneous tissues were condensed, and adherent to each
other ; the extreme shortness of the neck likewise gave
considerable annoyance, and, worse than all, the extension
of the neck, which might have counteracted this defect,
caused an apparent cessation of respiration, so that I was
constrained to relinquish that position. I was now obliged
to bend the director, in order to raise the tissues overlying
the trachea, which I had soon the pleasure of seeing at the
bottom of the wound. Having seized it with a hook, and
cut out an oval portion the size of a fourpenny piece, I in¬
troduced the double canula. The air was now breathed
with great force, for the space of half a minute, and then,
at once, an alarming state of collapse ensued. I may, with
truth, assert that all the signs of death were preseut. Res¬
piration ceased, the eyes became apparently glazed, and
that peculiar appearance so well-known, yet so difficult to
describe succinctly, became visible in the countenance. Ar¬
tificial respiration was immediately vigorously resorted to,
and after some time I had the satisfaction of seeing that
he breathed again. The paroxysms of cough were at first
violent, but soon abated ; there was no luemorrhage of any
consequence.
Ordered—Hot jar to the feet and legs; several vessels of
boiling water to be placed around the bed, to moisten the
air and elevate its temperature ; to get a teaspoonful of
brandy and water occasionally, and a little warm beef-tea
at intervals.
4 A.M. —Feels comfortable; breathing natural; has had
some sleep ; feet and legs have become warm.
18th_Removed the tube this morning, and introduced
another with a wide and flexible phlange, as I found that
the ordinary instrument had a tendency to sink into the
incision, and thus cause irritation. During the adjustment
of the tube the observation of Majendie was fully borne
out. When the curved extremity was directed upwards
toward the larynx, violent irritation and coughing was pro¬
duced ; on the contrary, when passed downwards toward
the lungs, no uneasiness whatever occurred.
From this period the patient has progressed favourably.
Pathognomonic changes are still evidently going on in the
larynx, small portions of cartilage having been coughed up
on a few occasions.
It is well to mention that he experiences much comfort
from the use of a vulcanized gutta-percha tube, which he
now wears in preference to a silver one. The appetite is
good ; the strength improving. He is using a nutritious
and tonic regimen.
ST. GEORGE’S HOSPITAL.
Dr. OGLE’S cases of abdominal tumours.
(Continued from page 280.)
Case XI. — peculiar thickening of the walls of
THE ABDOMEN OWING TO FIBRINOUS EXUDATION BE¬
NEATH THE MUCOUS AND SEROUS SURFACES; PLACENTA-
L1KE MASS FORMED BY SIMILAR DEPOSIT IN THE GREAT
OMENTUM. PERITONITIS ; PHTHISIS.
R» B., set. 35, was admitted February 21, 1855. He said
that he had lived freely, and that about five months be¬
fore admission he became subject to griping pains in the
umbilical region, with tenderness over the part. His
appetite failed, and he had feeling of weight after eating.
There was no swelling about the abdomen, and no vomit¬
ing of food, but often violent retching. The tongue was
coated ; bowels costive. He said he had had but little
sleep for three weeks. Under the use of aperients, with
hydrocyanic acid and soda, the vomiting was to some
degree stayed ; but it became worse, attended by more
pain in the abdomen ; and he had blood-stained muco¬
purulent expectoration. He got low and weak and de¬
sponding. The expectoration, which became profuse,
somewhat ceased under the use of acetate of lead and
opium. Stimulants were tried, but without effect; he
sank, and died March 31st.
Post-mortem examination. — The right pleural cavity
was full of yellow fluid, and the pleura puckered and
thickened. Both lungs contained miliary scrofulous de¬
posits, and much carbonaceous matter on their surfaces;
the latter was quite prominent in places, mapping out the
lobules. The heart was natural. On examining the
abdomen much yellow fluid existed in the general peri¬
toneal cavity, and the intestines were of a very dark pur¬
ple (almost black) colour, the various convolutions being
adherent to each other by soft fibrin, and looking like the
coils of a speckled snake ; their surfaces were roughened,
and in places had quite a reticulated character, owing to
effused fibrin upon them. The great omentum was con¬
tracted and drawn up, and reduced to a small placenta¬
like hard mass. The peritoneum everywhere was much
thickened, and especially about the mesentery and the
stomach, which was reduced much in size, and very much
thickened universally by a fibrinous exudation deposited
to a slight degree under the peritoneal, and to a greater
degree under the mucous surface, which was in places
roughened, the various folds being almost obliterated.
In places the peritoneal surface was studded with white
deposits. The lymphatic glands were indurated and en¬
larged.
Case XII. —tumour in the abdomen, close to the
BRIM OF THE PELVIS, FORMED BY SCIRRHU8 OF THE
PYLORUS OF THE STOMACH, WHICH WAS ENORMOUSLY
DILATED.
S. R., a woman, set. 33, was admitted November 7,
1866. She had been gradually losing flesh for nine
months, and the ^catamenia had been absent seventeen
months. She had become worse three months before ad¬
mission, and suffered from severe sickness and slight and
scanty action of the bowels. On admission she had con¬
stant vomiting. A large hard tumour could be felt very
prominently, close to the brim of the pelvis, on the right
side, and almost in the pelvic fossa. An apparent ob¬
struction was found on introducing the long O’Beirne’s
tube into the rectum, which could not be overcome.
Afterwards a small amount of fiecal matter was passed.
Stimulants were given, and the bimeconate of morphia
injected subcutaneously with great relief. She grew
weaker and thinner, and died November 18.
Post-mortem examination. — It was found that the
tumour felt during life was the displaced pyloric ex¬
tremity of the stomach, which was so contracted as
scarcely to admit a goose-quill, and surrounded by a mass
of scirrhus to the extent of an inch. The stomach was
enormously dilated. The large intestines were contracted
in one or two places, but no carcinoma of their valves
existed. The other abdominal organs were natural*
The lungs were very cedematous ; heart healthy.
Case XIII _tumour formed by a mass of extrava-
SATKD BLOOD, SITUATED BENEATH THE PERITONEUM,
AND HANGING BY A PEDICLE FROM THE TRANSVERSE
COLON.
H. B., a female, tet. 25, was admitted June 11, 1S58,
with evident disease of the brain. Delirium, strabismus,
and other symptoms set in, and she died June 17.
Post-mortem examination ,—Softening of the central part
Digitized by v^,oooLe
The Medical Press add Circular. FOREIGN MEDICAL LITERATURE. September 23, 1868. 27 9
of the brain, and effusion of serum on the surface And in
the ventricles of the brain, were found; Also psoas abscess,
connected with caries of the bodies of the fifth to the ninth
dorsal vertebrae. The intestines were tympanitic, and hang¬
ing from the transverse colon, about midway between its
attached border and the omentum, was a mass of extrava-
sated blood, covered by the peritoneum, and attached to
the intestine by a narrow pedicle.
Case XIV. —swelling op the hiotit iliac region in
CONNECTION WITH CANCEROUS DISEASE OF THE OECUM,
IN WHICH WAS AN ULCERATING CAVITY, HAVING THE
STOMACH AND SEVERAL PORTIONS OF THE SMALL INTES¬
TINE COMMUNICATING WITH IT.
J. P., set. 31, was admitted December 6, 1865, having
bad diarrhoea, attended by pain and swelling in the right
iliac region for four months. On admission there was
a hard diffused swelling in the right iliac region,
very painful on pressure, but the skin over it was not
red or painful: the bowels were quite regular. After
admission, the pain greatly abated, and the tumour
subsided, and the patient improved much in health. About
the end of January the swelling and pain returned, and
pus was gradually approaching the surface, when suddenly
there was an evacuation of purulent fluid by the rectum ,
and the tumour somewhat subsided. He now rapidly
emaciated, and his face assumed a cachectic appearance.
The right leg became cedematous, and its superficial veins
enlarged. Early in April he had an attack of lung-con¬
gestion, and he sank, and died April 15th.
Post-mortem examination .—A very large ulcerating
cavity was found within the abdominal cavity, surrounded
by a mass of intestines adherent to each other and to the
abdominal walls. This ulcerating cavity was evidently of
a carcinomatous character, and formed chiefly at the ex¬
pense of the caecum, and into it opened laterally the small
intestine and other ports of the large bowel. The stomach,
which was adherent to the mass, also communicated with
it at its pyloric end. The liver contained carcinomatous
deposits. The lumbar glands were not enlarged. Adhe¬
sions and fluid were found in the pleural sacs, in addition
to collapse of one lung. The heart was small, and the
mitral valve slightly thickened.
-♦-
Jump gpbiuil §tatto.
RECENT CONTRIBUTIONS TO THE THEORY
OF THE INNERVATION OF THE HEART AND
BLOOD-VESSELS.
(Reported by Dr. Christian Loven.)
Translated from the JTygiea for March and April, 1868, by
W. D. MOORE, MJD.Dub.etCantab., M.R.I.A., L.K.Q.C.P.I.
HONORARY FELLOW OF THE SWEDISH SOCIETY OF PHY8ICIAXB J OK
THE NOBWEOIAN MEDICAL SOCIETY; AND OF THE ROYAL MEDICAL
SOCIETY OP COPENHAGEN; SECRETARY FOB SWEDEN, NORWAY AND
DENMARK, TO THE EPIDEMIOLOGICAL SOCIETY OF LONDON.1
(Continued from page 145.)
8uch a special investigation, whose results, precisely with re¬
ference to the hypothesis just mentioned, are of great interest,
the same author has, with the employment of the above-
described method and apparatus, himself instituted in Claude
Bernard's laboratory in Parish
The object of the author in this investigation was to study
the influence which carbonic acid and oxygen exercise on the
heart of the frog, when separated from the body. To bring
the heart into contact with the agents named, the serum of the
rabbit, with which both the heart and the artificial vascular
system connected with it were filled, was saturated alternately
with carbonic acid and oxygen, and the various curves drawn
1 The delay in the appearance of the second part of this paper is
caused by the fact that the numbers of the Ilygita for April, May, and
June did not reach me until the month of September, after I had re¬
ceived the July number.— Translator.
2 Be Find nonce de l’acide carbonique et de l’oxygdne stir le cceur;
jw lL £. Cyon. Comptea Rendus, Tome LXIV, No. 20, p. 1049,
by the manometer, indicated the alterations in the activity of
the heart which occurred in each case. The experiment showed
that contact of the inner surface of the heart with a serum
saturated with carbonic acid produces a sudden arrest of the
heart in diastole. The drawing off of this serum, or changing
it for one impregnated with oxygen, brought the movements of
the heart again into play. The following facts show, that the
arrest in question is produced by irritation of the terminal
organs of the pneumogastric nerves in the heart:—(1.) The
sudden arrest in diastole. (2.) The possibility of producing,
during the same, isolated contractions by local stimulation of
the heart. (3.) The rapid return of the movements after the
removal of the serum saturated with carbonic acid. (4.) The
character of these new movements. They were, in fact,—
just as after irritation of the nervi vagi—considerably more
extensive than before, and were, moreover, separated by com¬
paratively long pauses. Furthermore, it was shown that if
the carbonic acid serum were mixed with a strong dose of
curare, which poison, as has already been stated, paralyses the
peripheral extremities of the nervi vagi, the arrest did not take
place, but the cardiac movements became extremely feeble,
and often even peristaltic and irregular. Also in this case the
serum impregnated with oxygen again produced regular con¬
tractions. This latter indicates that the preceding irregularity
in the movements was caused by want of oxygen, which was
confirmed by some experiments, in which the heart was both
filled with a serum saturated with a neutral gas, nitrogen, and
was at the Bame time surrounded with an atmosphere of the
same gas to prevent an absorption of oxygen through the outer
surface. In this case the heart stopped after some feeble con¬
tractions.
It was of consequence, also, to determine how far the pre¬
sence of oxygen is necessary for the development of the motor
forces themselves, or whether it rather plays the part of a
stimulant of the heart’s motor ganglia. In this respect Her-
mann’sl investigations have shown that oxygen is not directly
necessary for the contraction of muscles in general, and that
the carbonic acid thereby formed is not, as was before believed,
the product of an oxidation, but of a decomposition of certain
of the constituents of the muscle. It, therefore, remains only
to assume that the presence of oxygen is necessary to excite
the motor ganglia of the heart, in opposition to the carbonic
acid, which constitutes a stimulant of the heart's regulating
or restraining central organs.
A totally different theory of the cause of the heart's move¬
ments from that above described, is put forward by Eckhard.2
This investigator considers that we ought not to look upon
the heart as an ordinary striated muscle, wholly dependent for
its contractions on certain ganglia, but as a mass of contrac¬
tile tissue, which contracts in a quite peculiar manner, though
under an obscure influence of its nervous constituents. It
will be seen that this theory is directly opposed to that above
advanced. But how little support it finds in the facts lately
observed, appears at once from a closer investigation of the
reasons on which the author bases it. These are principally
three: 1. That in the heart (at least in vertebrate animals)
actual tetanus cannot be produced. The untenability of this
argument is proved by Cyon’s investigations above quoted,
according to which the heart, on a sudden elevation of tem¬
perature, from 32° to 104° Fahr., passes into a state of tetanus,
lasting from 15 to 30 seconds, and still more from the fact that
a local irritation of a heart, which is quiescent at a warm
temperature, produces a tetanus, which lasts so long
as the irritation continues ; 2. That a portion of the ventricle,
in which no ganglia can be discovered, is thrown by the most
inconsiderable mechanical irritation, not into local contrac¬
tions, but into regular pulsation ; and 3. That portions of the
ventricle, perfectly free from ganglia, when traversed by a con¬
stant electrical current, exhibit a series of regular pulsations.
From Friedlander’8 investigations, above quoted, it is evi¬
dent how difficult it is, without special precautions, to assure
one's self of the absence of ganglionic cells, even in vexy
small portions of the heart, and, therefore, no value is to be
attached to those postulates, least of all ought we to build
upon them a theory so opposed both to the results of anato¬
mical investigation, according to which the muscular structure
1 L. Hermann, “ Untersuchungcn Uber den Stoffwechsel der
Muskein ausgehend vom Gaswechsel derselben.” Berlin. 1867. Pp.
67 and 92.
2 “ Experimental physiologic dea Nervensystems. Giessen. 1866.
Reviewed in the Journal of Anatomy and .Physiology. No. II. May,
1867. P. 854, where this theory of the heart's action is warmly advo¬
cated.
Digitized by v^ooGle
280 The Medical Press and Circular.
FOREIGN MEDICAL LITERATURE.
September IS, IMS.
of the heart, with all its peculiarities, must be considered as
actual muscular tissue, and to our ideas based upon other facts
as to the physiological properties of nerves and muscles in
general.
We now pass to the question of the dependence of the
cardiac movements on the cerebro-spinal nervous system. It
h as been stated above that the Brothers Weber, by their dis¬
covery of the influence of the nervua vagus on the heart,
afforded the first incontestable experimental proof of such a
direct dependence. The latter, however, is of a totally dif¬
ferent nature from what had been supposed. Thus, from the
most remote ages, the tendency was to assume such a depend¬
ence, principally in the direction that the heart’s pulsation
should be, if not entirely caused, at least quickened and in¬
creased in intensity through the influence of the cerebro-spinal
central organs. Such an idea was maintained, and was toler¬
ably general in spite of the authority of Haller. But all the
innumerable experiments which, up to the latest period, have
been instituted by various investigators for the purpose of
deciding this important question, have been incumbered with
so many sources of error, and have yielded such contradictory
results, that no definite conclusions can be drawn from them«i
Von Bezold published, in 1863, in a voluminous work, a
number of investigations, by means of wfiigh he believed he
had established the existence of a distinct “ exciting cardiac
nervous system,” whose filaments had their central point
in the medulla oblongata, and thence passed through the
spinal cord and sympathetic nerve in many ways to the heart.
He based this view principally upon the fact, that division of
the cervical medulla immediately produces a very considerable
depression of the force of the blood with diminution of the
frequency of the cardiac pulsations, while direct electrical irri¬
tation of the spinal cord below the seat of the division, raises
to an equal extent the arterial blood pressure and the fre¬
quency of the pulse. The importance and value of the reasons
on which von Bezold based his assumptions were, however,
destroyed, or at least diminished, by the experiments made
upon frogs by Goltz,^ but especially by the masterly researches
of Ludwig and Thiry. 1 2 3 These showed in an incontrovertible
manner, that the phenomena which von Bezold considered as
results of a direct influence on the heart, for the most part
depended only on an indirect influence, as they were, in fact,
a consequence of the opposite effects produced, by the division
and irritation on the nerves, which cause the contractions of the
small arteries, therefore in the former case, a paralysis of the
“ vasomotor” nerves with consequent relaxation and dilatation
of the arteries ; and in the latter an irritation of the same
nerves, producing contraction of the vascular muscles. That
the force of the blood in the former case must increase, in
consequence of the augmented resistance in the course of the
current, and in the latter diminish, is self-evident, and the authors
mentioned showed moreover, completely to exclude all idea of
a direct effect on the heart, that this hapj>ened also, if all the
nerve filaments connecting the heart with the rest of the
nervous system, were destroyed by the galvano-caustic appa¬
ratus. As to the frequency of the pulse they found, that on
irritation of the spinal cord it at one time increased, at another
diminished, and the same took place also in those cases where
the cardiac nerves were destroyed. The above-mentioned in¬
crease of the pressure of the blood produced by irritation of
the spinal cord was equal to that produced by artificial com¬
pression of the thoracic aorta and of the innominata and sub¬
clavian artery ; on the contrary, compression of the abdominal
artery below the renal arteries was followed by only a very
inconsiderable increase of pressure —facts which prove on the one
hand what extreme influence the contractility of the small
arteries has in the production of variations in the pressure of
the blood with its results, on the other, what a capacious re¬
servoir of blood the vessels of the abdomen, properly of the
intestines, form—a capacity, which goes so far, that these
vessels under certain circumstances (for example when the
vena porta; is tied), can take up almost the entire stock of
blood in the body.
1 “ Untersuchungen uber die Innervation des Herzens,” 1863. 1 .
Von dem Einflosa des Nervus thrus auf die Herzbewegungen; 2.
Von dem Einfluss dee Halssympathicus auf die Herzbewegungen; 3.
TJeber ein neues “ cxcitirendes *’ Herznervensystema im Gehirn und
Buckenmark der Saugcthicre. [On the Influence of the Vagus and
Cervical sympathetic on the cardiac movements; on a new “ exciting ”
cardiac nervous system in the brain and spinal cord of the mammalia.]
2 Leber den Tonus der Gefasse und seme Bedeutung fur die Blut-
bewegung. Virchow’s Archiv. Bd. 29, p. 394.
3 TJeber den Einfluss des Halsmarkra auf den Blutstrom. Sitzungsbe-
richte der Wiener Aka dem ie. XLIX Band. II., pp. 421-454,1864.
Through Ludwig’s and Thiry’s investigations it now, for
the first time, became evident where the errors were to be
sought, which made all the experiments instituted for the pur¬
pose of demonstrating the existence of the excitant cardiac
nervous system unreliable and deceptive. These authors them¬
selves left the question undecided, but it was plain from their
researches, that if it should be possible to solve it experimen¬
tally, this must be done by elimination of the vasomotor
nerves.
Such a course was made possible by a new and important
investigation of Ludwig in concert with E. Cyon.* In their
essay these writers make us acquainted with a distinct hitherto
unknown nervous apparatus, through which the heart itself ha*
the power of, so to speak, regulating the res i sta n ce which ob¬
structs its work. This takes place through a nerve, which in
the rabbit arises by two roots—one from the superior laryn¬
geal branch of the vagus, and the other from the vagus itself
—runs down into the chest and enters into the cardiac plexus.
This nerve is sensory. After it has been divided, irritation of
its peripheral extremity produces no effect, but on the other
hand irritation of the central end constantly gives rise to a
very considerable depression of the general force of the blood,
and the authors propose, therefore, to call this the nervus de¬
pressor. The diminution of the pressure of the blool varies,
in different animals, between 50 and 70 mm. of quicksilver, or
to 0 70 and 0 45, but may even reach to merely 0*27 of the
normal pressure, so that it can be even distinctly observed in
dimin ution of the volume of the exposed aorta.
At the same time that the pressure of the blood begins to
sink, a diminution occurs also in the frequency of the pulse,
but this usually returns to the normal standard so soon as the
pressure of the blood has reached its minimum. The lowering
of the frequency of the pulse depends on a reflex action on the
vagus, for it does not take place when both vagi are divided,
whereby it is, moreover, plainly shown that the lessening of
the pressure of the blood is independent of any change in the
rapidity of the pulse. The effect on the pulse, just described,
is further characteristic of any sensory irritation, as the author
found in his investigations on this subject.2
The authors, moreover, satisfied themselves that bo move¬
ments in the thorax occasioned the change in the pressure of
the blood above mentioned, for this occurred equally in animals,
in whom the thorax was opened, or in whom ail muscles except
those of the heart and blood-vessels were paralysed by poison¬
ing with curare. Of course in such instances artificial respira¬
tion was kept up. Only two possible cases, therefore, remained
to explain the phenomenon—either a diminution of the force
of the heart, or a diminution of the resistance in the small
arteries. That no reflex action on the heart was exercised by
irritation of the central extremity of the nerve in question,
was proved by experiments in which all nerves connecting the
heart with the brain or spinal cord were divided ; the diminu¬
tion of the pressure of the blood took place as fully. An
observation which, however, indicated that it is not in the
heart we have to seek the most direct effect of irritation erf the
depressor nerve was, that by promoting the flow of blood to
the heart we can, while the irritation continues, at least for a
moment, bring the pressure of the blood up again to its nor¬
mal height; for example, if we strongly stroke and press the
'abdomen with the hand from the pelvis upwards towards the
liver. This shows that the heart works with undiminished
force.
Thus, it remained only to refer the abatement of the pressure
to a diminution of the resistance. It has already been stated
above what an enormous influence the condition of contraction
or relaxation of the abdominal vessels exercises on the pressure
of the blood in the aorta. It was therefore even a priori
probable that the irritation of the depressor nerve should have
a decided influence on the diameter of this vessel. To ascer¬
tain this the authors undertook first some experiments, by
which they proved that the nerve filaments innervating the
vessels having the greatest influence on the pressure of the
blood, are contained chiefly in the splanchnic nerves, for on
dividing one of these nerves the pressure sank immediately
from 30 to 50 mm. beneath the normal amount, and on sub¬
sequently diriding the other it sank further from 8 to 10 mni,
while, on the contrary, by irritating the peripheral extremity
1 “ Die Beflexe ein os der sensihlen Nerren des Herzens auf die mo*
torischen der Blutgef&sse.” Arbeiten a us der Phyaologischcn Anstan
zu Leipzig vom Jafire 1866 , mitgetheilt durch C. Ludwig. _
2 “ TJeber die Erweiterung von Arterien in Folge emer Nerrenrn*
zung.” Von Dr. Christ. Lov£n i Arb. a us der Phys. Anst. zu Lei p flg *
1666, p. 6, Hygiea, 18G6, Nov. p. 430. See an Abstract in the Journal of
Anatomy and Physiology, Cambridge and London, Nor., 1867, p. 194.
Digitized by
Google
ftaMedici Preta>d Circuit THE PURGATORY OF LONDON HOSPITALS.
September 23,1968. 281
of the divided nerve the pressure of the blood was again rapidly
driven up to a higher value than it had before the division.
The authors now irritated the depressor nerve in animals,
in whom either the Bplanchnic nerves were divided, or the aorta
was tightly compnesed below the diaphragm. In both these
cases file irritation spoken of had, as was to be foreseen, only
an extremely ineonsiderable influence on the pressure of the
blood, yet in the former case so much as to show plainly that
this influence extends beyond the circuit of the splanchnic
nerves.
As a result of the author’s investigations, it clearly follows
that irritation of the central extremity of the divided depressor
nerve produces, by reflex action, paralysis of the vasomoter
nerves, with consequent dilatation of the small arteries, and
diminution of resistance in the course of the blood. This effect
is most conspicuous in the region supplied by the splanchnic
nerves, as being in this respect the most important vascular
nerves. Of this the authors satisfied themselves by direct
observation, as they distinctly saw the exposed kidneys, when
they had previously been pale, on irritation of the depressor
nerve constantly assume a deep red colour, and again grow pale
on the cessation of the irritation. By separate experiments it
was shown that thb depressor nerves, as is not the case with
the vagus, are in a constant state of stimulation (tonus).
The authors finally direct attention to a contradiction disco¬
vered through their observations in the phenomena exhibited
by the heart on irritation, which can be solved only by more
accurate investigations of the arrangement of these nerves in
the heart itself. It is, namely, that while direct stimulation
of the heart quickens the pulsations of that organ, central
irritation of the depressor nerve, which must be considered as
a sensory, or at least as a reflex cardiac nerve, on the contrary
produces diminution of the frequency of the pulse.
At the same time, and, as it appears, independently of these
researches, v. Bezold and Beverl subjected the splanchnic
nerves to accurate experiment, by which their immense import¬
ance as the principal vascular nerves of the body is fully
established. Division of both splanchnic nerves produces
almost as considerable a diminution of pressure in the arterial
system, as division of the spinal cord on a level with the second
dorsal vertebra. By different experiments the authors ascer¬
tained that the most important vascular nerves, that is those
which principally enter into the splanchnic nerves, leave the
spinal cord between the second and eleventh dorsal vertebrae.
The importance of these nerves to the normal course of the
vital process can no longer be mistaken, and in truth they de¬
serve the close attention of pathologists. Y. Bezold says on this
point, “ these^two nerves, so minute in the rabbit, are of the
greatest importance to the normal continuance of life. It is
certain that their paralysis through the great dimi¬
nution of the arterial blood pressure, and in a certain
manner through an internal hemorrhage, gives rise
to insufficiency in the circulation of the blood, which
in a shorter or longer time must prove fatal. The paralysis of
all the vascular nerves running in the splanchnic induces, as
certainly as paralysis of the respiratory nerves,” though it
may be somewhat more slowly, the destruction of the organ¬
ism. The author points out at the same time what important
consequences a morbid change in each of the nerves running
in the splanchnic nerves may have on the several abdominal
organs supplied by them, for their functions are certainly at
least in mediate dependence on the condition in the branches
of the splanchnic nerve which they acquire.
(To be continued.)
At a bazaar kuld at Rowfant, Sussex, the seat of
Sir Curtis M. Lampson, Bart., for the benefit of the Cottage
Hospital, East Orinstcod, on the 5th and 7th instants, the sum
of £250 was received. This included £20 sent as a donation
by George Peabody, Esq.
The Irish Oyster Culture. — Her Majesty’s
government, on the representation and urgent request of Mr.
Blake, intend issuing an unpaid royal commission, with a
view to the encouraging and promoting of the Irish oyster
interest, and of extending their growth and improving their
culture. Evidence will be taken in various places in Ireland,
England, and France by the commissioners. Mr. Blake will
he the chairman, and amongst the other commissioners will be
"fr* Francis Francis and Mr. Hart, manager of the Hayling
Island O yster Fishery .—Irish Times .
1 V°* <k* Wirkutffin d<r yercitplanchniolaufdcn Blutdruck im Aortal •
Wtms, Unless, aua d. pbys. Laborat. in Wurzburg, 1867.
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Annual Subscription, post free, Ten Dollars.
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"SALTJS POPULI StJPREMA LEX.”
WEDNESDAY, SEPTEMBER 23, 1868.
THE PURGATORY OF LONDON HOSPITALS.
We have been accustomed to regard our Metropolitan
Hospitals with singular pride. In them, charity of the
noblest kind has found full exercise in the relief of suffer¬
ing, and professed philanthropists have been able to offer
no suggestions for improving them. Even those terrible
people who amuse themselves by visiting workhouses and
other institutions, from the resorts of casuals upwards for
the sake of describing iu sensational articles the horrors of
pea-soap baths, and bedfellows of the insect tribe, have
hitherto treated our hospitals with respect. In fact, they
have referred to them as the palaces of the sick poor, and
such they no doubt are.
Is the Commissioners 1 trade exhausted ? or has a bolder
commissioner than all forsaken the well-worn paths, and
struck out for himself a new one ? or has some member of
that singular genus determined to out-Herod Herod?
Whatever the cause, we feel it necessary to note the fact
that the London Hospitals have been put on trial.
The ninth number of a periodical we have already com¬
mended—the Public Health —opens with an article en¬
titled " a fortnight in a London Hospital.” The writer
draws a picture that will astonish many and excite incre¬
dulity in the great majority.
After reading it we cried, can these things be ? and we
could speak from large experience of most of the hospitals
in London. Yet there is an air of truth about the article,
and Public Health has been too respectably conducted at
present to let us imagine that some enquiry was not made
before admitting such a contribution.
The writer complains of being compelled, though suffer¬
ing much, to crawl to a bath which “ was repulsive, having
a dirty, greasy, covering over the paint, which felt sticky
to the touch,” &c. Then be bad no sufficient covering on
his bed to keep him warm after this bath, so he “ shivered
with cold.”
A “ female cerberus” ruled the room, imposed tasks on
the patients, took bribes, nay, exacted presents of various
kinds, and otherw ise acted in a manner that would have
secured her instant dismissal bad her conduct been known
to the committee of any hospital. The matron’s visits,
like those of angels, of a better sort, were few and far be¬
tween, and brought only " cold, disdainful glances along
both sides*’ of the wards.
Digitized by vJiOOQlC
282 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
September S3,1868.
Worse than all this, the professional staff of the hospital
is also assailed. The Surgeon under whose care the writer
was placed—at the request, be it observed, of one of that
gentleman’s private patient's who had given the letter of
admission—according to what this author could pick up,
“ was a first-rate surgeon where the use of knife or saw
was requisite, but that he was fond of showing his dex¬
terity, and liked to make a display of his skill and know¬
ledge, or rather seemed to treat the patients like play¬
things.”
Read, mark, learn, and inwardly digest that, ye
modern Surgeons, who sacrifice health and comfort, for
the sake of gratuitously attending our hospitals.
That is the laurel you strive for—the dead leaves of
patient's gratitude, by which you hoped to attain your
ambition. Worse than this, the Surgeon in question, at a
later date, evinced more care. The writer says that then
“ Mr.-, learning that I had influential friends,- was
extremely polite, and examined me in private.”
Although personally acquainted with most of the Hos¬
pital Surgeons of London, we must confess ourselves quite
unable to guess who could be the one alluded to. There
is no body of men that does its work more kindly and
more thoroughly, and is less influenced by such motives
as those insinuated than the honorary staffs of our hospi¬
tals ; and we are driven to the conclusion that the patient
who here relates his experiences, has permitted his judgment
to be warped by the illness under which he laboured. We
all know how irritable and unreasonable some persons be¬
come from physical suffering; and this may be a case in point.
The Chaplain comes in for an equal condemnation.
Now, we shall not be suspected of any leniency towards
the clergy. The Chaplains of hospitals are all paid officers.
Children of light are in this instance, at least, wise in
their generation. They consider themselves worthy of
their hire, whereas the medical men are content to give
their services. Yet we do not like the tone of the follow¬
ing observation:—“He went through the service in the
most listless and indifferent manner, more like an auto¬
maton than a man. Whilst on his knees, reading the
prayers (jrraying he was not), he held the book in one
hand, while the other was occupied with his watch-chain
and trinkets.”
Such is a summary of the statements put forth as to an
hospital “ considered one of the best, if not the best, in
London.”
For this vague description, we should much have pre¬
ferred the name of the hospital being given. If half the
allegations are true, we may be sure that the governors
would be too glad to be informed of the defects of their
charity; and the medical staff, and, we may add, the stu¬
dents, must be very blind never to have discovered any
imperfections. If not strictly correct, an undeserved sus¬
picion is cast by this publication on the noblest institutions
of the land.
The key to the whole complaint seems to lie in the con¬
clusion where the writer says that though good for the
poor, “ those occupying a higher social sphere, who are
reduced to avail themselves” of hospitals, find it “ very
distressing to their self-esteem.” Exactly so—this writer’s
“ self-esteem” does not seem to have been satisfied by the
surgeon until he had made a private examination.
How great that self-esteem must have been we may
guess from his conclusion. He says, “ every day spent in
hospital might take at least a year from purgatory.”
links on fcrmt
University of Cambridge.
The Professors of Medicine and Natural Science, having
found the time which has been usually allotted to their
lectures in each term insufficient, intend to begin their
courses in the ensuing terms earlier than has hitherto been
the custom. The courses in Anatomy and Chemistry will
accordingly begin on tire 12th of October, and on the 18th
of January.
It is expected that examinations in Natural Science for
scholarships will be held in the several Colleges, as follows:
—Sidney, Oct, 7; St. John’s, in April or May; Downing,
in May; St. Peter’s, in May; Trinity, on Easter Monday.
That in Trinity is open to all undergraduates of Oxford or
Cambridge. The others are open to all students (whether
they are members of the Church of England or not) who
will not have commenced residence in the University at
the times of the respective examinations.
Information may be obtained from the tutors of the
several Colleges, and notice is given beforehand in the
Times and other newspapers, under the head of “ Univer¬
sity Intelligence.”
Lord Amberley and the Fenians.
One of the “ Young Ireland” journals— a paper called the
Irishman —has been turning to account in the Fenian
direction, the views of Lord Amberley on over-population,
and the proposals of his Lordship to make things pleasant
for prolific mothers, which were lately made public through
the columns of our journal, and which have, as might be
expected, excited no little disgust in the English moral
mind. The Irishman , in a paroxysm of capitals and notes
of admiration, rankles the little ante English canker on
which its proprietors maintain themselves, into a perfect
agony of irritated torture, and calls upon its literary dis¬
ciples to “ come out of’ contact with the upper ten thou¬
sand Saxon Amberleys and abortionists. It is a pity the
nourished venom of the representative of Irish disaffection
should be wasted, for the Irishman divides its expletives
between the Liberal Lord who utters the condemned sen¬
tences and the Saxon journal which prints them, and it
pays our contemporary, the Medical Times and Gazette, the
compliment of mistaking it for The Medical Press axp
Circular.
We really cannot allow another periodical to wear our
laurels, and the honour of being denounced by the IrwV
man we cannot consent to part with. The Saxon journal
which has, as the Irishman would say, “ besmirched the
already corrupt morality of the Saxon,” is, unfortunately
for the force of the argument, The Medical Press asp
Circular, whose connection with Ireland is well-known.
We advise the Irishman not to waste its invective un¬
less the object is suitable.
An Insulted Coroner.
The fearful catastrophe at Abergele has given rise to many
painful reminiscences. Amongst these we cannot forget
the overbearing and insolent behaviour of that member of
the aristocracy who succeeds to the title of Lord Farnham.
Never, perhaps, in any court did any one indulge in such
impropriety. One would have thought that the filial feel¬
ings even of a person who had come to a peerage through
the accident, might have restrained his temper within
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NOTES ON CURRENT TOPICS.
September 28 , 1868 . 283
reasonable bounds. It is a disgrace to a large part of the
press that his conduct has not been denounced as it de¬
served. Reporters, who seem to have been dazzled by the
live lord, testify to enough to shock U3. The coroner would
have been justified in committing the man who set himself
up to bring his legal office into contempt. We regret that,
for example’s sake, he did not follow this course, and we
commend the true Christian charity with which he bore
with men on the ground of their sudden bereavement.
Still the coronetted recalcitrant should have been sternly
taught that his whims are not to supplant English law.
The coroner has issued a printed statement, which for its
moderation will entitle it to consideration, and which
clearly proves his fitness for the office he holds, and in
doing the plain duty of which he was rudely assailed.
Full Dress and Disease.
The late cab-strike in London dealt a severe blow on one
of the most immodest and disease producing absurdities of
fashionable dress. Tho manager of the Lyceum Theatre,
as its patrons depend on cabs to reach it, very sensibly
gave notice that evening dress was dispensed with.
Numbers of people did actually walk through the streets
in order to reach the theatre where they could sit at ease
in modest attire. It is really astonishing that ladies of
any sense and propriety should willingly expose them¬
selves in a condition which would be pronounced horrible
in a man. No wonder that sore throat, bronchitis, and all
the diseases that arise from catching cold are so common,
when people who shut themselves up in warm rooms, half
undress themselves to go out. The theatres could be
more safely frequented by ladies, were they to act as
rationally as young men in this particular. Fewer colds
would result even to the most delicate were cabs and car¬
riages discarded altogether, and unless the distance were
too great the walk to and from the place of amusement
undertaken. Invalids might safely go out much more
were they to try this plan. We put it as a mere question
of health, and as such medical men may fairly form an
opinion. Low dresses are dangerous.
We do not suppose our warnings will be minded.
Other journalists have denounced in no measured terms
the indecency of virtuous Englishwomen vying with the
demi-raonde in the display of what they are pleased to
call “their charms.” Yet the self-styled modest sex per¬
sists, and that too in places of public resort where the
only passport to a seat is the price of a ticket. If young
men conclude that the women of the day are not modest,—
what wonder ? -
Register.
The registration for the Scottish Universities closes on the
1st October. Some papers have stated that many graduates
have neglected to enrol. There is just time for them to do
so. They have only to send to the registrar of the univer¬
sity to which they belong their names, addresses, degrees,
and year of graduation, requesting to be registered as
members of the General Council. The letter must reach
the registrar at the university not later than the 30th.
The fee for registration is one pound, and must also be
sent before the month closes. A post-office order is the
easiest mode of remittance.
Lodgers and Graduates.
The registration courts are the scene of a difficulty on the
part of lodgers, from which university graduates had a nar¬
row escape. A lodger must fill up and sign his claim. He
has been required to give evidence of his signature and ox
the truth of the statements in that claim. This has given
him much trouble. Our readers will remember that when
the Scotch Reform Bill was under discussion it was pro¬
posed to make graduates sign their voting papers, and then
have them presented by some one who could depose to the
handwriting. This was nearly passing when a great oppo¬
sition was raised. The Scottish Universities’ Union took
up the question warmly, memorialised government and ap¬
pealed to Scotch members with success. The same society,
we believe, had a committee constantly watching the cause
of the graduates in other matters, for which it deserves the
thanks of all concerned. The obnoxious claim was struck
out of the bill, and the university electors are thus relieved
from the annoyance that lodgers are now experiencing. We
believe it was mainly in consequence of the representa¬
tions of this association that the fee was reduced in the
House of Lords from 30s. to 20s. The Duke of Argyle is
President of the Union.
The Coming Medical Session in London.
The class of students in London promises to be a large
one this year, if we may judge by the number of candi¬
dates passed at the last preliminary examination of the
Royal College of Surgeons. Two hundred and forty-seven
students presented themselves for examination, of whom
215 passed, and 22 were rejected. One hundred and
ninety-four of these candidates have qualified for the
membership, and 21 for the fellowship, and it is to be
presumed that the entire number will at once proceed with
their four years of study.
Coombe Lying-in Hospital, Dublin.
The Guardians and Directors of this institution have had
under their consideration since the period of their ihcor-
poration by Royal Charter, towards the close of last year,
recommendations made by the Masters of the Hospital for
the more efficient working of its several branches.. They
have accordingly, with this view, recently arranged, that
while the responsibility and supervision of each and every
one of the branches shall continue, as hitherto, solely with
the masters, Drs. Ringland and Sawyer, each of the depart¬
ments shall be respectively in charge of a district officer;
and to this end have created a new office—that of Ob¬
stetric Surgeon—who is to have under his care the ward
for the treatment of diseases of females, and the special
dispensary held at two o’clock f.m., on Tuesdays and Fri¬
days, for extern patients labouring under the like diseases;
whilst the general dispensary for the diseases of females
and children is to continue, as hitherto, in charge of the
Dispensary Medical Officer, and the management of the
midwifery patients, both intern and extern, has been, as
before, invested in the hands of the Assistant to the Masters.
The “ Guardians and Directors” have likewise added to
their staff an Analytical Chemist, whose duties will be not
merely to make such analyses as the Masters and other
Medical Officers may require, but also from time to time
to examine the food, &c., supplied for the use of the
patients, and report thereon as he may see fit.
Dr. George Hugh Kidd, F.R.C.S.I., who has been for
many years the able and efficient Assistant to the Masters,
has been appointed the Obstetric Surgeon; Dr. William
Roe, F.R.C.S.I., has succeeded him as Assistant to the
Masters, an office which, henceforward, under the provi-
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284 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
Bcptemter 23,1888,
»ion 3 of the Royal Charter of incorporation, can be held
for a terra of only three years by the same person. Sir
William Carroll, M.D., L.K. & Q.C.P.I., continues to be
the able attendant on the general daily dispensary, Dr.
Quinlan efficiently acting as his locum tenens during his
year of office as Chief Magistrate of.the city; and Dr.
Charles E. Cameron, L.K. & Q.C.P.I., the City Analyst,
has been elected to the office of Analytical Chemist of
the institution.
The foundation-stone of a new Cottage Hospital has been
laid at Ilfracombe. The Cottage-hospital system steadily
progresses.
Tiietford suffers from scarlet and other fevers, and an
inspector has been sent down by the Privy Council.
We remarked on the condition of the Navy Medical Ser¬
vice in our Student’s Number. Six candidates lately went
up for examination; three passed. What a state of affairs
for the first naval power !
The Poor-law Board is inclined to “ cave in” about the
increase of the salary offered by the Mile-end Guardians
to their Medical Officers. It is done, however, with an ill
grace. -
Mdlle. Gortchakoff has been admitted by the Paris
Faculty of Sciences to the degree of Bacheliete-des-
Sciences.
Mr. Rider’s tender of .£18,560 for enlarging the Essex
County Asylum has been accepted.
Another attempt is being made to alarm bitter-beer
drinkers, by stating that the “ large brewers ” are think¬
ing of employing strychnine instead of hops. Whatever
their iniquities in the way of adulteration, we cannot be¬
lieve they would like to risk poisoning their customers, or
ruining their trade, to say nothing of placing a halter
round their own necks.
An Association has been fonned for promoting a system
of constant water supply for the metropolis. If every¬
thing must be done by a society, or a limited company,
better thus than not at all. But the water supply is a
national concern, and we should be glad to see it looked
upon as such. Constant service somehow must be had.
The Social Science Congress opens on the 30 th inst.,
at Birmingham. Dr. Rumsey will preside over the health
section. The Secretaries are Mr. Clode and Dr. Hard-
wicke. The Local Secretaries, Dr. Bartleet, and Dr.
Balthazar Foster.
Dr. Frank Smith has returned to Sheffield, and re¬
appointed to the Physiciancy of the hospital which he
formerly held.
Mr. Holmes Coote, in a practical letter to the Times,
points out the rarity of hydrophobia. In another morning
paper Sir R. Mayne receives credit for having cleaned the
London streets of dogs. Twelve thousand of these wretched
animals have been captured, and the great majority being
unowned, were destroyed. No one can desire that the
streets should be infested with half-starved dogs. The
owners of valuable animals should not let them run loose
about a great city.
The Liverpool Mercury is responsible for the following
incredible story. We sincerely trust the conduct of the
surgeons applied to is not accurately described in the para¬
graph :—
“ About eight o’clock yesterday morning a qnarryman
named Pennington, employed at the Kendalfell stone
quarries, was seriously injured by an explbsion of gun cot¬
ton. Ho was preparing a “ blasting” charge, and while
ramming home the gun cotton, which is now extensively
used for such purposes in mines, the latter suddenly ex¬
ploded, caused, it is supposed, in consequence of the boring
rod being too small, and the stemmer, thus coming sharply
in contact with the dangerous compound, acted a3 a sort of
percussional explosive. A portion of one of Pennington’s
arms was blown almost entirely off, and the hand held only
by a ligament; one of his eyes was also dangerously injured,
and he was seriously burned and hurt about the head and
face. He was at once removed to his home, and medical
assistance was called in, but, although three doctors were one
after another requested to attend, each declined—one be¬
cause he had been up all night, another on the ground of
“ inability,” and the third on account of being at his break¬
fast. Meanwliile, the unfortunate man was lying at home,
his wounds unbound, and himself falling into a syncope
through loss of blood. The accident caused the greatest
excitement to prevail in the neighbourhood of Fellside,
where Pennington resides ; and when the refusal of the
medical practitioners became known, a number of persons
rushed into the main street, and for a time a commotion
but little removed from an indignation riot prevailed.
Ultimately, however, on the interference of the Mayor,
who was applied to, a doctor was obtained, and the injured
arm amputated. It is worthy of remark, as illustrating
the dangerous, explosive nature of gun cotton, that during
an experiment subsequently made it was found that by
striking a piece sharply with a hammer it would explode
with suddeness, a force, and a report each in every way
similar to that of gunpowder.”
We read in a moring paper that the “ Church of England
includes a Brotherhood of St. Luke, a religious confrater¬
nity confined to members and students of the medical
profession.” We suppose this last development of reli¬
gious and medical combination is prepared to show that
its patron saint belonged to the Church of England. St
Luke’s Hospital we have heard of. It is appropriated to
lunatics, but what has that to do with the Brotherhood of
St. Luke? Is the head office of this society in or near the
hospital ?
It appears that the Spanish authorities were lately mil¬
led by our Registrar-General’s returns. The number of
cases of cholera reported in the summer were supposed to
be of the Asiatic kind, and within a short period. Hence
the imposition of quarantine which so astounded us. What
a pity the Spaniards do not carefully study our weekly
returns, and imitate our efforts at sanitary improvement.
We should advise the Registrar-General to forward them
regularly his weekly sheet.
The Pharmaceutical Journal has a thoughtful article on
the relation of pharmaceutists to medical men. The same
journal contains an account of the adulteration of nitrate
bismuth with phosphate of lime, from the pen of Professor
Redwood.
The London Gazette has announced the appointment of
Professor Longmore, the Professor of Military Surgery at
Netley Hospital, as Honorary Surgeon to her Majesty the
Queen. This appointment contrasts most forcibly with the
recent appointment of an ex-general medical practitioner
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CORRESPONDENCE.
September 28,1888. 285
to a similar post of honour in connection with the house¬
hold of their Royal Highnesses the Prince of Wales and
the Duke of Edinburgh. Professor Longuiore richly
merits the distinction, and his selection may, perhaps, serve
to redeem the medical attendants of royalty from the slight
oa them conveyed by the last appointment.
Dr. Lory Marsh, the indefatigable honorary secretary
of the Medical Club, which he originated, has been made a
Justice of the Peace.
-♦-
THE TITLE OF DOCTOR.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
SiR,—The letters of “ M.D., L.S. A.” and “ A Member of
Three Corporations/* commenting on my remarks, having re¬
ference to the College of Physicians of London, in your issue
of September 2nd, are of more than ordinary interest, inas¬
much as they demonstrate the existence in the profession of a
real and earnest desire to move onwards and upwards in the
good spirit of the times.
I quite agree with “ M.D., L.S.A.** when he says that “ the
degree of Doctor of Medicine is only conferred by Universi¬
ties ;’* however, his astonishment at my defence of men who
have not an University degree assuming the title of Doctor
will, without doubt, undergo some modification when he reflects
on the fact that in the year 1839 the College of Physicians
entered into an agreement (bona fide) to give the title of
“Doctor of Medicine 1 ’ to its members, whether they possessed
a degree in Medicine or not; and that this same agreement or
promise given to the medical public had the effect of inducing
gentlemen practising purely either as surgeons or general
practitioners to incur the cost and trouble of presenting them¬
selves for examination at the said college. Further, “ M.D.,
L.S.A.” should bear in mind that in 1859 the College in Pall
Mall resolved to recall or ignore the aforesaid “ agreement” or
“promise,” or, in other words, to un-doctor its members—t.e.,
those of them who for a period of twenty years had enjoyed
U 8ummi8 honoribus , ct titxdis , ct privile'jiis , qucecunquc nuc vtl
alibi Medic is concedi solcnt intra auctovitatis nostree limitcs fon'tc
dedisse.” Now, it was this latter act of the governing body
of the College of Physicians of London that I have con¬
demned ; whilst I have ventured to “ defend” or fight the
battle for those gentlemen (members) so illiberally, even un¬
justly treated.
Your correspondent will then, I feel sure, echo “ the re¬
grets” of “ the College” for the “ error” of its ways, sympa¬
thise with the Baid members, and feel no longer “ astounded”
at myself.
The result of the course adopted by me was, as my last let¬
ter affirms—each of the un-doctored gentlemen had restored to
him “ the title of doctor,” with its ordinary advantages, and
this after five years’ degradation (?)
I come now to the second letter named. I am well aware of
Dr. Prosser James* view of “ reform and was much struck
by it on reading that gentleman’s address to the members of
the two Scottish Universities. That each and all of the medi¬
cal corporations must and will be, ere very long, re-modelled
or reformed— i.e., brought into harmony with reason and right
&, to my mind, certain. That the “ Medical Council ** must
and will be made subject to the same process, no one can
doubt. Which one of the two plana named in the letter of
your correspondent can be carried out the better, and the more
quickly ? The medical corporations and the Council I look on
as parts of one medical whole. Shall we reform the first by
means of the second, or conversely—the second through the
first ? For myself I dislike losing time. In the matter under
consideration, I should prefer those means of a short, sharp,
and decisive character, provided, of course, such are based on
reason, precedence and equity.
The “ completeness” of the plan of Dr. Prosser James is
unquestionable ; but I ask, will or will not reformers delay
this completeness by seeking to reach the Medical Council
through the Corporations ?
This is the question.
At this present time my inclinations go towards the refor¬
mation of the Medical Council as the preliminary step. Thi9
Council has not had the very long time to rust as the several
Colleges of Physicians and Surgeons up and down the country.
Moreover, the profession has been very especially wanned
towards the necessary and inevitable changes in regard to the
Baid Council.
Inasmuch as “the representation of the registered practi¬
tioner in the Medical Council” stands No. 1 in “the special
points” before the Medico-political Association, I feel some¬
what committed to a line of conduct in this matter.
In conclusion, let me add, that I am quite as much inclined
as “ A member of three t Corporations ** is to “ look upon medical
reform” in the “ larger sense;’* but I cannot, at this time, and
under present circumstances, feel so certain as he does of “ the
only plan that is both effectual and feasible.”—Yours, Ac.,
James G. Davey, M.D.
Northwoods, Bristol, September, 1868.
COMPOUND AND COMMINUTED FRACTURE
OF THE PATELLA.
TO THE EDITOR OF THE MEDICAL PRES3 AND CIRCULAR.
Sir, — I wish to lay before the profession the following very
interesting and instructive case of conservative surgery,
particularly as the recognised authorities lay it down that iu
similar injuries to large joints amputation should be had
recourse to, in which, notwithstanding compound and com¬
minuted fracture of tne patella from direct violence, when the
whole cavity of the knee joint waB laid open from condyle to
condyle of the femur, the limb has been preserved, and the
patient has now perfect power of the leg.
The following is an abstract of the case taken from the
Hospital records of this regiment:—
Private Denis Regan, aged 30 years, an Irishman, by trade
a tailor ; total service nine years, all in the Mediterranean ;
brought to Hospital at 1.30. p.m., on the 26th July, 1867, by
the Civil Police, who found him lying in the ditch opposite
the “ Auberge di Bavaria.” When admitted he was in a state
of intoxication, and it was found that he had sustained a
compound and comminuted fracture of right patella, laying open
the knee joint, also a severe lacerated and contused wound of
the integuments covering the lower part of os frontis, and left
ala of the nose was split by direct violence, as when running
away from the picquet he leaped over the bastion opposite the
“ Auberge di Bavaria” to affect his escape, sustaining a fall of
about forty feet. I saw him in about half an hour after his
admission to hospital, and found him in a state of great ex¬
citement from drink. When placed in bed it was found that
the right patella was fractured perpendicularly into several
small pieces, the knee-joint was laid open from condyle to
condyle of the femur. It was found impossible to bring the
lips of the wound together, as he kept violently and forcibly
flexing the joint, and each time he did so the crucial ligaments
were brought into view. He was seen by all the medical
officers in the general hospital, Valetta, who strongly advised
immediate amputation. Considering the saving of the limb
hopeless, and that there would be less shock to his system by
performing primary amputation, although he had received
such a fearful injury, I determined to give him the chance of
saving the limb. With this view he was restrained by the
united power of relays of three men until the excitement from
drink passed off. The limb was forcibly extended and placed
loose in a fracture box ; the lips of the wound were drawn
together by four points of suture, and a compress of lint
dipped in the blood from the orifice of the wound was placed
over it. On the following day violent reaction was estab¬
lished, and considerable oozing of blood mixed with synovial
fluid took place from each angle of the wound, the joint was
also enormously tumefied, the limb was retained in the frao
ture box, and ice in a bladder suspended from the central
ring of a cradle, so as to take off its weight, was kept
constantly applied to the joint ; the next day he had several
rigors and a discharge of blood. Synovia and pus took place
from the angles of the wound, accompanied with dusky redness
of the surrounding integuments. On the 30th July the oozing
of blood and pus ceased, the tumefaction abated, as also the
discolouration, and the lips of the wound had united except
at its angles, the points of suture were removed, and ice in a
bladder as before, and poultices were alternately applied to
the joint; he continued uninterruptedly to improve, and almost
free from any constitutional disturbance. The external angle
at the end of six weeks united, the internal one remained open
until a month ago discharging an oily fluid very much resem¬
bling synovia from which several small pieces of dead bone,
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286 The Medical Press and Circular.
MEDICAL NEWS.
September 33,1606,
portions of the broken patella, have exfoliated. All the openings
are now perfectly healed ; the patient’s general health is very
good, he daily takes walking exercise in the open air without
the trilling aid of a stick, and the power of flexing the joint
is almost as good as in the normal state. I have no doubt
in process of time, when the exuberant formation of callus
thrown out in the union of the several broken pieces of the
patella is absorbed, he will have a very serviceable limb.
He is now in this hospital, not for further treatment, but
awaiting his discharge from the service, prior to which I shall
have great pleasure in allowing any gentleman who takes an
interest in such cases to examine him.—Yours, &c.
John Madden, M.B. T.C.D.,
Fellow Royal Coll. Surgeons, Ireland,
Surgeon-Major, 2nd Battalion, 8th Regiment.
South Camp, Aldershot, 12th Sept., 18G8.
REPRESENTATION OF THE UNIVERSITIES OF
GLASGOW AND ABERDEEN.
TO THE SECRETARY OF THE IRISH MEDICAL ASSOCIATION.
Dear Sir, —In your number of the 29th of last J uly, you
kindly published a letter of mine headed—“The Representa¬
tives of the Scottish Universities.” As no medical candidate
seemed likely to come forward, I addressed a letter to the
Lord Advocate, Edward S. Gordon, a copy of which, as well
as his reply, I beg to enclose. I have just signified my inten¬
tion of voting for the Lord Advocate.—I remain, dear sir,
faithfully yours,
Charles Armstrong, Hon. Sec.
Cork, Sept. 12th, 1868.
To Echoard S. Gordon , the Lord Advocate.
Sir, —The strange fact that, while all other interests are
represented, the medical profession has no advocate in the
House of Commons, urges me to ask that, in the event of my
giving you my vote and support, as Parliamentary represen¬
tative for the Universities of Glasgow and Aberdeen, will
you afford the subject of the medical profession your serious
consideration, the respectability of which is so much identi¬
fied with the welfare of the community.
I beg your attention to an agitation, on behalf of which, an
important deputation of the Faculty of Ireland lately waited,
by appointment, on the Irish Government, the deputation
seeking a retiring allowance for the Poor-law Medical Officers
of Ireland, when, from infirmity and disease, after long and
faithful service, they become incapacitated for more labour.
Pray, may I ask your ideas, particularly on the latter sub¬
ject ? I seek no pledge.—I have the honour, sir, to remain,
your obedient, humble servant,
Charles Armstrong, M.D.,
Hon. Sec. Cork Medical Protective Association.
To Charles Armstrong , M.D., Honorary Secretary , Cork Medical
Protective Association.
Sir, —In the event of my being returned to Parliament for
the Universities of Glasgow and Aberdeen, it will give me
great satisfaction to take care that the interests of the medical
profession are attended to.
I have on several occasions done my best to promote these
interests. According to the opinion which I have at present
formed, I think that the medical officers who are incapacitated
for the discharge of their duties, by old age, or ill health,
ought to be treated in the same manner as those officers who
are engaged in the Civil Service, and ought to receive super¬
annuation allowances, similar to those given in the Civil
Service. I hope these views will be considered satisfactory
by you.—I have the honour to be your obedient, humble
servant, Edward S. Gordon.
P.S.—Absence from home prevented my sooner replying
to your letter. E. S. G.
Sltoicaf gto.
The Public Health.— It appears from the re¬
turn of the Registrar-General, that in the week that ended on
Saturday, Sep. 12, 4214 births and 3003 deaths were regis¬
tered in London and in 13 other large towns of the United
Kingdom. The annual rate of mortality was 24 per 1000
persons living. The annual rate of mortality last week was 21
per 1000 in London, 27 in Edinburgh, and 22 in Dublin, 18 in
Bristol, 23 in Birmingham, 29 in Liverpool, 34 in Manchester,
40 in Salford, 27 in Sheffield, 29 in Bradford, 37 in Leeds, 25
in Hull, 26 in Newcastle-upon-Tyne, and 25 in Glasgow. The
deaths registered in London during the week were 1246. It
was the thirty-seventh week of the year; and the avenge
number of deaths is, with a correction for increase of popula¬
tion, 1284. The deaths in the present return are therefore
less by 38 than the average of corresponding weeks, and are
less by 106 than the number recorded in the preceding week.
The deaths from zymotic diseases were 332, the cor¬
rected average number being 408. Six deaths from small¬
pox, 20 from measles, 57 from scarlatina, 7 from diphtheria, 15
from whooping-cough, and 64 from fever, were registered.
The deaths of 91 children and 8 adults from diarrhoea were
recorded. In the three preceding weeks the numbers were
246, 186, 173. Eleven cases occurred last week in the West,
23 in the North, 17 in the Central, 20 in the East, and 28 in
the South districts. Cholera or choleraic diarrhoea proved
fatal to 2 children and 3 adults. During the summer season
diarrhoea and choleraic diarrhoea are generally to some
extent prevalent in London, but although the tempera¬
ture has lately been remarkably high, these diseases
have not been epidemio. The mortality from diarrhoea
and choleraic diarrhoea in the London waterfields to 100,000
living, was 4 in the New River, 3 in the Grand Junction, 4 is
the Southwark and Lambeth, 4 in the East London and
3 in the Kent field of supply. 158 deaths occurred from
phthisis, 61 from bronchitis, 40 from pneumonia, 47 from dis¬
eases of the heart, and 155 from diseases of the brain and
nervous system.
Chancellorship of the University of Edin¬
burgh. —We beg to remind our readers that the election to
this office takes place at the end of next month, but only those
who are enrolled in the new register now being made up, and
which is closed for fourteen months on the 80th instant, will
be entitled to vote. We therefore hope that none of the sup¬
porters of Mr. Gladstone, whose claims to the vacant office are
so many and strong, will fail to secure their privileges bj
neglecting to register. We understand that it is not quite
clear that persons claiming under the four sessions’ clause of
the new Act require to establish attendance for two sessions
in Arts classes. We therefore strongly advise all those who
before 1861 had attended four sessions at any classes in the
Edinburgh University to send a matriculation and a da»
ticket and a certificate of attendance for each of these session*
to the Secretary of Mr. Gladstone’s committee, at 5 St
Andrew-square, Edinburgh, in order that their claims may be
submitted for adjudication by the University Court, upon
appeal
-♦-
NOTICES TO CORRESPONDENTS.
Mr. W. E. Monroe, F.R.C.8., Brighton.—Your letter shall appear in
our next. . .
Comtos Mektis.— I. Possible, but not probable, n. The effusum »
a little too savoury, and were it to appear without your signature the
authorship might be attributed to a certain irascible gentleman, whose
writings are well-known in the profession.
A Nkw Subscriber. —We candidly admit, “Students’ Numbers” *w
not always acceptable to subscribers—especially where there are no bob*
for the profession—as they thereby miss the regular weekly summary
of medical items, hospital reports, &c. But as this particular numb®
is very useful in other respects, and widely used for reference, vr
ask the indulgence of the few to whom it is of little service, in order to
supply a public need.
-♦-
APPOINTMENTS.
William Ron, M.D., F.R.C.S.I., has been appointed Assistant*
Master to the Coombe Lying-in Hospital.
R. Gkorok Frndick, Esq., was appointed one of the medical office** <*
the Bristol Dispensary, on the 31st of August.
-♦-
anh §fat|r.
BIRTH.
Gibbon— On the 15th September, at 39, Oxford-terrace, Hyde Park, the
wife of Dr. Gibbon, of a daughter.__
MARRIAGE.
Johnstone—Halliburton.— At Brampton, on the 3rd instant* Jok*
Joseph Johnstone, Esq., Surgeon, L.R.C.8.Edin., to Amelia, dan*#-
ter of the late Mr. John Halliburton, of Brampton._
death.
Peirce— On September 18, at Newcastle, county limerick, John
M.D., F. A L.R.C.S.I., aged 67 years.
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, SEPTEMBER 30, 1 868.
CONTENTS.
ORIGINAL COMMUNICATIONS.
PAGE
Morbid Conditions of the Throat in their
Relation to Pulmonary Consumption:
their Diagnosis and Treatment. No.
VIII. By 8. Scott Alison, M.D. Edin... 287
Experiences of a Regimental Surgeon in
India. By C. A Gordon, M.D., C.B.,
Deputy Inspector-General of Hospita's 289
The Spinal Ice-bag in the Treatment of
Delirium Tremens. By Edward Hamil¬
ton, F.R.C.S.I., one of the Surgeons to
Stevens’ Hospital. 291
Reynolds’s System of Medicine. 292
LEADING ARTICLE.
Squeamish Lieutenants . 298
Parliamentary Representation.—Sir
D. Corrigan. 293
PAOE
NOTES ON CURRENT TOPICS.
Tweedledum v. Twcedledee.—The Mo¬
rality of Lord Amberley’s Platform.—
Vaccino-maniacs.— Public Health.—Is
Smoking Injurious!—The New Water
8upply of Dublin.—Tlio Health Section
of the Social Science Association.—Tho
Indian Pharmacopoeia. —Parish Doctors
andthe Franchise.—Dr. Humphry 8and-
with.—Scientific Popular Lectures—
Examination and Prize Scheme—The
Purgatory of London Hospitals.—The
Value of a Diploma .294-297
Report on Wine. 297
HOSPITAL REPORTS.
Db. Stk evens’ Hospital—
Abscess of the Prostate Glnnd, Re¬
ported by R. L. Swan, F.RC.S.I., Re¬
sident Surgeon.—Removal of the Eye¬
ball .299-300
CORRESPONDENCE.
PAGE
A Governor of a London Hospital on
“The Ailment of the Medical Body
Corporate.”...... 300
M.D., L.S.A, on “TheTitle of Doctor.” 301
Walter Rivington on “The Representa¬
tion of the Profession on the Medical
Council.”. SOI
Isaac Ashe's “Letters on Medical Re¬
form.”—No. Ill. 801
Army Medico-Chirucgical Society of
Portsmouth.*... 302
Medical News, Notioea to Correspondents,
&c. 302
frighid (iDommuttiraliotts.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
By S. SCOTT ALISON, M.D. Edin.,
FELLOW or THE ROYAL COLLEGE OF PHYSICIANS, LONDON, AND
FHYSICIAS TO THE HOSPITAL FOR CONSUMPTION AND DISEASES OF THE
CHEST, DKOMl’TON, AND THE SCOTTISH HOSPITAL.
No. VIII.
Treatment addressed to the system for the correction
of general evils and local disorders’ at a distance result¬
ing from, or accompanying the local disorder of the upper
air-tube apparatus, is in many groups of cases of the
utmost importance. In some groups we find great con¬
stitutional disturbance, a febrile state, debility, ner¬
vous irritability, wasting, dyspnoea, dyspepsia, dysmenor-
rhcea, diarrhoea, or constipation of the uowels, and these
evils must be duly dealt with. Besides this, medicines
and other agents applied not merely locally , we know
serve to abate local mischief, and therefore find a place in
a comprehensive plan of treatment
In case3 of throat disorders, particularly those simu¬
lating pulmonary consumption, a febrile or quasi febrile
3tate will be found one of the most important forms of
>g«neral disturbance, and treatment addressed to this state
not only immediately obviates it, but such treatment in
some cases is almost immediately followed by the entire
removal of the local throat disease. The treatment
which has produced these results has included more par¬
ticularly preparations of bismuth, potash, and soda.
These have been given singly ; but in combination, the
happiest effects have resulted. When no flatus has op¬
pressed the stomach and bowels, 1 have ordered these
medicines—the two last in the form of bi-carbonate—to
be taken with citric acid, so as to produce grateful effer¬
vescence. I generally order the citric acid in solution
conMbinCd with syrup of tolu, of lemon juice, or orange
peefc ; and when there is atony of the stomach, the tinc¬
ture- of nux vomica or the compound tincture of chloro-
fonrn, these latter, viz., the nux vomica and chloroform
X\i\c%urc3 being ord^tifc in doses of 10 drops.
in co«iu|Hri with the febrile state we have
<lryne$$ of the j MW friges, ipecacuanha wine may be
added in small doses; but I have found ipecacuanha to
be very disagreeable to the patient from its tendency to
produce nausea; and I may add the rather important
fact that, the patient is often injuriously nauseated, in¬
juriously chiefly to himself, no doubt, with the practi¬
tioner who has prescribed it. In short, he has become
sick of the doctor.
General nervous irritability, common more particularly
in females, has demanded the exhibition of hyoscyamus,
extract of Indian hemp, camphor, ether, assafootida,
lavender and ammonia. Opium has been given occa¬
sionally to procure sleep, but its continuous employment
has not been adopted except in rare cases, on account of
the interference it causes with the functions of the sto¬
mach, bowels, liver, and kidney.
Wasting has been met by the exhibition of cod-liver
oil in moderate doses. I have lately found Moller’s to
be very efficacious aud as little disagreeable as any.
Nourishing diet, including butchers 1 meat, potatoes, and
butter, witn milk and eggs, have reinstated many wasted
hospital patients in their wonted condition.
The demulcent decoction of the slippery elm, a native
of Canada, has proved an admirable vehicle for bismuth
in cases of irritability of stomach, accompanied with
pain and retching.
When severe vomiting has characterised throat dis¬
orders simulating or accompanying phthisis, great relief
has been obtained by the exhibition of ice, lime water
with cow or ass’s milk, the effervescing draught of bi¬
carbonate of soda, alone or combined with two or three
drops of chloroform, or twenty drops of compound tinc¬
ture of chloroform, or with ten drops of tincture of nux
vomica. A good reserve has not unfrequently been found
in the exhibition of one or more pills, each containing
one grain of opium and one drop of creosote. Vomiting-
whicn had tor weeks defied every usual remedy, has been
at once and altogether controlled by the exhibition of one
or two such pills. This has occurred in many cases.
Dyspepsia of an atonic character has beeu succesfully
dealt with by the exhibition of vegetable bitters, such as
cinchona, gentian, quassia, chirayta, cammomile, tannic
acid, and cascarilla. Preparations of iron, bismuth, zinc,
and the mineral acids, suen as sulphuric, hydrochloric, and
nitric, have been very useful. Phosphoric acid in com¬
bination with a vegetable infusion has done good service.
Dyspepsia, with irritability, vomiting, and retching, has
been clealt with very successfully with bi-carbonate of
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288 The Medical Press and Circular.
ALISON ON CONSUMPTION.
September 80,1848.
soda, bismuth, and magnesia, with water or a mild
bitter infusion, and in combination with hydrocyanic
acid.
Diarrhoea, constipation of the bowels, and dysmenor-
rhcea, have frequently demanded attention ; and these
disorders, if neglected, will interfere for the most part
with any treatment that may be adopted, and of course
with the recovery of the patient. The particular means
adapted to these conditions are so obvious that they need
not be detailed here. I would, however, utter a word of
caution respecting the old-fashioned domestic, and now in
some quarters the much extolled practice of administering
castor oil in cases of diarrhoea. When no accumulation
or irritant materials are present in the bowels, such
treatment is simply illogical and calculated to be dis¬
agreeable and injurious to the patient. I cannot either
approve of sulphuric acid, for I have found this to be a
comparatively irritant, cold, and unkindly body.
In cases of irritability of the mucous membrane of the
alimentary canal, either in part or in the whole of its
course, the diet must be strictly directed. Beef, in the
form of Liebig’s Extractum Carnis, has been found most
useful; and tne farinaceous articles of diet, with milk
and eggs, have proved of permanent value. Liebig’s
beef biscuits, prepared by Peak and Freen, have been
tolerated in the stomach in a remarkable manner. I
have lately made trial of Coleman’s extract, biscuits and
lozenges of beef, all prepared by Tooth, of Sydney, in
Australia, and I have no hesitation in recommending
them. I have myself prepared in one minute an admi¬
rable half-pint of beef-tea with half a teaspoonful of the
extract: I have nowhere or at any time tasted its equal.
The temperature and purity of the atmosphere which
the patient, suffering from throat disorder simulating
pulmonary consumption, have been found to demand ^hc
utmost attention. In all cases of disease of this class,
coldness of the atmosphere, alternations of the tempera¬
ture, and impurities of the air which have been respired,
have acted an important rdle in the production of the
malady. Sometimes these have acted alone, and some¬
times they have operated in combination with the morbid
conditions of the general system, such as have already
been mentioned. It is, therefore, obvious that, the atmo¬
sphere cannot with impunity be disregarded in our plan
of treatment It has been found necessary to withdraw
patients from warehouses, shops, and factories where it
has been impracticable to avoid impurities in those
E laces; and under this arrangement the obstinate disease
as become the tractable one.
The winter temperature of the atmosphere in this
climate has been found to offer the greatest impediment
to the cure of these maladies, and it has been necessary to
send many private patients to milder climates at a dis¬
tance. This has been the more necessary where a tubu-
cular or strumous diathesis has increased the danger
of the patient. Patients who have had that irritable
condition of trachea, which has done best in an uni¬
formly mild and equable climate, have found great
advantage from a winter residence at Pau. Others, in
whom there has predominated relaxation, with fair
general health, free from febrile conditions, have de¬
rived great advantage from winter residence in Nice
and Mentone. When the patient has suffered also from
a herpetic diathesis, a sojourn for a few weeks in May and
June at the Eaux Bonnes, in the Pyrenees, after spend¬
ing the winter in Pau or the North of Italy, has
seemed to give permanence to the advantages derived
from an absence from this country during the winter.
The irritable glottis, the congested larynx, and the nar¬
rowed and spasmodic trachea have in many cases been
greatly improved by removal from the pungent cold of
England’s winter.
When circumstances have precluded removal to
foreign places of residence, other means, though inferior,
have done good service. A warm locality in this country
on the coast, removal to a milder quarter of Loudon than
that previously inhabited, as to Brompton or Kensington,
the warming of the house or apartment by means of ample
fires, and the prevention of the entrance of undue quan¬
tities of cold air from the exterior, and even the warming
by means of the respirator have contributed to disarm the
winter cold of its previous injurious influence.
In many examples of throat disorder simulating pulmo¬
nary consumption, I have found the pure and mild atmo¬
sphere of the Brompton Hospital to produce the very best
effects upon the patient during the short period he has
been kept under inspection and medical surveillance. The
patient, the subject of simulated phthisis, is seldom or
never discharged after only one examination, but is kept
a reasonable time for confirmatory evidence. In this
way alone the Hospital has rendered services to the
public of the greatest importance and contributed to the
saving to society of many valuable lives. 'Hie atmo¬
sphere has been kept during winter at one uniform tem¬
perature of 60° Fahrenheit. One wing of the Hospital is
warmed by means of heated air, and the other by means
of hot water. This important fact, that the Brompton
Hospital, in cases of throat disease simulating pulmonary
consumption, has largely contributed to the cure of
patients, will amply supply in the estimation of practical
men an answer to the objection which may be started,
that, in the treating of such cases the benefits of that
institution ^reljeing diverted from the proper objects of
the Hospital, which was founded for the purpose of treat¬
ing those only suffering from consumption and other
affections of the chest. In this matter we can only do
what is possible. What human skill shall at once, in
many instances declare with certainty the absence of
tubercle 1 What an injury to the patient really affected
with incipient tubercle of the lung to be turned away!
What a discomfort to the physician of the Hospital
such an occurrence would be,—what good cause it would
give for regret on the part of the supporters of the institu¬
tion ! Better far that some patients suffering from only
simulating consumption should be received, and be re¬
stored to health, than that one really consumptive person
should be neglected !
In cases of great ulceration of the larnyx accompanying
pulmonary consumption, the physician can seldom recom¬
mend residence abroad. Death is usually so near at band
as to forbid absence from home, relatives, and friends,
I may even say from the tenderly loved parish church¬
yard, or the rural cemetery where rest the patient’s kin,
departed, not forgotten.
In the selection of a place of residence for winter the
physician has to regard the usual habitat of the patient.
Thus, a few days ago, I gave a preference in some degree
to Algeria and the Canary Islands, because the patient
was a Spaniard, the first place being accessible from Spain,
and the islands being under the dominion of the Spanish
Crown. Of course the medical requirements of the esse
ought to form the first element in our judgment, but other
circumstances nevertheless are often important; for a few
degrees of temperature, we would not wantonly separate
a girl from her lover.
The summer climate for chronic cases of throat disease
simulating consumption with general debility, may he
found at Spa, in Belgium, the numerous sea resorts
along the east and western coasts of England and Scot¬
land ; and the bracing and varied climates of a sea voyage
around the British Isles, or along the coasts of Norway
and Sweden, will frequently succeed in at once imparting
tone to the throat and its appendages, and vastly im¬
prove the condition of the general health, and remove
many associated local evils.
Lastly, I would press upon the practitioner that, the
knowledge of the features of this or that health resort,
and a loose general conviction of the nature or even the
stage of the disease of the patient, will not suffice to
make a good selection of climate. The actual position of
the disease, its leading features, its probabilities, po*‘
sibilities, and impossibilities, fb cTe .gleaned from its
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The Medical Press and Circular.
EXPERIENCES OF A SURGEON.
September 00,1868. 289
history, and frotn the knowledge of the lcedentia, and
adjnvantia,in the individual case, must be regarded quite
as much as the average temperature and moisture, and
the geological formations of proposed health resorts. We
must bear in mind that the active case of to-day may
become the passive one of to-morrow, that humid disease
may rapidly become dry disease, and even dry disease
humid disease; that the patient who has long derived
advantage from residence abroad may at lengtn become
so greatly exhausted in vitality as to be grievously wronged
by any removal whatever from his home.
-#-
EXPERIENCES OF A REGIMENTAL SURGEON
IN INDIA
By C. A. GORDON, M.D., C.B.,
Deputy Inspector-General of Hoep Itala.
Wounds and Injuries.
Wounds and external injuries are generally believed to
constitute the especial province of the military surgeon.
That soldiers are, from the nature of their life and the
casualties in campaigns, more liable to injuries from ex¬
ternal violence than persons in civil life appears self-
evident, but that the proportion of deaths from this cause
is not excessive when compared with that from the ordi¬
nary diseases incidental to a hot climate will be best illus¬
trated by the subjoined table:—
Officers. Strength, 409.
Cases per
100
Strength.
0*97
0*97
0*97
0*48
3-36
8-29
0*24
:
III
i&l
a : |
:
i
©
h ; j ; ; ; ; ; ;
.
rH
to -d
CO
Soldiers. Strength, 11,780.
g. 4 |
j8f 1 SS?2S§83 :
S-g I C*0©00iMC*0 ’
O M
|
Deaths
per 100
Admitted
7-87
11*76
1
Died.
20
*2
22
Cases
Ad¬
mitted.
3jf
OO
0>
CO
Wounds and Accidents.
Valums Sdopitonm ...
Vulmus Incisum.
Amputatio .
Fractura .
Luxatio .
8ubluxatio .
Contusio .
Ambuatio.
Concus8io Cerebri .
Total .
H«0O<«IC(DN0O A
The numbers of men and officers who have, on the
various occasions when the 10th Regiment, in which I
had the honour to serve, was engaged in action, been
killed on the field are, as a matter of course, not included
among the above. They will be more particularly alluded
to in their proper place ; but, for the sake of indicating
side by side the rates^f admissions and deaths from ex¬
ternal* injuries compared with but a small portion of
diseases incidental to Europeans resident in India, let us
briefly enumerate a few of the latter:—
Diseases.
Soldiers.
Officers.
Total
Ad¬
mitted.
Died per
cent.
Treated.
Tota
Ad¬
mitted.
Died per
cent.
Treated.
Pulmonic.
1050
6*90
55
»!
Fevers .
6273
2*88
283
1*41
Stomach and Bowels.
3043
8*21
144
2*77
Liver and Spleen .
| 871
619
29
10*34
Brain and Nerves .
1 322
17-39
16
1875
Wounds and Accidents ...
898
1
2-44
64
1-56
These figures show that external injuries do not by
any means constitute so important a class of cases in
India as might probably he supposed, and that, with the
exception of the now happily rare occasions when our
troops are called upon to take the field, surgery must be
considered as holding in military practice a very second¬
ary place to medicine.
Before entering upon the consideration of the statistics
of the particular injuries, I would observe that there are
some whose very absence must attract attention. Of
these are punctured wounds, such as are caused by a
bayonet thrust, and the various description of poisoned
wounds.
The rarity of bayonet wounds in hospital is a general
subject of remark by military surgeons in India, and
must arise from one of two causes: either that the enemy
does not often allow our white troops to come to hand-to-
hand conflict with them, or else that the wounds inflicted
by a bayonet are so generally fatal that the person in¬
jured dies on the field. The latter explanation is, I sus¬
pect, the true one, for in the battles that during the fifteen
years, from 1842 to 1857, have taken place between our
forces aud Marhattos, Scindian, and Sikhs, there are
numerous instances of our soldiers, when entering the
enemie8 , batteries or storming fortresses, encountering
the most desperate and deadly opposition. Under such
circumstances the musket is comparatively little used,
the bayonet being almost alone trusted to by the English,
as the same weapon and heavy sword, or tulwar, nave
unquestionably been by those races.
With the exception of one of hydrophobia not another
case attributable to poisoned wound is recorded. This
is the more remarkaole when we consider the abundance
of venomous reptiles and insects that occur in India and
that soldiers are so constantly unavoidably, or by their
own want of care, exposed to danger from such sources.
Although snake bites are conparatively rare among white
troops, there is no doubt that many cases among all
classes of persons in the regiment occurred, where in¬
juries were inflicted, by the smaller class of such creatures
as scorpions, centipedes, spiders, wasps, and mosquiteos,
while I have myself seen vesication, attended by much
pain and heat, of the part occur from a common wall
lizard falling upon the uncovered skin of a person, os
described by Hasselquist.*
On the 10th February, 1846, the 10th Regiment^ con¬
sisting of 742 men and 34 officers, was present m the
action of Sobraon. Of the men 29 were killed on the field,
or a proportion of 3*87 per cent., 136 men were wounded,
or 18*32 per cent., making the proportion of casualties
' * Ptyodactylus Gecko.
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290 The Medical Press and Circular.
EXPERIENCES OE A SURGEON.
September 80,1868.
among them 22*19 per cent.; of the officers 1 was killed,
or a proportion of 2*94 per cent., and 2 wounded, being
a ratio of 5*88, thus making the casualties among them
8*22, or 13*37 per cent less than w*hat occurred among
the soldiers.
Among the affairs in which the regiment took part
during the second Sikh campaign, was that of the 9th
September, 1848, when a night attack was made with
four companies upon one of the enemies’ fortified out¬
posts at Mooltan. This attack is stated to have, for the
time, been unsuccessful, and we learn that of the men
engaged 9 were killed and 33 wounded; 1 officer being
severely wounded. The precise strength of this detach¬
ment does not appear, but it is fair to presume that the
companies were made up to their full strength for the
occasion, in which case there would have been 400 men
and 13 officers.
According to these we should find the ratio
j Of Killed.
Of Wounded.
Of Casualties.
Among Men. j 2*25
Among Officers... 1 „
8*25
7*69
10*50
7*69
Here, again, we find the ratio of casualties in battle
to be less among the officers than the men.
The assault was renewed shortly after day-light on the
12th September. Six companies "of the regiment formed
part of the attacking column, and, according to the
report of the medical officer in charge at tne time.
u although hundreds of the enemy were slain, we yet haa
to lament the fall of many gallant and brave soldiers/
Our loss consisted of 1 officer killed and 2 wounded, 5
rank and file killed and 29 wounded, so that if, as before,
we suppose the companies complete, we shall have 600
men and 19 officers going into this action.
This would give us a ratio
Of Killed.
Of Wounded.
a
l
f
Among Men. 0*83
Among Officers... 5.26
4*83
10*53
6'66
15-79
Here we have the ratio of casualties among the officers
nearly three times the amount among men.
At the battle of Goojerat, fought on the 21st February,
1849, the regiment had 7 men killed and 52 wounded,
but the officers do not appear to have suffered at all on
this occasion. We have reason to suppose that the regi¬
ment went into action at Goojerat 700 strong in men, so
that, according to this, the ratio would be
Of Killed.
Of Wounded.
| Of Casualties.
|
Among Men. 1
7-42
8*42
With regard to the precise nature of the wounds of
men admitted into the field hospital during those opera¬
tions we find the following to be on abstract; namely—
Stump cases.9
Injuries of the head.2
)f ,, neck • . . « .2
ft n thorax • • • • • 3
„ „ abdomen .... 3
Compound fractures.2
Injuries to joints.3
Wounds of soft parts.22
Simple and miscellaneous wounds • .10
Incised wounds . . . . • • 7
bums ........ 1—64
That tetanus occasionally occurs among soldiers in
India who are wounded, is well known, but thal the
affection is not so frequent a3 many persons believe
appears in the fact that no case of it happened in any of
the cases to which the above figures refer, neither did
hospital gangrene show itself.
The surgeon remarks, on alluding to the absence of
hospital gangrene, that he attributes this to the great
attention paid to cleanliness . He also observes that
during the campaign (Second Sikh War) the general
health of the men was good, and this was in a great
measure attributable to the attention that was paid to
the clothing of the men, and to the adoption of flooring of
wood in their tents while in a standing camp, by which
the beds were kept raised from the cold ground. Here,
then, we have the explanation of the general efficiency
of soldiers in India on a campaign, the small percentage
of sickness among them, and the favourable and rapid
recovery of those who are wounded otherwise than very
severely. These circumstances are in themselves so im¬
portant that T recapitulate them
1st; Cleanliness.
2nd. Good clothing.
3rd. Elevation of beds from the cold ground.
We have in India two other valuable adjuncts for
maintaining the health and efficiency of the men;
namely, regular and w*ell-cooked meals, prepared by
people maintained for that particular purpose, and good
and ample protection in the superior description of tents
supplied by the local government to regiments; nor
must I omit to observe that, during ordinary marches,
an ample supply of straw is always available to be placed
under the rugs on which the men in health sleep.
The cases of gun-shot wounds do not seem to have
constituted one half the entire number of casualties that
occurred among the soldiers at the battle of Sobraon,
55 men suffering from injuries of this description having
been admitted out of a total of 136. Of these 55, six died
shortly after being admitted, exclusive of those who
underwent amputation.
At the affairs of 9th and 12th September, 1848, already
mentioned, the gun-shot and incised wounds were in
more equal proportions, and at Goojerat the wounds
were almost entirely caused by gun-shot. The nature of
the military tactics employed during an action influences
the character of the injuries, inseparable from the en¬
gagement of an infantry regiment with the enemy.
Thus at Sobraon, where the regiment was called upon to
make a rapid advance and carry batteries, the celerity with
which they charged the Sikh guns diminished the degree
to which the men would otherwise have suffered from *
heavy fire of artillery ; but, in the hand-to-hand conflict
in which they immediately became engaged while wrest¬
ing the guns from their artillery, the wounds were almod
all inflicted by swords.
In the night attack made on an out-post at Mooltan,
on the 9th September, when our men were exposed to a
heavy fire from walls, the mass of casualties consisted of
musket and “ zambouruk,” or swivel gun-shot wounds
On the 12th of the same month, when they captured
the post, they had the same large proportion of wounds
from fire-arms, prior to an entrance being effected; but
after that, when they came to hand-to-hand conflict witb
the defenders, the injuries, as before, were from the “ tul¬
wars, * or native sword.
At the battle of Goojerat, which ? as is well known,
was almost entirely decided by artillery, the nature ol
the wounds were all occasioned by grape and round shot.
If we draw our conclusion solely from the numencal
return, we should be inclined to consider that tecaw*
no death appears by it to have occurred from indeed
wounds, injuries of this description are, therefore, of in¬
considerable danger. Actual experience, however, mnst
convince us that they are far otherwise, for, while many
cases of gun-shot wounds, of an evidently mortal nature»
are brought to hospital, and thus included in the hoapit* 1
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THE SPINAL ICE-BAG.
September SO, 1868. 291
returns, an incised woand of such a nature as to be
mortal, usually terminates existence almost instantane¬
ously, so that the majority that come under notice are
mere cuts of the soft parts; sometimes of fearful extent,
no doubt, and frequently inplicating other tissues, but,
nevertheless, in tneir nature comparatively free from
actual danger to life. The vast majority of cases of this
description healed without the occurrence of any unto¬
ward symptoms, and their treatment appears, as a general
rule, to have been very simple.
The statistics regarding amputation are, it mu9t be
allowed, very incomplete; it is evident, however, that
the majority of cases here recorded were instances of
disease. It, moreover, would appear that in the hurry
unavoidable in battle, some coses of amputations were not
distinguished from the gun-shot wound that rendered
the operation necessary.
We learn that among five patients, four of whom
underwent primary amputation, three died. The one
subjected to secondary amputation recovered ; but this
is manifestly too small a number to he brought forward
for or against either of those measures.
Fractures and dislocations are by no means so frequent,
apparently, among infantry soldiers in India as might be
supposed. They occur under the same circumstances as
in Britain ; but there are some points with reference to
fractures that deserve notice. When a person sustains
an accident of this nature during the cold season, bis
general health being at the time unimpaired, and he so
situated that he can be treated in his own regimental
hospital, the progress of such cases is much the same,
and his chances of a good recovery, similar to what they
would be in the United Kingdom. If, on the other
hand, the regiment is on a march, and the person has
to be carried in a dooley a distance of ten to fifteen miles
daily, it is clear that lvith the apparatus necessarily applied
in such circumstances, there is not the same chance of
good and straight union taking place that there would be
under more favourable auspices. And again, when a
person already debilitated by fever, or other endemic
disease, meets with a fracture in India during the hot
season, not only is he likely to suffer severely from sym¬
pathetic fever, aud thus have his powers still more debili¬
tated, but there may be insufficient action to carry on-
the process of reparation. Callus may not be thrown
out at all, or if secreted in the first instance, may cease
before it is sufficiently consolidated, and thus the solu¬
tion in the bone remains unrepaired.
Sprains and bruises appear, as a rule, to be of less fre¬
quent occurrence among soldiers iu India than in the
United Kingdom; nor is this to be wondered at when
we bear in mind how little inducement there is in India
for the men to wander far from their barracks—they
cannot mix with the residents as they do at home—and
when indulging in their cups and quarrelsome, the
violence they sometimes offer to the Asiatic is not quite
so certain of being returned a9 it would be by the lower
orders of most garrison towns in Britain.
The men of the 10th regiment were fortunate in
escaping severe burns in action by the explosion of
mines, tumbrils, &c.; but other corps have not been
equally so, and when such injuries happen they consti¬
tute some of the most painful and terrible that have to
be treated. The slighter kinds are often occasioned by
trifling with gunpowder, or by the unexpected explosion
of a musket; but, from the general want of fires in
barracks in India, this class of accident is less common
than they are in the United Kingdom.
It is now a tolerably well established fact that the de¬
struction of one-third of the cuticular surface is sufficient
to render death inevitable, and that cases of bum usually
terminate fatally in consequence of the occurrence of
exhausting diarrhoea.
The last accident recorded is concussion of the brain.
It must be a matter of surprise how casualties of this
description are so few as they are among bodies of troops
in India. In fact, this very rarity is more deserving of
remark than their occurrence, and this circumstance
tends to show still more clearly the correctness of the
rempk already made—namely, that external injuries in
India, even including those inseparable from engage¬
ments with the enemy, are a source of inconsiderable
loss to a regiment when compared to the climateriai
diseases to which it is constantly exposed during its
service in that country.
-♦-
THE SPINAL ICE-BAG IN THE TREATMENT
OF DELIRIUM TREMENS.
By EDWARD HAMILTON, F.R.C.S.I.,
One of the Burgeons to Steevens’s Hospital.
Attention having been directed to this practice by a
communication made to the Surgical Society of Ireland
in the past session by Dr. D. B. Hewitt, the following cases,
in which this method was adopted with marked success,
may not be uninteresting to the profession.
I was called to see Mr. T. S., the proprietor of a tavern
in the suburbs, And found him with all the symptoms of
delirium e potu well pronounced; he was in a suite of great
excitement and could with difficulty be controlled ; pulse,
120, weak; hands tremulous; face pale; tongue large,
soft, and creamy. He laboured under the hallucination
that his wife f s coffin was always beside him, and that he
was himself dead and should be placed in it. In addition
to this state of the nervous system, he suffered from very
considerable derangement of the digestive organs, his
eyes were icteric, he had vomiting and hiccup, with much
tenderness oyer the right hvpocbondrium. He had been
forsome time An habitual tippler, but on the death of his
wife, some short time previously, he took to drink con¬
tinuously. Has had a slight attack before the present.
He has had no sleep for the last three nights. A blister
was applied to the epigastric region. He was ordered to
take a draught every third hour, containing twenty drops
of tincture of cannabis indica, two drops of dilute hydro¬
cyanic acid in camphor water; by this treatment the
vomiting was relieved, but the patient had no sleep; in
the evening he was ordered two grains of watery extract
of opium in a tumbler of brandy punch, to be repeated in
six hours if sleep was not procured. The following morn¬
ing I found him still labouring under great excitement,
having had no sleep. The skin was clammy and bedewed
with cold perspiration, the pupils were contracted, pulse
120, weak; it was evident that in his present condition
narcotic treatment could not be further pushed with any
degree of safety, and yet the exhaustion from want of
sleep was sure to be fatal. Accordingly I procured one
of Dr. Chapman’s ice-bags, and, having filled it, applied
it to the back from the occipital bone to the lumbar
regions, having passed the elastic band round the fore¬
head and secured the lower end with a bandage round
the waist, giving directions that it should be renewed
when the ice had melted. He was placed in bed, tho
room darkened, and strict quietness enjoined. In the
morning, after the ice was applied, he became quieter and
more manageable, being, as his attendant expressed it,
“ cooled downat the same time the temperature of the
surface was sensibly raised. In a quarter of an hour
after the second charge of ice was applied he fell into a
deep sleep, which lasted for eight hours. On waking he
expressed a wish for food; he had a broiled chop and
some bread, and on my evening visit I found him again
sleeping naturally. Abstemiousness quickly restored his
digestive organs and brought him to bis ordinary health.
I was requested by Mr. W., residing some distance
from town, to see his head gardener, who was labouring
under an attack of delirium tremens. I found him walking
about bis room in wild delirium; his brother, who was in
attendance on him, found the greatest difficulty in re¬
straining him, as he made violent efforts to escape from the
room. I had seen him in two similar attacks, but in
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292 The Medical Press and Circular.
REYNOLDS’S SYSTEM OF MEDICINE.
September 80,1868.
neither was the excitement so great as on the present
occasion. The plan of treatment which was adopted in
his previous illness was resorted to: he was given a dose
of castor oil and turpentine, and at night, three grains of
watery extract of opium in a glass of punch; on this
occasion it was not so successful. I was sent for to see
him again the next day, as he bad no sleep in the night,
nof for the three nights previously, and was stated to be
much worse, the opiate had rested on his stomach ; but I
found him still violent, pulse 100, skin clammy, pupils
contracted ; his bowels had been well cleared out. I
resolved to try the ice to the spine, but not having the
India-rubber bag with me, although ice was easily pro¬
curable, I obtained the trachea of a cow from a butcher
in the adjoining village, and it answered the purpose
admirably—the ends were plugged with cork and lapped
over with twine. It was applied to the nape of the neck
and down the back. After the third application he fell
into a sound sleep, which lasted for six hours, and was
followed by complete recovery in a few days.
J. H., proprietor of a public-house in Dublin, usually
of moderate habits, became much depressed at the death
of his brother, to whom he was greatly attached, and
took to drink. He was a man of weak constitution and
delicate, although not subject to any special ailment. I
found him suffering under great depression ; pulse 60,
skin cool and moist, tongue peculiarly furred in patches,
stomach instable. No sleep for the last two nights. He
was rational, except at intervals, but was not violent. He
was ordered tincture of cannabis indica, chloric aether,
and camphor water, every third hour, and at night to
take one grain of watery extract of opium every third
hour; to have four ounces of wine and strong beef-tea.
I saw him the following morning, he was more excited,
pulling the bed-clothes, and very restless. He did not
sleep, although three of the pills were given to him; his
pulse was 80 ; he complained of headache and great
thirst. He was allowed ice in his mouth. The ice-bag
was applied to the spine, as in the case above. In lialt-
an-hour after the first application he slept soundly for
several hours, and in the course of the night, his friends,
finding that he was not inclined to sleep, and having
witnessed its good effects, of their own accord, applied
the ice with the best possible result, as he slept the entire
night and was convalescent on the following day.
-♦-
REYNOLDS’S SYSTEM OF MEDICINE.*
Although we have on more than one occasion noticed
some of the separate articles in this immense undertaking,
we have waited until the completion of two-thirds of it
before referring to it as a whole. It is now time to bring
before our readers as a whole the only encyclopaedia of our
art that has been attempted recently, and which will con¬
stitute an epoch in medical literature. The profession owe
much to the publishers who so boldly projected and carried
out a work of this importance ; and the praise due to them
must be shared by the editor who has so ably fufilled their
design. The work bears more resemblance to the “ Ency¬
clopaedia Metropolitana ” than to other attempts with which
it may be justly compared, inasmuch as it consists of a
series of valuable monographs by various authors, working
indeed conjointly to the accomplishment of the end, but in¬
dependently so far os each subject is concerned. It is
therefore no compilation. Each writer has been entrusted
with the preparation of his own article, and we have conse¬
quently a much larger mass of original investigation than
has ever been brought together before. It must be remem¬
bered, consequently, that this System differs in toto from a
Dictionary of Medicine compiled by one or two deeply-read
men, and ought not to be compared with such works,—
useful and valuable for their purposes, but having no
common aims with this.
Two volumes out of the three proposed are now before us.
A considerable interval elapsed between the issue of them,
but this is not to be wondered at when we look at the long
* A System of Medicine. Edited by J. Russell Reynolds, M.D.,
F.R.C.P. Vole. J. wjd 1J, J/mdou; MnqnUlwi and Co.
list of eminent men who have contributed to the general
stock. The editor, indeed, is^ rather to be pitied than
blamed for any delay, since it is obvious that ne must at
times have felt weary of his task, and wondered how he
should be able to redeem his pledges.. Any one who knows
what a busy life in full practice is, will feel that it was no
ordinary effort to bring into one work the toil and thought of
some of the foremost minds in the profession. He has,
however, his reword in seeing at length as his labours draw
nearer to a close that his success is as certain as his trouble
has been great. These remarks need no justification; they
are best exemplified by the volumes before us. In his brief
preface the editor tells us his object was “ to present, within
as small a compass as is consistent with its practical utility,
such an account of all that constitutes both the natural his¬
tory of disease and the science of pathology, as shall be of
service in either preventing the occurrence or detecting the
presence, and judging the treatment of special forms of
illness.” This comprehensive task has been attained, os
we have stated, by entrusting each special form or group
to some one who had specially qualified, him sel f to wnte
upon it; and the brilliant list oi names is justifiably referred
to as a sufficient guarantee for the excellence of the per¬
formance. We need only say that twenty-four names of
contributors to the first volume alone attest the truth of
this remark. This first volume is devoted to General Dis¬
eases, and opens with an able introduction by the editor
himself. This essay has the merit of brevity, consurting of
only twenty-five pages ; yet it includes Definitions and
Names, Structure and Function, Natural History, Course,
Derivation, Termination, and Diagnosis of Disease. Patho-
logy, Prognosis, Therapeutics, Hygiene, and Classification
have also each a paragraph. Passing from this, the subject
proper of the volume, General Diseases, or affections of the
whole system, is opened by Professor Parkes with an essay
on Influenza, which we commend to the earnest study of
alL This is the first of the General Diseases determined
by agents operating from without. The authors of the
essays upon them are : Malarial Fevers, Dr. Maclean *,
Diarrhoea, Dr. Goodeve; Dysentery, Dr. Maclean ; Cholera,
Dr. Goodeve ; Pyaemia, Dr. Bristowe ; Parotitis, Dr. lunger;
Croup, Dr. Squire ; Hooping-cough, Dr. Ed. Smith; Syphi¬
lis (constitutional), Mr. Jonathan Hutchinson ; Plague, Dr.
Gavin Milroy ; Scarlet Fever, Dr. Gee ; Dengue, Dr. Ait-
ken ; Diphtheria, Dr. Squire; Measles, Dr. Ringer ; Roseola,
Dr. Beigel ; Small-pox, Mr. Marson; Vaccination, Dr.
Seaton ; Chicken-pox, Dr. Gee; Typhus, Dr. Buchanan;
Typhoid, Dr. John Harley; Relapsing Fever, Dr. Warbur-
tonBegbie; Yellow Fever, Dr. Denis Macdonald; Erysi¬
pelas, Dr. Reynolds, the editor; Glanders and Hydrophobia,
two separate essays, each by John and Arthur Gamgee con¬
jointly ; Sudamina and Miliaria, Dr. Ringer. The above
is certainly a tolerable list, and would suffice for more than
one such volume. But it is not all contained in this: as
yet there remains the General Diseases determined by con¬
ditions existing within the body. These are : Scurvy, Dr.
Buzzard ; Purpura, Dr. Hillier; Rickets, Dr. Aitken; Gout,
Rheumatoid Arthritis, and Rheumatism, three separate
essays, each by Dr. Garrod ; and Gonorrhoeal Rheumatism,
by Mr. Brodhurst Such being the list of essays comprised
in one volume, what can the reviewer with a column or so do
but commend them to the study of his brethren, an d turn
to some more cursory notes or proceed to volume II ? 1°
try to criticise each separately would be absurd, and the
best use we can make of them is probably to refer to them
at intervals as we have occasion to mention the various
subjects in other departments of our journal, as in fact we
have already several times done. We may, indeed, than*
the publishers for the good type and paper and generm
getting up of the work, though that might only remind
of our old grievance against binders, who will not con®®?'
rately cut the edges of all such books. Ragged edges reauy
ought not to harbour the dust on such magnificent worm* i>
and^though we advise them to be constantly
dust has such a terrible tendency to accumulate, and house¬
maids are so constantly in commotion, that it penetra
the best book-cases. Besides, these are not books to oc
up in a case ; they should be ever close at hand, ready
tempt the busy practitioner to refer to them as a .
and to study them as text-books,—familiar consultants u»
all cases of doubt or difficulty, pleasant companions wiw
which to converse constantly and freely.
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SQUEAMISH LIEUTENANTS.
September SO, 1868. 293
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“SALUS POPULI SUPREMA LEX.**
WEDNESDAY, SEPTEMBER 30, 1868.
SQUEAMISH LIEUTENANTS.
Towards the end of last May cholera threatened to
occur in epidemic form among the troops quartered at
Cbinsurali, one of our military stations in Lower Bengal.
Every ordinary precaution against such an emergency
appears to have been taken by the medical officer in
charge, and by the officer commanding the depot.
Among other measures, Captain Brown issued an order
that officers commanding sections should ascertain per-
ponally that each man of their sections respectively had
a cholera belt on, and to note the same on the back of
the parade state. To the thinking of most men, and
certainly to that of all who have had experience in India,
this order was a most judicious one, and the means of
ensuring its execution effective. But a certain Lieutenant
Macdonell was of a totally different opinion. He point
blank refused to perform the duty. Soldiers might die
of cholera, but a subaltern of ten years’ standing should,
according to his opinion, have a soul considerably above
cholera l>elts, and so ho returned the duty state of his
section, but not until he had expressed his views upon
it. “The duty,” he was pleased to observe, “of in¬
specting half-naked soldiers is surely the duty of a non¬
commissioned officer, not the duty of a gentleman.”
Unfortunately for him, a general court-martial before
which he was arraigned held somewhat different views on
the matter. The finding of that august tribunal declared
the gallant officer guilty of conduct unbecoming his posi
Uon as 4 such, and the Commander-in-Chief, in remarking
upon the proceedings, observed that a more flagrant and
deliberate instance of insolence and insubordination had
never been brought to the notice of the superior military
authorities; that the defence of the prisoner was utterly
untenable ; and that the order in question wo8 in com¬
plete accord with the custom of the service in well-
regulated regiments. Accordingly the “prisoner” was
reprimanded in accordance with the sentence of the
court. But the Lieutenant is not without his fri ends
and supporters. The Army and Nary Gazette falls foul
of Sir William Mansfield, observing, among other hard
things, that the offence for which Lieutenant Macdonell
was tried was, though still an offence, yet of $ slightness
almost venial; that “ the duty appeared more suitable
to a medical or non-commissioned officer,” and so on.
Who shall decide when “ doctors,” and such doctors
as these disagree ? Let us see what say the published
regulations on the subject. According to the twentieth
section of those for hospitals, the officers of the medical
department are charged not only with the medical care
of the sick, but with the duty of recommending to com¬
manding officers whatever precautionary measures may
conduce to the preservation of health of troops, and the
mitigation or prevention of disease in the army. They
are moreover directed weekly to inspect men for the de¬
tection of various ailments. During the prevalence of
cholera they are required daily to inspect the men, and
thus, it may be, detect the first indications of that disease
among them ; and they are, moreover, directed by the
special instructions regarding that disease to devote their
whole time to efforts for its prevention among them. It
is well known that attention to clothing is among the
important measures to be considered under such circum¬
stances ; so also is the wearing of liannel waist-belts ; so
cleanliness and free ventilation in barracks; cleanliness
of the drains outside ; cleanliness of latrines and uri¬
nals ; removal of refuse ; and all the other matters that
come under the head of conservancy. Let us remember,
however, that the functions of medical officers are not
executive . Their proper functions cease when they have
submitted their recommendations. It is, then, as much
the duty of the officers appointed to give effect to their
recommendations, to make certain that the one having
reference to the wearing of cholera belts by the men
is effectually carried out, as it is to see that all the other
measures indicated are enforced. Carpet-knights aiul
drawing-room lieutenants would most benefit the public
service by adhering to those vocations for which Nature
has been pleased to fit them.
PARLIAMENTARY REPRESENTATION.—
SIR D. CORRIGAN.
The name of our worthy medical baronet has been so
freely mentioned in connection with the representation
of Dublin and other constituencies that we think it well
to state the two classes of reasons, totally outside political
considerations, for which it is desirable that an able
physician should enter Parliament.
lstly. Legislation on public health questions has been
imperfectly and clumsily done in England : in Ireland it
lias been neglected. Surely, if able and energetic medical
men bad seats in the House of Commons, the cholera and
cattle plague epidemics would have been more promply
and effectively met; English workhouses would have
been long since reformed; the machinery for the pre¬
vention of disease and for the ascertainment and registra¬
tion of the causes of death would not still be directed by
over a score of fragmentary and often contradictory acts ;
and their extension to Ireland would not have been de¬
layed for twenty years after they had proved beneficial
in the sister country.
2ndly. While clerical, legal, commercial, and agri¬
cultural interests are fully cared for, the medical profes¬
sion has no efficient champion—witness the refusal of the
Government to provide superannuation for disabled Poor-
law physicians. If the entire profession in Ireland were
polled, we doubt that one pf its members would deny
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294 The Medical Prm and Circular.
NOTES ON CURRENT TOPICS.
September SO, 1868.
that Sir D. Corrigan was the most fitting representative
who could be found for a university or medical corpora¬
tion, if enfranchised.
His administrative ability has been proved at the
governing boards of many of our charitable institutions,
the Board of Health, the Medical Council, and several
Royal Commissions. His splendid ability, strong common
sense, and independent bearing have raised him to a
most exalted position. He would enter Parliament for
no selfish purpose, and the turmoil of an election would
not have to be repeated, as would happen if a lawyer be
chosen, for no lawyer could be selected save one whose
ability had already put him in the groove for promotion,
and Dublin City should never become as convenient a seat
as that of the university, which has accommodated in suc¬
cession so many Attomeys-General. It is said, however,
that that learned constituency is likely to choose another
class of representative in future.
-4-
Ifcrte Current Copies.
Tweedledum v. Tweedledee.
Concurrent with the Peruvian convulsions of nature,
the medical oracle has spoken. The mental tranquillity
which the leading medical journal had shed upon the
minds of the British nation in connection with the health
of the sovereign is, at the bidding of Jupiter Tonans No.
2, cruelly dissipated, and grim despair, issuing from
Great Queen street, Lincoln’s Inn, has cast its gloom
around the people of Europe.
We hasten to relieve the sickening apprehensions of
loyal subjects by a friendly editorial whisper. We are
in a position to state that her most gracious Majesty is
decidedly better than when she was worse ; and that in
the absence of any reliable information whatever, the
plush liveries of the Lancet and British Medical Journal
may be refolded in their lining of silver paper and con¬
signed to oblivion. Our own special Court flunkey has
deferred producing his uniform, and anxiously awaits
some inteligence more real than the guess shots of our
contemporaries. Perhaps the aura may return.
The Morality of Lord Amberley’s Platform.
The young hopeful of the professed reformers and
radicals has questioned the accuracy of our representation
of his views on large families. Will he repudiate the
other theories of his party as easily ? But his remedies
for over population are a part and parcel of their views
we may assume, from the following quotation extracted
from a journal edited by Mr. Bradlaugh, the expectant
representative of the Reform League. Discussing the
remedies for poverty, a lady correspondent (save the mark)
writes
“ Another party suggests a remedy, namely celibacy.
What ignorance ! Man, know thyself, has been wisely
urged. What does celibacy mean ? It means this, pro¬
stitution or insanity. The man who advocates celibacy
knows nothing of himself and his physical organization.
.... What are the majority of women in our towns fit
for after they have borne a laige family, and lived a
half-starved existence ? .... I trust they may learn to
understand the laws of population, so that each man may
not have more children than will produce comfort to
himself, and justice to his fellow men. Man might then
if he choose live out a noble life, and if we beheld vice in
our streets we should not have to sigh and exclaim while
we deplore it — 1 This evil is a necessary one.’ ”
If Lord Amberley is incompetent to understand the
vile suggestions hidden under the phrases of the morpm y
we would explain that the writer means that continence
is a physical impossibility, and the “ noble life” alluded
to is neither more nor less than unbridled licentiousness
under a “reformed” system.
Vaccino-maniac8.
The myrmidons of a tyrannical monarchy have no re¬
spect of persons, and its minions in the blue coats and
the felt helmets appear to be lost to all just appreciation
of the enquiring mind, it would appear that the patrons
of small-pox are groaning under the oppression of the
Vaccination Act, and the divine right of stupidity is Dot
reverenced in the persona of the Vaocino-maniacs. Pub¬
lic Opinion records that one of its most trenchant anti¬
vaccination correspondents, whose nom de plume is
“Search” has been actually fined ten shillings for aiding
and abetting the spread of small-pox, in refusing to allow
his child to be vaccinated.
“ 1 Search and ye shall (be) fined ” (may we be excused
the misquotation) proves true once more, and the great
privilege of pigheadedness for the British subject is un¬
fringed.
But no! The Vaccino-maniacs are not forgetful of
their rights as men : we are in a position to assert that
they will try the great question of the Female Franchise
by returning Mrs. Borrodaile as the representative of
their intelligence in the next Parliament.
Public Health.
We make our usual quotation from the Registrar
General’s return of births and deaths in the week that
ended on Saturday, the 19th of the present month. In
London and 13 other laige towns of the United
Kingdom, there were 4,332 births, and 2,981 deaths ; the
annual rate of mortality being 24 persons living, distri¬
buted as follows : 20 per 1,000 in London, 29 in Edinburgh,
and 22 in Dublin, 19 in Bristol, 23 in Birmingham, 30 in
Liverpool, 36 in Manchester, 30 in Salford, 26 in Sheffield,
24 in Bradford, 31 in Leeds, 30 in Hull, 29 in Newcas¬
tle-upon-Tyne, and 22 in Glasgow.
In London 1,220 deaths were registered during the
week. The average number of deaths for the correspond¬
ing week of the year is 1,252, consequently, the deaths in
the present return are less by 32 than the estimated
amount The deaths from zymotic diseases were 348, the
corrected average number being 392. Four deaths from
small-pox, 22 from measles, 74 from scarlatina, 15 from
diphtheria, 32 from whooping-cough, 56 from fever, and
86 from diarrhoea were registered. The deaths of eight
children and one adult from syphilis, of three children
and four adults from burns or scalds, of five persons from
drowning, of three infants from suffocation, of four persons
who committed suicide, and of two persons who were
killed by horses or carriages in the streets, were regis¬
tered last week.
The daughter of a gentleman died on the 11th Sep¬
tember, aged 19 years, of sunstroke (7 days), and the
daughter, aged 18 years, of a carpenter on the 12th Sep-
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NOTES ON CURRENT TOPICS.
September 30, 1808. 295
tember, of typhoid “ fever from sun exposure, 1 ” also an
infant 10 months old, the son of a builder, died on the
15th September of choleraic diarrhoea (5 days).
Is Smoking Injurious ?
We notice another attempt to revive the auti-tobacco
crusade. One would have thought that by this time all
that could be urged for and against the habit of smoking
had been said more than once. Not at all. There are
always persons ready to inveigh against tobacco, in spite
of the thousands who show their contempt for the argu¬
ments used by steadily persisting in their enjoyment.
We have no wish to enter the lists. It is more amusing
to watch the combat. Yet, as we have recorded the opi¬
nions of some accurate observers during'the past year, it
may be worth while to object to a statement that has
been “ going the round ” of the papers during the last
week, but is destitute of the scientific accuracy to which
it pretends. In the paragraph alluded to, entitled “ To¬
bacco an Enemy to Public Health,” it is calculated that
lllbs. of tobacco per annum is a moderate quantity for
the habitual smoker. It is then added that “ the nico¬
tine inhaled would, if concentrated, have killed a hun¬
dred times over.” Now this statement need not alarm
any one. It is a mere presumption of the writer that the
nicotine is ever inhaled at all. The nicotine contained
in a small quuntity of tobacco would no doubt, if inhaled,
destroy life ; but then it never is inhaled. The major
part is really burnt, that is to say, decomposed into other
substances by the heat, and is no longer nicotine. The
residue is not inhaled.
The same paragraph contains auother equally unfounded
remark. It speaks of the “ many thousands who smoke
their ounce a-day, or a dozen of cigars or more a-day, and
thus pass through their lungs the carbonized vapour of
some twenty odd pounds of the weed annually.” Now
this is mere nonsense. They do not pass the “ carbonized
vapour if that may be taken as the pseudo-scientific
term for smoke—through their lungs at all. The smoker
draws the smoke into his mouth, and then puffs it out,
as any one with the least observation may see every day.
We should have thought that the fact of a smoker cough¬
ing violently should he accidentally get a little smoke
into his windpipe, would have preserved the most care¬
less from the blunder of thinking that devotees of the
weed breathed smoke. We are not defe nding the use of
tobacco, any more than joining in the counterblast against
it. We merely intervene to prevent such baseless state¬
ments being supposed to rest on a scientific foundation.
The New Water Supply of Dublin.
The new and expensive provision of water for the City
of Dublin from the river Varty has lately been very un¬
satisfactory, and universal complaint has been made of
the water, wdiicli is of a dirty yellow colour, and repulsive
in appearance. Mr. Parke Neville lias attempted to ex¬
plain this condition by saying that the deposit from the
liard water recently used has been detached from the
inside of the pipes by the solvent action of the soft water;
that this has occurred everywhere under similar circum¬
stances ; and that the evil will be remedied by time. We
believe this explanation, though perhaps good in theory,
is not the cause of the unpleasant turbidity in the case of
the Varty water. We have a sample taken from the river
Varty al>ove the reservoir, perfectly pure, clear, and sapid,
and another taken from the reservoir itself, straw-coloured,
evidently impure, and no doubt dangerous. We believe
the people of Dublin are drinking the solution of the
dirty mud and lx>g which forms the bottom of the reser¬
voir, and which was, before the water was let in, closely
covered with mud cabins, each with its inevitable cess¬
pool If our impression be correct, tbe citizens of Dublin
need expect no relief imtil they have disposed of the ob¬
jectionable solution, and until the reservoir becomes
thoroughly washed out by repeated rains.
The Health Section of the Social Science Association.
The following questions are those proposed for discus¬
sion at the approaching meeting of the Association which
will open at Birmingham on this day. In this section the
following questions will be specially discussed. 1. Can
the public Hospitals and Dispensaries of this country be
so administered as to conduce more to the welfare of the
community ? 2. What ought to be the fuuctions and au¬
thority of Medical Officers of Health ? 3. What is the
relation of the Water Supply in large towns to the Health
of the Inhabitants ?
TOE INDIAN PHARMACOPOEIA.
It is twenty-four vears since tbe last Bengal Pharma¬
copoeia appeared. TLe publication , therefore, of an Indian,
based on tne lust edition of the British, Pharmacopoeia is
of considerable importance. We have looked through
the book with great interest, and hope shortly to give
further information about it. At present we desire to
express the gratitude which the profession, and most
especially that part of it engaged in India, owes for the
book, 'the editor, Dr. E. J. Waring, deserves a separate
“ vote of thanks” for the toil he has spent upon it, and
but for which it would not have been of half the perma¬
nent value it may now prove. It is at once a text book
of materia medica, and a complete pharmacopoeia for
Indian practitioners.
PARISH DOCTORS AND THE FRANCHISE.
It is said, and we hope truly, that some of the working
men who formerly obtained orders for tbe parish doctor
have determined to be in future private patients, in order
that being struck off tbe parish list they may exercise the
franchise they have so recently obtained. If the franchise
educate men into independence of this abominable system
of getting relief in sickness, at the expense of others, it
will indeed piove a boon to ail. Let men honestly try to
avoid this degradation, and they will find their old friend
the doctor will not oppress them by long bills. In most
cases he would be able to arrange for them to be attended
on very easy terms.
DR. HUMPHRY SAND WITH.
This gentleman is pursuing an active canvass for
Marylebone. A contemporary, which ignores politics, and
thinks medicine above party, but lias not systematically
supported all medical candidates, wishes him success.
We wish him well equally, but we have not observed
that at present he bus made any profession as to medical
politics, without which we recognise no exclusive claim
on medical men. We shall vote for him, and hope he will
serve his profession.
SCIENTIFIC POPULAR LECTURES.—EXAMINA¬
TION AND PRIZE SCHEME.
In anticipation of the third season for the delivery of a
course of familiar scientific lectures, prepared by Thomas
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THE VALUE OF A DIPLOMA.
September 30,1868.
Twining, Esq., in connection with the Economic Museum
at Twickenham, that gentleman has propounded a plan
for examination, and offered prizes to be competed for by
the attendants at his lectures. The course will embrace
the subjects of Physics, Chemical Physics, Chemistry,
Natural History, Human Anatomy, aud Human Physio¬
logy. Arrangements are at present made for the course
at the Lambeth Baths, and although Mr. Twining will be
happy to receive proposals for the gratuitous delivery of
the lectures in other localities, the examination and prize
scheme is, for the present, limited to the Lambeth Baths,
where the most numerous and attentive audiences have
been present in past seasons. One of the examiners will
be Mr. YYilliam Hudson, ctemical superintendent of the
Twickenham Museum, another will be the Rev. G. M.
Murphy, and a third is to be named by the Society of
Arts. Mr. Twining has desired special precautions to be
taken to exclude all except bond Jide working class com¬
petitors. It is sincerely to be hoped that this practical
attempt at popular technical and scientific instruction will
meet with the success so well-meant an endeavour de¬
serves. It is to be followed, according to present arrange¬
ments, by a South London Industrial Exhibition in the
Lambeth Baths, opening early in March next.
- ♦-
THE PURGATORY OF LONDON HOSPITALS.
As might be anticipated, the assertions contained in the
article printed by Public Health , and criticised in our last
issue, have given rise to no little excitement. They were
of such a nature that we felt constrained to give them a
wider publicity than they could attain in a monthly
journal so recently started. We are gratified that the
profession^enerally should admit the justice of our re¬
marks. We feel it superfluous to say more than w T e did,
knowing full well the character of our hospitals and their
a sicians and surgeons. It is equally unnecessary to
lish letters from persons officially connected with any
of these incomparable institutions. The accusation has
been made by a quondam patient. We therefore prefer
this week to print the reply of such a person. Our cor¬
respondent, perhaps carried away by natural indignation,
appears to have confused our journal with the one in
which the impeachment appeared. We must beg him
therefore to look again at The Medical Press and
Circular for last week, when he will find that the word
purgatory and other phrases, which equally amazed him
and ourselves, are quotations from the article in the
Public Health . The conductors of that magazine—not
we, are called upon to explain or justify the allegations
made.
Here is the letter of our ex-Patient:
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —Looking through your valuable paper of the 23rd
inst., I was surprised to see an article headed 44 The Purga¬
tory of Ixmdon Hospitals.” I therefore think it a debt of
gratitude to one of those establishments, viz., “the West¬
minster,” to contradict the above title to Life in the Hospi¬
tal, experienced by myself for six weeks in this year. The
parti particularly allude to is this,— 4 4 Those occupying a
higher social sphere, who are reduced to avail themselves of
hospitals, find it very distressing to their self-esteem.”
Now, I have a slight idea that the writer of that sentence
must be either a very disagreeable, discontented, or selfish
individual, never trying to make himself comfortable under and
circumstances, or thinking that perhaps he should have had
all attention paid to him, and that other patients of the in¬
ferior order to himself should be neglected.
Abcut being obliged to crawl to a bath, I can only say
that patients who were unable, or who asked for a bath to
be brought to their ward, were never refused, and more than
that, the porter used to come up for orders.
Referring to the 4 4 female Cerberus ” who ruled the room, I
can speak as to the willingness and kindness of the Sister
and nurses towards all the patients both night and day with¬
out looking for bribes, and as to imposing tasks, that is
Simply absurd, The patients, if convalescent or not confined
to their beds, were asked to assist in the various duties of
the Sister or nurses, such as washing up the tea-things, lay¬
ing the cloth, looking after the kettle, carrying up bread,
the milk, and such lie, which I myself never for one mo¬
ment considered hard work, but rather felt pleasure in help¬
ing those who have plenty to do and who never grumbled to
r irform any duties they were called upon, and, in addition,
thought that 4 4 helping fellow-creatures ” must be always
pleasing to any well-disposed person, and, furthermore, out
of gratitude to the promoters and subscribers of such
charitable institutions, I might surely give a helping hand.
If the writer of that wora purgatory considers tho«e lash
as such, I fancy that he hardly understands the word, and
sincerely hope he may never experience the “realplace of
abode.”
As regards the Matron’s visits 4 4 being few and far Jbc-
tween,” 1 witnessed, during the six weeks I was taken can
of, the Matron—a most estimable and kind person—go the
rounds of the different wards every day, and frequently
during the day, and that lady was always ready, should
either of the Sisters or nurses require anything, and instead
of 44 bringing a cold , disdainful glance along both sides of the
wards , ” was always anxious to hear how the patients were
going on, and studying their comforts.
From the tone of the purgatory author, I am not surprised
at the Chaplain being condemned. I am glad to say that
our Chaplain was not one he described, which, I must con¬
fess, I hardly credit, I fear his own thoughts and eyes were
wandering. We had service in the chapel twioe on Sunday
and during the week, and those patients who were not able
to attend were visited by the Chaplain, who read to them.
Lastly, but of course of first consequence, the physicians,
surgeons, and others connected with the establishment, de¬
serve the highest praise for their great care and perseverance
in all cases. The House-Surgeon, who has, of course, an
immense amount of work, was ever ready to come up to any
patient, at all hours of the night. And when, sometimes, l
nave heard grumbling and dissatisfaction, I could not help
speaking my mind to those who are ever ready to condemn,
but seldom grateful to confess their cures.
With regard to the nurses receiving bribes, there is a notice
in every ward forbidding money to be given by a patient or
received by a nurse, and, from my experience, the nurses
never behaved in the slightest respect different to the poorest
or those of a 44 higher social sjtherc.”
As a proof of what I have here written with regard to the
feeling of patients towards the much-abused functionaries, I
can only add that during my stay I saw very many old pa¬
tients call to see their old nurses. I have done so myself,
and would certainly never think I was losing my self¬
esteem by paying a visit to your correspondent’s so-called
Purgatory.
The only thing I regretted was that I was obliged to fill
up a bed which many a poor creature would have found a
44 Paradise .”
Not being an author nor medical man, but the relative of
a subscriber to your journal, and wishing to give you my
experience, to refute the ill-natured remarks about the in¬
valuable institutions, I trust you will excuse me taking so
much space.—I am, Ac.,
R. L
P.S .—One of the Governors or Members of Committee
was constantly through the wards enquiring if there were
any complaints to be made by the patients, and visit the kit¬
chen to see that the rations were good.
When a patient was discharged, he had to go before the
Board and there make a complaint of any ill-treatment or ir¬
regularity, and he was especially asked about the nurses or
other members of the establishment receiving or borrowing
money.
-:— -
THE VALUE OF A DIPLOMA
With the exception of the degree of M.D. of London
University, which is sought for only by those who aspire to
a place amongst the diU of the profession, or who can bring
the necessary amount of ability, time, and money for this
attainment of this qualification, we would seem to attach
too much importance to the licenses of our different Colleges,
whether it be theMembership of London, or the Licentiato-
ship of Edinburgh or Dublin. In reality, the diplomas them¬
selves will depend for their value on the ability and character
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REPORT ON WINE.
September 30, 186?. 297
of their possessor, fts well as on the subsequent zeal or
indifference in the profession.
With some, the obtaining of their diploma is the ending
of their studies. They have obtained their El Dorado from
one of the Colleges which pride themselves on their licence
being of the highest order.
With others, it is but the commencement: they look
upon the profession in a more extended view, and consider
their few brief years of medical study as only a pupillage,
and their diploma as a blue valetis to enoourage them to
further exertions.
The latter is the more noble view. By further observa¬
tion and study such men fit themselvee for their calling,
and are likely to be of benefit to mankind.
“Vita Brevis—Are Longa,” say the philosophers. Of all
professions, that of medicine comes under this category.
Yet if a license is to stamp a man for life, how brief the
period in which it has been acquired, how easy has been the
acauirement.
What are three or four years spent in the acquisition of
knowledge, whether of the general literature of our own
country, or of the language of Greece, of Rome. How much
longer must they who seek some of the honorary prefer¬
ments of our Universities devote themselves to study ?
Yet the recipients are comparatively not benefited in the
race of life, for but to a few are these honours of utility.
There are long years spent at Harrow, or Eton, or one of
the other public schools, under masters of ability ; and
these are but the preparatory schools, where the mind, if it
is not stored with the rich lore of classical or general infor¬
mation , is yet prepared for its reception, and undergoes a
process of formation which i? subsequently turned to account.
Then several years are passed at a University, and ever
after those years, the knowledge acquired is felt by those
who appreciate what knowledge is, to be comparatively
trivial. It was a saying of the ancients, ‘ ‘ The more we
know the less we know ; ” but this, in modern days, is, un¬
fortunately, often reversed, so that ’tis said, “ The less we
know the more (we think) we know/’
Seeing that so many years are spent in acquiring a know¬
ledge of languages and literature which are only required to
give a man a status in society and toenable him to mingle with
nia compeers, of what account are three or four years spent
in the acquisition of the knowledge of a profession which
embraces such a wide field, and into which so many col¬
lateral branches of science enter, for each of which the
whole period would be required ? Of what worth is the first
year? The embryonic surgeon has the vast ocean of medi¬
cal and surgical knowledge spread out before him. He is
like the youth who makes his first voyage. He is dazzled
by the extent of surface which he has to survey. As yet he
knows not the land-marks or the soundings, nor can he read
the stars or foretell a gale. As the voyage goes on he gets
faint glimmerings of nautical knowledge, and all is not the
chaos he once thought. Thus with the student: he is per¬
plexed and bewildered—long-sounding names and opposite
theories confound him ; but as the year grows on he begins
to Bee his way, and finds that the mysteries of diseases can
he read. He has acquired some little knowledge, learnt a
part of the grammer, and got by heart some of the names.
In his second year he makes improvement, and reads
»me of the authors, the text books. The third year comes
on : he is well “ made up ; M he receives his diploma ; he is
stamped on an “ omatus vci,” —then farewell to books,
during those years what has he read ? A text book on
Anatomy, with some directions ; text books on Medicine,
Surgery, Physiology, and the various other subjects—in all
about nine text books.
The diplomas of our best Colleges can be thus obtained.
Nor jan we object to this. Yet, knowing that such is the
nature of medical education, it does seem absurd to attach
&ny intrinsic value to such qualifications. Nay, worse : it
was the boast of “ a grinder,” now deceased, that he would
take a carman of “ ordinary ” ability off the street and put
him through our Colleges in six months. This sad truth
was foroea upon him by the class of men whom ho had pre¬
pared, and by their success in obtaining their qualifications.
Much has been said of late years about improving our
College examinations. This is beginning at the wrong end.
We must teach our students what is the meaning of the
t?nn, “reading.” We must introduce some of the Univer¬
sity element into their studies. We must make them un¬
derstand that a “ reading man ” is one who is not content
with merely getting through a certain set of books,—as few
as possible—but one who studies for the benefit and the
gratification which learning affords.
Many may laugh at these ideas, may view them as
“ transcendentalyet this is owing to the education they
have received. With pity more than anger we may look
upon such. They cannot understand what it is to read
/Eschylup, Euripides, or Sophocles, for pleasure, whose
works they consider dull, stale, and useless.
W e may make our examinations more difficult, and may
thus exclude many who should never have diplomas ; but
the wiser and better plan would seem to be to diffuse dif¬
ferent ideas about medical studies, to change the typical
medical student, to break through the prejudices and asso¬
ciations connected with the caste; then it would follow, as
of necessity, that the rank of the profession would be im¬
proved, and the value of a diploma would be proportionately
increased.
G. H.
-♦-
REPORT ON WINE.
The wines generally known and commercially dealt with
under the name of u Sherry ” comprehend all white wines
imported direct from Cadiz, but the true sherry is the pro¬
duce of that triangular portion of Spain included between
Puerto Santa Maria, San Lucar, ana Tribujena, including
the wealthy town of Xeres, from which sherry acquires its
name. The choicest wine is the produce of the vineyards
between the two latter places, that is, north of Xeres. But
the exports from Cadiz are drawn from all parts of the
vast vineyard of Spain, and embrace many varieties
which have a reputation almost equal to that of the ex¬
ceptional Xeres. It would be well if these supplies were
derived exclusively from such sources, but there is too
much reason to believe that of late in particular, they arc
sometimes referable to a much more questionable origin;
but the wines of Montilla, La Mancha, Valencia, Malaga,
&c., are fully entitled to rank with the produce of any
other part of the Peninsula.
It would be beside the object of these reports to enter
into any consideration of wines in general, or sherry in
particular, as a commercial commodity ; we are only con¬
cerned with the nature and characteristics of the genuine
article in its various aspects from a sanitary point of
view, and the sophistications or adulterations which may
interfere with or neutralise its hygienic properties, and
we feel confident that what follows will sufficiently de¬
monstrate the importance of the inquiry.
Wine, particularly port, and still more especially
sherry, is frequently prescribed as a tonic or restorative.
We have already shown how little claim port wine com¬
monly has to such a distinction, and trust to prove that
in some respects at least sherry is quite as objectionable,
unless with proper discrimination.
When a physician prescribes, he does so knowing to a
tittle the proportions of the medicaments recognised by
the Pharmacopoeia ; but in the article of wine it is to be
feared that his knowledge is exceedingly vague, and de¬
rived more from popular impression than from scientific
research. In proof of this, in a lately published medical
W'ork upon the effects of alcohol on digestion, sherry, as
something definite and beyond question, is put upon the
same low alcoholic footing as beer, w’hich never exceeds
14° of alcoholic strength. The subjoined results of our
examination will show how u wide as the poles asunder”
these two may be, and how fallacious, consequently, the
conclusions drawn from such premises must be.
The type of a perfect sherry is a bright amber colour,
inclining more to yelluw than green, clean on the palate,
dry, full of body, and characteristically fragrant. When
fully fermented and matured, it possesses tliese qualities
in perfection. The natural alcoholic strength is from
25.5 to 30° per cent, of proof spirit (the latter equivalent
to about 17 per cent, of alcohol). As the wine ages it
acquires a somewhat deeper colour, and a slight accession
of strength, rarely, however, exceeding 33 per cent, of
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298 The Medical Crest and Circular.
IiEPOET ON WINE.
September SO, ISO.
proof spirit; the latter, however, depends upon its being
matured in bulk in its own country, as the dry climate of
Spain abstracts the watery portions and concentrates the
others. In a damp climate the contrary effect would
follow.
The leathery flavour 60 often found in sherry as to give
rise to the popular idea that it is an inherent distinction,
is not a natural characteristic, but is derived from the
skins in which it is frequently carried ; the pitcliy flavour
sometimes found is also owing to the practice of coating
the skins, or other vessels, with pitch, for the purpose of
preserving them. This resinous flavour, arising from the
same cause, is still more frequently found in the Cyprus
and some other Greek wines of the Morea, where the
practice extensively prevails.
The various coloured sherries, golden and brown, are
produced artificially by the addition of boiled must (mosto,
the expressed grape juice), called via de color , in greater
or less proportions ; and the sweet varieties or liqueur
wines such as mountain Malaga, and those generally
kuown as Paxarete or Pedro Ximenes, either by arresting
the fermentation before the decomposition of the glucose
into alcohol is complete, or by using either wholly or
supplementarily the juice of over ripe or artificially dried
(ramnee) grapes, in which the saccharine element is super¬
abundant. Another variety is the “ tent”—a boiled wine,
or rather a conserve of grape juice, which being totally
uufermented contains no natural spirit Upon this ground
it is almost universally used in the Anglican churches for
sacramental purposes, in ignorance of the further iact
that from 15 to 35 per cent of proof spirit is subsequently
added as a preservative ; thus putting it, in that respect,
upon the same footing as a fermented and fortified wine.
The Romish church, better informed on the subject,
employ for sacred purposes, only the purest fermented
white wine largely diluted. Tent however is regarded
more as a red than as a white wine in consequence of the
deep brown colour acquired by the boiling process, and
is besides so mawkish and destitute of all the qualitiea
which recommend fermented wine ; that it is rarely re¬
sorted to for sanitary or even potable purposes in this
country. Our investigations will therefore be confined
chiefly to the pale golden or brown sherries, or wines
coming under that denomination. The variety in the
latter, viz. the brown sherries, depends almost wholly
on the proportion and quality of the vin de color or
arrope (boiled must) employed for their manufacture, and
which in a certain measure overlays their true features.
They are consequently never so clean or dry as the pale
wines, of which there are several varieties deserving at¬
tention. Manzanilla, distinguished by a peculiar dry.
aud pleasantly bitter flavour, not uulike that of camomile,
which abounds in the neighbourhood of Seville and other
districts where this wine is produced. Some eighty years
ago this wine enjoyed a great and deserved reputation, which
has since declined, there being reason to believe that its
distinctive qualities are due rather to clever manufacture
than natural peculiarity. The wine known as Montilla
is another variety, which while equalling the Xeres wines
in other qualities, rather excels them if anything in fra¬
grance, is the produce of the higher and cooler climate,
amongst the spurs of the Sierra Suzana the fine olive-
clad country surroundin" the towns and villages of Fenian
Nunez, Moutemayor, Montilla, Rambla, Luzena, Cabra,
Done Mencia, &c., but are all included under the name
of Montilla. Another so called variety, which was greatly
in vogue for dyspeptics, called Vino de Pasto (breakfast
wine), is of no particular class, and is merely a selection
of the lighter descriptions of the other wines. But the
most notable is thaj called “Amontillado,” which possesses
remarkable characteristics. It is a perfectly accidental
production, that is, out of fifty butts of precisely the same
wine undergoing fermentation, oue or two may turn out
to be Amontillado, while all the rest retain the usual
character, but the causes of this remarkable change have
not been traced or controlled hitherto. Some are of
opinion that it is a disease of the ferment, others that it
is merely a diversion from the ordinary course of fermen¬
tation, caused by the accidental presence of some sub¬
stance of an exceptional character originally produced
with the grape. The colour of Amontillado is much
lighter than ordinary and inclining to green, with a very
bitter and aromatic flovour not unlike that of an orange
pip. The taste for it is rather an acquired than a natural
oue, and is more relished by high connoiseurs than by the
general consumer, by whom it is regarded rather as a
curious than a fine wine. Its peculiarity, its scarcity and
the high price it commands for imparting to other heavier
wines a lightness, for which it is incomparably useful to
the wine grower, prevents its cotniug largely into use os
an ordinary beverage, and the Spaniams themselves rather
decline the use of it under the impression that it pro¬
motes a tendency to paralysis. Iudeed, it has been ob¬
served that the inhabitants of those districts where white
wines are largely produced aud commonly consumed have
a tendency to nervous disorders. The same tendency has
been remarked in some parts of the East, where the
favourite wine amongst the foreign inhabitants is very dry
pale sherry. These about exhaust the various Sp&uish
white wines commonly known as sherry.
We now place before our readers the subjoined table,
in preparing which neither time, labour, nor expense have
been spared, exhibiting, in a condensed form, the results
of the alcoholic examination of between three and four
hundred samples of white wines, obtained indiscriminately
from importations into London direct from Cadiz in the
beginning of the present year. As the question is a very
broad oue, embracing almost every variety of wine
under the name of sherry, the uselessness of confining
such an inquisition to only a few samples will be at once
apparent, and considering that of the many to whom wine
is necessarily prescribed as a tonic or restorative, the ma¬
jority have been hitherto entirely at the merev of the
retail wine merchant, grocer, or petty “ agent,'' we iu-
dulge a sanguine hope that the information now afforded
will be found useful both to the patient or convalescent,
and the medical practitioner, who w f ill be less perplexed
than hitherto, when he finds that the effects following the
use of the wine do not coincide with the hopes of the one
side, and the expectations of the other.
That wine was bestowed and intended by a beneficent
Providence to restore or sustain, has been recognised in all
ages, and wherever wine is produced ; and it is only when
man interferes to u improve ” Nature’s work, that it be¬
comes a source or instrument of evil.
We would, in illustration—extreme, no doubt,—of the
confusion and worse likely to arise from alcoholic adultera¬
tion (which 6uch an excessive addition of spirit, no doubt,
is) to the two samples of 54 per cent at No. 4SL
The brandy of commerce is generally from 10 to 12
deg. underproof, and the equivalent of 54 per cent being
46 underproof, there are only 34 deg. difference between
the alcoholic force of the two—in other words, an addition
of one-third part of water would put both on the same
level as to strength. Even the recognised commercial
limit of 42 deg. is only 6 deg. less than half-and-half grog.
But we forbear further argil ‘uent, and rest our case en¬
tirely on the evidence of the accompanying table, from the
study of which the thoughtful examiner will learn much
more than any commentary of ours could teach.
It is like a new reading of the fable of Tantalus—un¬
like his case, our enp is filled, and exhausted by dnr ami
thirsty lips, but a worse disappointment than las follows,
for in place of the promised life and vigor that should
succeed the wholesome draught, the seeds of disease and
death are found plauted by a spurious potion assuming
the name and attributes of wine. Except when thus adul¬
terated by being overloaded with adventitious spirit,
sherry is a noble wine, full of rare and excellent qualities
and entitled on its merits to maintain its place by the
side of any other produce of the vine. We do not go the
length of affirming that it should in all cases and under
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The Medial Pros and Circular.
Hospital reports.
September 30, 1868. 299
all circumstances, be pure and absolutely unfortified :
when old and matur&l in bulk in the hot and arid
climate of Spain, it develops a strength of from 30 to 32°,
hut if removed at an earlier period and lower strength to
Number of
Samples Tried.
Per cent, of Proof
Spirit found.
Proportion of
Pale Samples.
Remarks.
1
1
1311
These are all either
2
1
16 5
“Tent” wines or “ Mos-
3
1
17*7
to,” that is, expressed
4
2
20-5
grape-iuice, sometimes
5
1
20*8
-
slightly inspissated, for-
6
1
21-4
titled, and imported for
7
1
22-0
the purpose of improv-
8
I
239
ing other wines different
9
1
252 J
in bodv or richness.
10
1
25 9
1
Limit of Is. duty.
11
4
26*5
One, a “Tent” wine.
12
1
26*8
13
6
27*2
14
1
27-5
1
15
2
27-9
One, a “ Tent ” wine.
16
1
28*6
1
17
I
29*9
18
1
30*6
19
2
31*3
1
One “ Pedro Ximenas.”
( One “ Montilla.”
20
6
32*0
3
< One " Paxarete.”
( One “ Solera.”
21
9
32-6
4
One “ Montilla.”
22
11
333
3
23
7
34*0
3
24
17
a
j One “ Vino de Pas to.”
•j*± /
O
( One “ Amon till ado.”
25
18
35*4
11
26
30
361
11
One “ Amontillado.”
( One “ Solera.”
27
37
36*8
21
< One “ Pedro Ximenes ”
( Two “ Amontillado.”
28
29
37*5
12
Three “ Solera.”
29
41
38*2
29
30
32
38*9
21
One “ Amontillado.”
31
20
39*6
15
32
30
40*3
22
33
19
41*0
8
34
10
41*7
8
Limit of the 2s. 6d. duty.
35
1
42*4
1
36
1
43*1
1
37
1
43*8
1
38
3
44*5
3
39
3
45*2
1
40
1
45*7
1
41
1
497
1
42
S
540
2
Note.—“ Solera, 1 ” or “ mother” wine : fine wine accu-
m jj|*ted for many years, and used from time to time to
refresh and improve other wines ; and replenished from
the best stock as it is used, so as to maintain the quantity.
this cold and humid climate, it would not only have dif¬
ficulty in sustaining itself under such altered circum-
but it woula be deficient in one of the qualities
which recommend it. and which within certain limits is
far from objectionable. But we contend that it is neither
necessary nor convenient, in the interests either of con¬
sumers or as an improvement of the article itself, that the
strength should exceed 32°, or at the very utmost 34 p .
It is mercenary interest which chiefly prompts such
excessive fortifying — or as it might proj erly in
some cases be termed fiftifying. The cheapness
and purity of the German spirit, which can be ob¬
tained at an almost nominal price, at a strength just
below’ absolute alcohol, enabling the astute manipulator,
under the name of fortifying, to convert every single
gallon of it into two or three of some strong-bodied w’ine
of double its original value, is a sufficient inducement
to follow up so profitable a practice, which no doubt will
continue as long as the same facilities exist, unless sternly
discountenanced by consumers. We do not bring any
change against the quality, but against the quantity of
spirit used. Alcohol {ethyl) is the same whether it be
obtained from grapes, potatoes, or any other sugar-giving
substance, provided it be pure ; and w'e are not unwilling
to admit that the bulk of the German spirit employed for
the purposes of fortification is as near absolute purity as
may be ; but w’e must record our emphatic protest against
those abominable compounds which are daily foisted upon
the public as wine of various sorts, the principal consti¬
tuent of which, however, is spirit. These compounds,
supplied principally, we do not say exclusively, out al¬
most exclusively, from Hamburg, bear about the same
relation to wine that plated ware does to plate of silver or
gold—there is the genuine article, then there is only a
substructure of some base metal, either plated, electro¬
plated, or only washed over ; finally, the baser imitations,
German silver and mosaic gold. In like manner much
pure good wine comes thro’, and consequently from Ham¬
burg, and a great deal more from it consisting merely of
spirits flavoured, and coated with wine as it w ere, begin¬
ning with a considerable proportion and ending with a
minimum, growing “ small by degrees and beautifully
less,” until it merges into the pure imitation, guiltless of
grape juice. These productions, we learn, are termed, ns
ingenuously as ingeniously, “ Elbe sherries,” and find a
ready consumption under that imposing title. The river
Elbe is no doubt the fertile and inexhaustible, or in this
case it may be truly said fruitful, source of their supply
of sherry, and may successfully dispute the palm with
another equally appreciated perennial resource, the merits
of which are not so ostentatiously paraded, but which is
not less useful in its generation, considering its opportu¬
nities. We allude to that interesting and universally
useful institution, known in the natural history of dairies
as the “ cow’ with the iron tail/* but more familiarly and
generally as the Pcmp.
-♦-
itopitnl Htporls.
DR. STEEVENS’ HOSPITAL.
ABSCESS OF THE PROSTATE GLAND.
Reported by R. L. SWAN, F.R.C.S.I.,
RESIDENT SUBORON.
James Whelan, aged twenty, gunsmith, was admitted into
hospital under the care of Dr. McDonnell, on April 6th,
suffering from retention of urine. He gave the following
history of bis case:—He had been labouring un ler
onorrhcca for three weeks. On the day before admission
e had a rigour, the gonorrhoea discharge ceased, and
suddenly he found that he could not pass water. On ad¬
mission the bladder was very much distended, and be was
in great distress. The water was drawn off by a moderate
sized instrument, which was introduced without difficulty;
ordered a warm bath, a dose of castor oil, and an opiate
enema at bed time.
For some weeks the patient was unable to pass water
without the ure of a catheter. This he learnt to introduce
for himself, using a No. 9 instrument several times a day ;
the urine was alkaline, and contained, a large q uantity of
muco-purulent deposit. On examination through the
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300 The Medical Press and Circular.
CORRESPONDENCE.
September SO, 18CS.
rectum the prostate was found to be enlarged, but it was
not until June that anything like distinct fluctuation could
be detected. There was no fulness, pain on pressure, or
redness on the perimeum, yet the feel of the prostate
when reached by the finger n the rectum left little doubt
that it was the seat of abscess. It was determined to
puncture the prostate through the rectum ; this was
accordingly done on June 13th. Dr. McDonnell intro*
duccd along his finger a curved Stafford’s instrument,
with a concealed blade, which on being pushed out punc¬
tured the back of the gland. A large quantity of pus
escaped, much to the patient’s relief. On the following
day the urine came from the rectum. This continued for
some days, but the patient’s general state improved, and
at the end of ten days all the water came by the natural
passage, and had returned to the normal acid condition.
The patient left hospital, having completely regained
control over the bladder, on July 1st, and although the
prostate gland is still considerably enlarged, he is now in
good health.
REMOVAL OF THE EYE-BALL.
James A., aged eighty years, about a year and a half ago
lost bis right eye from acute glaucoma. He suffered very
severe pain at the time, but for some months remained
free from suffering. For some weeks past however he had
suffered distracting agony from paroxysms of pain in the
eye-ball, and neuralgia on the same side. He sought
relief in having the eye-ball removed; this operation was
performed by Dr. McDonnell on September 12th.
The conjunctiva having been divided, the tendon of each
of the muscles attached to the globe was raised on a blunt
curved hook, and cut across with a pair of scissors. All
the muscular attachments]having been divided, the lids
were pressed gently back, the ball starts from the socket,
and the optic nerve being severed by curved scissors the
globe is removed. Little or no haemorrhage follows this
operation, and in a week or ten days an artificial eye can
generally be worn with ease.
The patient obtained immediate relief This operation,
which is simple and free from serious risk, was first pro¬
posed by Dr. O’Fcrrall, of this city ; Bonnet, of Lyons,
first practised it. It is now frequently had recourse to in
cases in which surgeons would have hesitated to perform
the operation of removing the entire contents of the orbit.
J. R., aet. fifty, was admitted on the evening of August
30th ? under the following circumstances:—Half-an-hour
previously, while walking on a wall, he fell a height of
about five feet, striking against a heap of stones, and had
subsequently remained insensible. On examination, a small
wound was discovered on the vertex leading to the bone,
the pupils were contracted and fixed, head sunk on the
chest, pulse 65, small, and intermittent.
Some hours afterwards he recovered consciousness, and
remembered how the accident occurred, but was extremely
querelous and uneasy. Sensibility and motion were now
found to be completely lost in the trunk and limbs. The
bladder was paralysed. He could not rest in any one
ositiou, but continually required to be turned over in the
cd. Skin warm. Complains of thirst.
31st.—Did not sleep during the night. Urine drawn off*.
Pulse 72, intermittent; respiration, 32 in the minute, and
entirely performed by the diaphragm. Temperature, 102°.
On making careful examination of the spine, it was now
discovered that crepitation existed at the lower portion of
the cervical region. This indicated the nature of the in¬
juries, which was previously only conjectured.
Died at ten o clock p.m., asthenia being apparently the
immediate cause of dissolution. The heart’s action gra¬
dually became weaker and more intermittent. In other
respects no material change since morning. There seemed
to be an effusion of mucus in the bronchi, which he en¬
deavoured in vain to expectorate.
Autopsy.—No injury to cranium ; brain healthy; spi¬
nous process of fifth cervical vertebra detached. The
laminso of the same vertebra were fractured, a dislocation
existed, and the ligament was torn. The cord itself was
soft and disorgnnised. Blood to some extent was effused
throughout the spinal canal in the vicinity of the injury.
This case presents many points of interest, and none
more so than those which would lead to considerations ot
a practical nature. The question of trephining the spine
must enter into the mind of the surgeon, and in this, as io
many similar instances, he is naturally swayed by the re¬
sults of prior investigations of the subject M&lg&igne’s
statement, “ The operation is a desperate and blind one,
and should not be attempted,” must not, we now know,
under all circumstances, be regarded, but still, the strong
opinions expressed in its favour by Sir A. Cooper, Cline,
Brown-S£quard, and others, and the few favourable cases
recorded, cannot conceal the uncertainty of success. The
symptoms which existed before death were extremely
diagnostic of the injury, and the mode in which respira¬
tion was performed showed the excellence of the division
of fractures of the spine into those occurring above and
below the origin of the phrenic nerve.
4 -
Carrejarptmirente.
“ THE AILMENT OF THE MEDICAL BODY
CORPORATE.”
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, — I heartily thank you for the manly, sensible, and
straightforward article in your impression of September 9, on
“ The Ailments of the Medical Body Corporate.” I agree
with every word of it; and trust you will continue boldly to
put before ua the truth. For many years past there has been
too much sacrifice of essentials for the sake of making things
pleasant. It is now time to speak out We be the
stronger and the better for it, though it may not be always
what we like at the moment.
It goes against the gTain to think that the position of onr
profession is a subordinate one, but such is the truth ; there¬
fore it is sounder and wholeaomer to admit the fact at once.
Had we all been outspoken upon it twenty years ago, had we
said in a direct manner, the thing is so, what are its causes,
and where are the remedies ? And had we then fully diseased
the matter in a liberal, yet practical way, our profession most
by this time have stood in a better position. But the feelings
of some will not allow them even to whisper to themselves the
unwelcome truth. In the case of some, high in the profession,
prosperity and distinction combine to blunt their perceptions
of the low social status of the majority of their professional
brethren, or of the consequences of the same to others. These
and similar causes have produced an unwholesome reticence,
and a disposition to silence those who spoke too plainly. The
real truth, however, is, that a very large number of people Ieoh
on medical men as a superior class of tradesmen ; nor is the
conduct of doctors calculated to dispel this illusion. Onr
medical brethren do not always remember to try and raise the
position of the profession they belong to ; in their conduct to
each other, some of them forget themselves ; in their deport¬
ment towards the public, many of them sacrifice self-respect
to secure practice.
The opinion thus entertained is applied to almost the whole
profession ; whereby those among us who are gentlemen, are
indirectly injured and pulled downwards by those who are
not. It is most salutary to preach upright and strictly hon¬
ourable conduct. This is a sermon which may be profitably
heard over and over again. But it goeth not to the root of
the matter. Ex quoois lingo non fit Mercuriut, If the pecu¬
liarities of the trading mind are let in at the gate
of the profession of medicine, the study of anatomy and thera¬
peutics have no power to neutralize them. If youths who
have not been educated as gentlemen ought to be, art ad¬
mitted to study our profession, we must not expect of the®
that “ nameless and indesirable combination of gentleness, hon¬
our, and fine feeling ” which “ make a gentleman.” In short,
you cannot gather figs of thistles ; where great care has been
taken to raise one kind of crop, it is folly to expect another.
As you most justly observe, the materiel of the profession u
the whole point and centre of the question. Rem acu
Every medical man in the kingdom should read and in*
wardly digest your admirable article of September the 9th;
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The Medic*! Preas and Circular.
CORRESPONDENCE.
September 30,1868, 301
and it ought to become an established rule of medical etiquette,
that no one is to be received as a pupil, either by private prac¬
titioners, or at medical schools, who has not been well and
liberally educated, and carefully brought up.
More of this hereafter; I hope we shall have it from all
quarters ;it will be the better for every one of us.—I am, Sir,
your obedient servant)
A Governor op a London Hospital.
September, 1868.
THE TITLE OF DOCTOR.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—I t seems to me that Dr. Davey, in your last, suffi¬
ciently acknowledges the force of my objections to his
former communication. He admits that the M.D. can
only be given by the universities.
As to the London College having once authorised its
licentiates to assume a degree that did not belong to them of
right—I only say—it had no legal power to do so, and
countenancing such assumption was countenancing a fraud
on the public. I do not, therefore, condemn it for tardy
repentance. How weak the case is appears from the words
intra auctoritatis nostrae limites.
Conferring degrees was not within the limits of the
authority of the College, any more than of the Apothecaries’
Society.—I am, &c.,
M.D., L.S.A.
THE REPRESENTATION OF THE PROFESSION ON
THE MEDICAL COUNCIL.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Silt,—It is to be hoped that the Medico-Political Associa¬
tion will at once begin a course of vigorous action for ob-
taining the great object of its formation - the Representation
of the Registered Practitioner in the Medical Council. The
British Medical Association will continue its efforts and the
Politico-Medical Association should, to say the least, keep
pace with it. Belonging, as I do, to botn these Associa¬
tions, I should rejoice to see them co-operate together for
the common good. The profession requires organisation for
the purpose. Meetings should be held all over the country,
centres established in the various counties, committees
formed, petitions drawn up, and delegates appointed to
join in a deputation at the proper time. All minor differ¬
ences must be sunk, all jealousies abandoned, and an united
effort made. If the members of the profession throughout
the kingdom show themselves to be really in earnest, they
cannot fail to succeed.—I am, Sir, your obedient servant,
Walter Rivington, B.A., M.B., &c.
One of the Vice-Chairmen of the
Politico-Medical Association.
LETTERS ON MEDICAL REFORM.
No. III.
TO TIIE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—I have endeavoured to show in my last that an in¬
creased stringency in the preliminary examination, and its
modification so as to test specially the faculties which
r lify a man for the successful pursuit of medicine, would
changes altogether in favour of the sons of professional
men as against tneir competitors from humbler walks of life.
It will be obvious on the slightest consideration that no less
an advantage can be gained for the sons of medical men
against all competitors whatsoever by increasing the strin¬
gency, and especially the practical nature of the professional
examinations.
I have said that the atmosphere of thought in which a
child is brought up becomes almost a part of his own mind ;
and especially is this the case in medical training, where a
long and habitual familiarity with professional subjects is
required rather than a hasty and superficial cramming of
whatsoever severity. The medical man’s son has all the ad¬
vantages of an apprenticeship without its acknowledged dis¬
advantages ; he is taught not by a master whose object it is
to save himself as much drudgery and obtain as much profit
out of his apprentice as he can, at the smallest possible ex-
r ise to himself, but by a father whose object it is earnestly
prepare his son as best he can for that walk in life iu
which he can best further his advancement. The contrast
is so strong that it is unnecessary to do more than merely
state it. The advantages gained against competitors from
other walks of life are incalculable in favour of a lad thus
brought up. He enters on his studies in the metropolis
already familiar with the scientific vocabulary of the pro¬
fession, in learning the use of which a whole session must
be thrown away by all others before the meaning of what
they hear talked about can fairly enter into their minds.
His ear is already accustomed to the use of the stethoscope,
his eye to the use of the microscope, his finger to the appre¬
ciation of the pulse ; yet more, he has been for years accus¬
tomed, under tne teaching of his father, to recognise disease
when presented to him, to investigate its symptoms, to trace
out its causes, to exercise his judgment in its treatment, and
practically to carry out the measures so indicated. He has
cultivated and trained that ‘‘ medical eye,” that *‘ surgical
eye,” that seemingly instinctive appreciation of disease on
the importance and method of training of which I have
elsewhere insisted. All this, be it observed, is practical
work, and gives the son of the medical man a practical ad¬
vantage in his studies over all other competitors. But all
such advantage is now absolutely thrown away by reason of
the unpractical nature of the examinations. Such a young
man sits down at the table in the examination hall with one
who has simply walked his hospital for so many months,
and crammed in the grinder’s study for so many more ; they
are both subjected to a searching examination on, let us say,
aneurism ; theoretically, they both may know the subject
pretty well, the latter has been carefully put up to it, knows
the tip, the peculiar views of the examiners, the questions
that will be asked, and the answers he is to give; hence
they are both pronounced competent on this ami other sub-
i 'ects, to practise as medical men, and the young man who
ias been for years practically trained by his father finds
himself with one more competitor of inferior qualification to
undersell him in the professional labour market, and lower
the public estimate of his services ; but had these same two
young men been taken to a hospital, and there subjected to
a clinical examination by the Dedside of two or three pa¬
tients suffering from aneurism, how instantly the practical
skill and ability of the first would have been manifested —
how instantly tie practical helplessness and incapacity of
the other would have been detected, his rejection secured,
and the profession and the public delivered from one more
incapable. What I urge, then, is this : that the present low
standard and unpractical character of the professional exa¬
mination bears hardly upon the sons of medical men, de¬
priving them of their relative advantages as compared with
others, and hence that it is emphatically the interest of
those who have sons to put into the profession to see that
the standard is raised and the character of the examination
altered. I refer principally to them, since I have sometimes
found that they entertain objections to such changes, ad¬
mittedly good tor themselves, on the score of anxiety, lest
their sons should be thereby excluded from the profession in
which they can best further their success in life, and hence
I wish to show that such changes would be altogether in
favour of their sons as against the sons of non-professional
men. True it is that before we can enforce such changes we
must obtain power in the General Medical Council by our
being practically and potentially represented thereon ; but
it is by pointing out these and similar advantages to be de¬
rived from the carrying of such a measure that we must hope
to arouse the profession to earnestness on this, the most im¬
portant professional Question of the present day, and one
lying at the root of all farther progress in social estimation
and in the obtaining of our just claims from society. It was
gratifying to learn from the letters of your Cambridge cor¬
respondent that there is no such thing as nomination in the
Cambridge senate ; there are certainly other universities
where it exists, and this danger of too influential nomina¬
tion is to my mind one great omection to Dr. Prosser James’s
scheme of representation, the discussion of which, however,
I must reserve for some future occasion. At present I can
only remark that, nevertheless, the Cambridge election,
even as it is represented by your Cambridge correspondents,
is most unsatisfactory ; for in the first place the privilege of
voting is not extended to all medical graduates, but only to
those who hold either the M. A. or M.D. degree, and who
have, moreover, kept their names on the books; and se¬
condly, the wishes and votes of these are liable to be over¬
powered by the votes of 5,000 gentlemen who are indeed
M.A’s of the University, but too are not members of our
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302 The Medical Press and Circular.
MEDICAL NEWS.
September 30,1008.
profession, and therefore are certainly not entitled to vote
on questions which only concern us and our proper self-
government.—I am, Sir, yours faithfully,
8 Isaac Ashe, A.B, M.B., T.C.D.
JHtiitnl profits.
ARMY MEDICO CHIRURGICAL SOCIETY OF
PORTSMOUTH.
September 2, 1868.
Deputy Inspector-General Dr. C. A. Gordon, C.B., in the
Chair.
Surgeon Poulton, 85th Regiment, read a paper on a
cose of
sporadic cholera
that lately occurred in a soldier in this garrison. The subject
of the attack, who was thirty-seven years of age, and had
served in the army twenty oue years, was, on the 7th of last
August, brought to hospital in a state of collapse, with livid
face and hands, sunken eyes, cold breath, hollow voice, and
all the ordinary symptoms of that disease in an aggravated
form. In the early part of the preceding night he had be¬
come affected with diarrhoea, the matters voided being de¬
scribed as greenish and watery. On questioning him, however,
the fact was elicited that a degree of laxity in the state of his
bowels had been observed on the morning of the* day before
his admission, although not until shortly before he was
brought under treatment did cramps occur iu his lower limbs
and weakness become alarming.
The treatment employed consisted of stimulants internally
and rubefacients externally, a few grains of calomel with
opium, which were given on his admission, having been in¬
stantly rejected. Ice, in small portions, was placed in his
month as often as he expressed a wish for it. His condition
remained critical until tho morning of the third day after
admission, when a distinct improvement was observable.
Urine was then for the first time voided, tho evacuations be¬
came faical, and recovery from that period progressed favour-
ably.
No diarrhoea existed in the regiment at the timo when this
case occurred, nor was there any apparent cause to which the
attack in this man could bo attributed ; it was, iu fact, one
of those sporadic cases that occasionally occur among com¬
munities.
Dr. Jessett read a paper I
ON THE USE OF CARBOLIC ACID IN THE TRF.ATMENT OF
WOUNDS, ETC.
He considered that with regard to the effects attributed to
this remedial agent, it would be well if surgeons were to refer
to their notes of former years, and compare their cases of
gunshot wounds, compound fractures, and ordinary wounds
treated in the old way with those that have, during the past
twelve or eighteen months, been treated with carbolic acid.
The qnestiou was, “ How does carbolic acid act?” and to
this he found some difficulty in giving a correct auswer. It
appeared to him that as applied, the remedy in many in¬
stances had no other effect than that of assisting Nature, and
as excluding the air from the wound or sore to which it is
applied. He then alluded to some of the cases lately pub¬
lished in which peculiar virtues were attributed to carbolic
acid, and expressed a belief that recovery would in all of
them have been equally effected by tbe ordinary means. He
believed that where suppuration had already taken place the
acid acted as an antiseptic or disinfectant, and quoted some
cases in support of his views. In other instances he failed to
see any special advantage to be gained by the remedy, but
commended the subject of its employment to tho attention
of the Society.
Dr. Lamprey, Surgeon 67th Regiment, brought forward
A CASE OF INDURATED CHANCRE TREATED BY EXCISION.
The history of the case was related by him as follows : —
Private John Ahearn, aged forty, but apparently much
older, twenty-one years’ service, light complexioned, but
othenrsc in apparent good health, was admitted on the 5th
of May Ins*, for primary syphilis, being the first time he
suffered from that disease. Ho had on the prepuce a sore
about half an inch long, narrow, oval in shape, margin
thickkh, prominent, and abrupt* hard to the feel, surface
yellow in colour, and capped ; no vascular areola about it.
The inguinal glands appeared to be indurated in knots, and
cord-like lymphatics were found in both groins. There was
no enlargement of the suboccipital glands, no eruption on the
skin, or sore-throat.
Inoculation was tried in this case with negative result
On the 17tli of July the sore was found covered with epi¬
thelium, and he was discharged from hospital.
The treatment consisted in the local application of carbolic
acid lotions of various strength ; ferri potass, tart.; chlorate
potass.; and iodid. potass.; but no mercury, either locally or
constitutionally.
He was readmitted August 9th, with an ulcer presentin';
almost the same character as that observed on tho 2nd of
j u ly_viz., the surface was pale ashy yellow, margin unde¬
fined, and having decided hardness about it; an indurated
gland was observed in the left groin ; no eruption ; no sore-
throat. .
August 10.—I removed the ulcer by one clean cut with tue
scissors, applied strong undiluted carbolic acid to the fresh
cut surface, which caused little pain—it was described as a
burning feel at first, but very transitory ; the bleeding ceased
on the application of the carbolic acid. I then brought the
edges of the wound together by four fine needles, and allowed
them to remain in position till the following morning, when
they were removed. It was expected that the wound would
have united by the first intention, and this was thought to be
the cose till the gaping of the wound some days afterwards
dissipated the idea. Subsequently, the margin of the wound
became thick and indurated, the surface unhealthy, «»by-
yellow ir. colour, and in short, it presented all the characters
of the original sore ; thus bearing out the general experience
of such treatment in similar cases.
Observing this to be the case, I ordered the iod. potass, be
was taking to be increased to twice the strength, to ten
grains three times a day, and pill, hydrarg. gr. v., to be
taken at bed time every third night. It was observed that
tho effect of this treatment has gradually produced healthy
action in the ulcer, and though ouly four pills have been
taken between the 2*2nd of July aud the 2nd of September,
the whole character of the sore is altered—a margin of ucw
skin is forming around it, vascular granulations are taking
the place of the yellow surface, and the hardening and pro¬
minence of the edges are subsiding. The local application
consists of acid, carbolic much diluted.
Dr. Bkuen exhibited a specimen of
ANEURISM OF THE AORTA,
and offered some remarks on that disease which he considers
to bo of more frequent occurrence iu tho army than in civil
life ; but much more so in the latter than was generally be¬
lieved, in consequence of tho difficulty experienced in per¬
forming post-mortem examinations, except iu the public
services.
gpiral ittfos.
Kino and Queen’s College of Physicians is
Ireland.—T he following gentlemen obtained the licences in
Medicine and Midwifery in May, June, July, and August
last • —
J. Backhouse, Carrick-on-Shannon : D. W. Behan, Blackrock ; VJJ-
Bodkin, ITuam; O. Boyd, Castletown; J. K. Bradley, 8toneyf-»w,
13. F. Bradshaw, Bansha; J. P. Byrne, DrnmdWigan; J-Cr^attertoo.
Ballynamote; H. Clerke, Dublin; E W. Collins, Dublin; P.CtonijolL
Hill of Down; J. Crawford, Longford; C. E. Crean, Balunnu.
J. J. Crean, Clonmel; B. Crean, Ballina; M. Daly,
E. Fawcett, Blacklion; H. Fra er, Gilford; J. J. Fumiss, Dublin.
J. Gabe, Wrexham; E. Hadden, Maryborough; H. G. Hall Dubta,
J. Kieman, Dublin: J. Laird, Drumsliambo; E. T. Lloyd, Dnww ^
T. J. McGrath, Dublin ; R. St. J. Mayne, Dublin: J. O Belly. K"*S?'
court; R. Spence, Co. Wicklow; H. Stannard, BaPs Bridge; OR;
Torrance, Dublin; J. F. Walker, Bonmahon; R. B. Wallace, Tti» .
F. J. A. Waring. Blackrock; T. Wilson, Long ord.
The following obtained the license to practise Medicine
C. J. Anderson, KUkeel; W. O. Barker, Dublin: J. Broc^KkUgro":
J. Carson, Dowra; V. de 8. Duke, Dublin; W. Graham, Roya!
M. J. Keating, Dublin; B. Kelly, M.D., New York; J. Rhjg;
Killeshandra; F. H. Lyon, Boscrea; J. Owens, Dublin; H.
St John’s, Newfoundland; T. P. Walshe, Dublin; G. F. J. Worthington.
W. Worthing.
The following obtaiued the license in Midwifery
J. Barton, TUtlifamhiro; J. A. BotUr.ll. Montreal ; F. ChueMOM-
Dublin; J. F. Fitxgerakl, Tinpcrary; J. W. Mulligan, AnghMeioT,
M. O’Donohoe, Fienelmark; W. II. Saunderson, Edenderry, *•
L. WaM», Kilflnane O. R. Woodward
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- 1 _
u SALUS POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 7, 1868.
CONTENTS.
ORIGINAL COMMUNICATIONS.
PAO*
Pemphigus Syplititicus. By John Morgan,
A.M., T.C.D., L. k F.R.C.S.E.. 808
HOSPITAL REPORTS.
Dr. SniviKa’ Hospital—
Cases under the Care of Dr. Freke. Re*
ported by 8. Flood, M.B.—Ptyrlaais
Versicolor and Idrosis.804-805
St. Gko&ok's Hospital—
Dr. Ogle’s Cases of Abdominal Tumours 805
Recent Contributions to the Theory of the
Innovation of the Heart and Blood-ves-
PAOS
sels. (Reported by Dr. Christian Loven.)
Translated by W. D. Moore, M.D. Dub.
et. Cantab., M.B.I, A., L.K.Q.C.P.L .. 808
LEADING ARTICLE.
Hospital Ships. 811
NOTES ON CURRENT TOPICS.
The Introdnctoi les. — The Dinners. —
Prises.—Queen’s College, Birmingham.
—A Medical Lecture in a Chapel.—Uni¬
versity of Cambridge—The Fall of the
Leaf.—The Aberdeen and Glasgow Uni¬
versities Election. — Another Medical
Candidate for Marylebone.—Poison in
Socks.—An Unfinished Infirmary. 311
PAQB
CORRESPONDENCE.
The Lancet exposed. 812
INTRODUCTORY ADDRESSES.
The London Hospital . 815
Kino's College. 318
Quern’s College, Birmingham . 320
University College. 321
Guy’s Hospital. 322
Army Medico-Chirurgical Society of
Portsmouth. 322
Medical News, Notices to Correspondents,
Ac. 828
PEMPHIGUS SYPHILITICUS.
Bt John Morgan, A.M., T.C.D., L. k F.R.C.S.E.,
Professor of Practical Anatomy (Surgical and Descriptive) Royal
College of Surgeons, School of Surgery, and Surgeon to Mercer’s
Hospital.
The occurrence of this rare form of syphilitic eruption
has been noted by most modem sypnilographers, and
recognized as one of the protean form of constitutional
infection; but the disease having been chiefly observed in
infants, its specific character has been questioned. Thus
Bassereau mentions that in his experience of ten years he
met with but two cases in the adult. Cazenave and
Dubois observed it in children only, and in them occur¬
ring in the palms and soles of feet. Ricord has given an
excellent illustration of the disease in his “ Iconographie”
(plate 46), where the chief surface of the body of a newly-
born child is covered over with the eruption. Bumstead
likewise mentions a case under his own observation of an
infant where, on the third or fourth day after birth bullae
formed on the arms, abdomen, and chest, and in the third
week were followed by the formation of mucous patches
at the buttocks and inside of the cheeks.
Krauss, in 1834, tabulated a large number of cases
of this disease in infants, but overlooked its syphilitic
origin. Alibert describes it as a syphilide pustulentc
pcmphigoide , and as occurring in adults of irritable tem¬
perament and in contaminated infants.
It is remarkable that in the cases referred to, the dis¬
ease showed a predilection for the denser tissue of the
palmar and sole-of-feet integument, some of the bull®
being isolated and others confluent, ending finally in
desquamation.
As the records of the Lock Hospital, Dublin, present
no instances of this disease in the adult, the following
case, under my care in the Hospital, will be interesting,
and will bear out the Temarks of Bassereau in his accu¬
rate description of the affection as seen by him, with
indurated chancre and general signs of secondary syphilis.
In one case given in full by Bassereau, the patient had
been the subject of indurated chancre three months pre¬
viously, and eruption for fifteen days, nocturnal pains,
&c., and the bull® formed in the palms of the hands,
containing a sero-sanguineous fluid, ending in desquama¬
tion, and left dark-coloured stains. There were no bull®
on the body.
F. R., aged twenty-six (bed No. 5, ward 1). Unvir-
tuous for seven years. Having been two years on the
town, contracted a soft sore and bubo, for which she was
treated in the Hospital without mercury, and was dis¬
charged cured. She remained free from any symptom
for a period of about two years, when she suffered
from an extensive eruption, for which she was again
admitted to Hospital, submitted to mercurial treatment,
and discharged cured. No further symptoms presented
themselves till about July, 1867, when a sore formed at
the side of the vaginal orifice, which gradually increased
in size, yet without causing much pain. She was admitted
to Hospital in October, 1867, about three months subse¬
quent to the first formation of this sore (during all which
time she was pursuing her unfortunate course). She was
now treated in Hospital for three and a-half months, but
though not cured, she left, and resumed her mode of life
for eight weeks, when a papulo-squamous eruption having
manifested itself, she again was admitted, March 3rd,
1868, subjected to a mildly mercurial treatment by the
exhibition of the compound calomel pill. Under this
influence the eruption gradually yielded and the general
health improved, but the sore remained.
In the first week of July, 1868, another crop of papular
eruption appeared, some of the papules being isolated
and some in clusters and annular. On the 27th of
July, the patient complained of lassitude and debi¬
lity. On tne next day a bulla had formed on the right
thigh; during the next forty-eight hours another bulla
on the left thigh; the next day another over the mons
veneris. These bull® were very tense and dark-coloured,
filled with a sanguineous fluid, and surrounded by a blush
or areola extending to three inches around, of a vivid
red, shading off gradually. When broken, the cutis was
found superficially ulcerated, leaving dark-coloured
stains. A fourth and fifth bulla formed at succeeding
periods on the shoulders, but were small, not exceeding
the size of a fourpenny-piece, whereas the first nearly
equalled a billiard-ball in size. The bull® were not inter¬
fered with, but simply kept covered and warm. Ten-
grain doses of iodide of potassium and bitter infusion
were given every six hours. Moderate stimulants and
nutritious diet ordered. The illustration shows the size
of the bulla, and the circumference corresponds to that of
the surrounding areola.
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HOSPITAL REPORTS.
October T, 1866 .
At thus date the stains are very distinct, the patient’s
health is good, and the genital sore in process of healing.
From the fact of this patient suffering from repeated
eruptive attacks, and being the subject of a genital sore
at the same time, I looked on the pemphigoid bull® as
of specific character, and treated them accordingly with
iodide of potassium, administered in frequent and as
large doses as the patient would bear. The formation of
more bull® I believe to have been arrested by its in¬
fluence.
My colleague, Dr. McDowell, has had lately a some¬
what similar case in his wards, where the bull®, as here,
formed on the inside of the thigh, equalling a large
marble in size.
The histoiy of this woman, as a source of contagion,
during the last few months, will show the amount of
mischief that can be done by an individual; and not¬
withstanding due regard for the liberty of the subject, so
natural and so national, affords a strong argument in
favour of legislative interference to compel all such cases
to submit to treatment Thus, about fourteen months
ago she was infected, and was admitted to the hos-
ltal eleven months ago for this same sore, not then fully,
ut very nearly as extensive as now ; its characteristics
were then, and are still, those of insensibility and density,
having been in Hospital for three and a-half months,
she claimed her discharge, and returned to her mere¬
tricious course of life, with the sore much in statu quo,
for eight weeks. An eruption having now appeared over
the body, of a papulo-squamous character, partly in
clusters, accompanied by osteoscopic pains, she again
appeared and was re-admitted, having thus beyond doubt
existed as a source of contagion for aoout four and a-half
months.
A girl of eighteen, always having been strong and
healthy, stated tnat three weeks before admission to Hos¬
pital she had been ill, and had, as she supposed, caught
cold, and in about ten days afterwards bull® formed over
the inner part of the thigh, abdomen, pudendum, and
finally on the face the last formed being that shown on
the lower lip. Sloughs appeared underneath the bulla
when burst. When admitted, each was fully three-quarters
of an inch deep and the size of a crown-piece; the
face was pale, the tongue dry, the pulse weak and small,
and the body exhaled a sickly cadamic odour. The most
active treatment was adopted, chlorate of potash, hark,
wine, &c., very freely administered, notwithstanding
which the girl died the next day.
-♦-
JJnapifnl lEUporta.
DR. STEEVEN’S HOSPITAL.
Cases under the care of Dr. Freke.
Reported by S. FLOOD, M.B.
J. C., aged forty-five, a fireman, was admitted on the 6th
of July. He stated that he always enjoyed excellent
health until March last, when he caught cold, which he
neglected. On admission his face was anxious and haggard,
skin moist and perspiring. Great emaciation. Pulse 112,
soft and compressible. Anorexia. Bowels confined. Con¬
siderable dyspnoea. Respiration twenty-seven. Decubitus
dorsal, and on the right side. Sleep badly. Cough very
troublesome, especially in the morning. Has had hemop¬
tysis twice during the past two months. Expectoration
copious and tinged with blood. Flattening under right
clavicle. Dulness over the upper third of the right [lung
anteriorly. Coarse rales, cavernous respiration, and pec¬
toriloquy heard under right collar bone. Exaggerated
respiration on left lung.
Cod-liver oil in 3j. doses with 3j. of syrup of the phos¬
phate of iron, quinine, and strychnia was prescribed, but
the patient was unable to continue its use after four days,
owing to the nausea produced by it. The oil was now
omitted for six days, during which time he took 3j. of
pancreatic emulsion in milk three times daily. His appe¬
tite improved considerably, and he was enabled to return
to the oil, which he has continued in increasing doses up
to the present time. With the aid of the emulsion he can
now easily take from three to four ounces of cod-liver oil
daily. Under this plan of treatment he has rapidly and
decidedly improved. His appetite is good, cough very
much diminisned ; can lie in any position ; expectoration
scant; skin cool; pulse ninety-two ; sleeps well; has
steadily gained flesh (191bs. in forty-nine days). Tm*
it will be admitted was an unpromising case. The
disease had made rapid progress and had engaged a
considerable portion of the right lung in which a cavity
existed. Coa-liver oil could not be taken, and the patient
was fast losing ground; the employment of pancreatic
emulsion at once produced a marked improvement in the
digestive organs, and in this way allowed of the employment
of oil, the result being a great alleviation of all the mom
distressing symptoms, at least a temporary check to the
disease, and a decided improvement in the patient’s gene¬
ral health. The emulsion and cod-liver oil was tried m
six other cases of pulmonary consumption under Dr.
Freke’s care, in all of which it produced a speedy and
well marked improvement in the digestive organs, and
proved far superior to the oil alone. In no single instance
did it disagree, and in several instances patients who were
at first quite unable to take cod-liver oil, even in small
doses, found that a few drachms of pancreatic emulsion
enabled them readily to do so. There is at present on®
case in which the emulsion has been given alone. The
patient, who is in the second stage of phthisis, gained 1 libs-
m about three weeks, but has since lost 5lbs. Owing
the expense of this medicine, sulphuric ether in T(\jl doses
has been lately tried in combination with cod-liver oil. It
makes an agreeable mixture, easily taken, but has not been
yet continued for a sufficient length of time to warrant any
conclusions being drawn as to its efficacy.
Digitized by kjOOQle
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HOSPITAL REPORTS.
October 7,1868, $05
Pityriasis Versicolor and Idrosis.
J. M’D., aged 30, gardener, was admitted into hospital
on Sept. 8th. He states that he was in the habit of sleep¬
ing with his brother, who was suffering from a akin dis¬
ease. This was in 1855. During that year he observed
that he became affected with a similar complaint, which
has continued up to the present time. His father and his
brother’s child have long suffered from the same disease.
On admission, his chest and back were covered with
large patches of a yellowish colour, slightly elevated above
the surrounding skin, and covered with minute branny
desquamation. This caused him no inconvenience beyond
a slight degree of itchiness occasionally when he over¬
heated himself, and did not affect in any way his general
health. He also complained of profuse perspiration of the
palms of his hands and the soles of his feet, which com¬
menced in 1861, accompanied by dyspeptic symptoms.
R Bal. sulphuretis potass® at 100°, onini die.
R Acidi tannici, 3ij.
Aquas calcisae, jviij.
M. Ft. lotio. To be rubbed to the hands and feet fre¬
quently.
This plan of treatment was steadily persevered In for
fifteen days, when the skin had regained its healihy ap¬
pearance, the idrosis was also completely arrested, and the
patient was discharged on the 26th. He presented him¬
self at the hospital to-day, and continues apparently quite
well.
The history of this case seems to point to its contagious
nature. The inicrosporon furfur was not looked for, as the
appearance of the skin was considered quite characteristic
of the disease.
ST. GEORGE’S HOSPITAL*
Dr. Ogle’s Cases of Abdominal Tumours.— Continued .
Case XV. — So-called polypus, or pedunculated fibrous
tumour growing from the inner surface of the small
intestine , causing invagination of the bowels, and death.
Thomas G., tet. forty-six, was admitted August 13,
1845. He had been ill since Easter with pain in the
abdomen, attended at first by violent constipation of
eight days’ duration. Since then almost constant diar¬
rhoea had existed. For a few days before admission the
pain had been unusually severe, and rigors had existed.
There was loss of sleep and much emaciation. He had
been actively treated by leeches, blisters, &c. On admis¬
sion, the abdomen was tympanitic and painful on pres¬
sure, chiefly at lower part, and there was a catching res¬
piration, apparently from pain. There was some expec¬
toration, but nothing wrong about the chest was indicated
by the stethoscope. The diarrhoea for a time gave way
under the use of chalk and opium, and occasional doses
of castor-oil. On the 25th he was suddenly taken with
excessive and more extended pain, and with rigors, vomit¬
ing, and dispnoea. In spite of remedies, the pain con¬
tinued, and the tongue became dry and brown. He sank
and died August 30th.
Post-mortem examination .—Extensive indications of
serous inflammation and lymph and fluid of a frecal
odour in the peritoneal sac were found, and in the left
lumbar region, on removing certain adhesions an invagina¬
tion of the small intestine was found to have occurred, the
bowel above being very much dilated, and below slightly
contracted. In the immediate neighbourhood of the invagi¬
nation the coats of the intestine were very soft, and gave
Way to a small extent when slightly pulled upon, thus
allowing of the escape of a portion of the contents of the
gut. On laying open the portion of gut below the in¬
vagination. a large pendulous growth was found in the
cavity of the gut,and connected by a broad pedicle to the
extremity of the invaginated portion of intestine. The
body of the polypus, of a pyriform shape, was about 2j
in. long, and at its broadest part about 1 j in. in width ;
its pedicle about the size of tne middle finger, 1J in. long.
The portion of intestine which was the seat 01 the polypus
was about two feet from the ciecum. The other parts of
the intestine presented nothing unusual; neitner did
the liver and spleen. The kidneys were not examined.
The thoracic organs presented nothing worthy of note.
Case XVI.— Tumour above the brim of the pelvis on the
left side , the result of suppuration outside the peritoneum
following ulceration of the sigmoid flexure of the colori.
Phthisis ; disease of the kidneys.
Michael M*D., set. fifty, was admitted December 21,
1866. Ho had had an inflammatioh of the testicle and
gonorrhoea two years before admission, and some scrofulous
abscesses connected with the left side of the dhest. For
twelve days before admission he had had pain in the left
groin, and for two days he had great pain in emptying
the bladder. There had been no vomiting or constipa¬
tion. A hard mass was found lying above the left brim
of the pelvis, apparently connected with the bowel, which
was slightly diminished by evacuation of tlio bowels, but
no pus existed in the motions. The swelling increased
(in spite of iodine lotion), and extended towards the right
side of the body, and became very tender. Afterwards
the pulse became very weak, much weakness was com¬
plained of, and rigors. The urine contained albumen
and pus, and from tne first was passed with pain. Vomit¬
ing came on and profuRe sweating, and deficient breathing
with moist sounds was found in the left lung. It ap¬
peared as if he was suffering from py®mia. He became
weaker and less conscious, the motions were passed in¬
voluntarily, and he sank, and died December 27th.
Post-mortem examination. —A scrofulous abscess was
found connected with the first rib and its cartilage on the
right side. Both lungs contained scrofulous deposit at
their apices, and traces of recent and old pleurisy existed.
Among the pleuritic adhesions low down on the left, a
collection of thin purulent fluid was found.
The liver was cirrhosed, and the kidneys granular, with
diminished cortex. A firm cartilaginous stricture of the
urethra existed, and the bladder contained purulent fluid.
The tumour in the left groin, which was a collection of
pus, extended in front of Ponpart’s ligament, along the
crest of the ilium, and into the pelvis external to the peri¬
toneum. The sigmoid flexure of the colon was adherent
to the abdominal parietes for a considerable length ; and
at one spot, of about the size of a shilling, the coats of
the bowel had ulcerated through, and the abdominal walls
formed the outer wall of the bowel. From this perfora¬
tion the suppuration appeared to have arisen. The edges
of the ulcer were rounded, and the mucous membrane was
more destroyed than the other coats. The small intestines
were matted together in the neighbourhood. The other
parts of the large bowel were natural.
Case XVII.— Abscess between the liver and the colon , cbbimu-
nicating with the interior of the gall-bladder (which was
full of gall-stones), by several perforations through Us
walls . Ulceration of the duodenum and transverse colon .
Mark P., ®t. sixty-four, was admitted November 24,
1858, in a state of great prostration following an attack of
gall-stones. It seemed that be had fbr ttrenty years been
subject to what were called " bilious attacks, and in 1851
had had jaundice. Eighteen days before admissioii he had
suddenly been seized with pain in the epigastrium on the
right side, which continued five days ; ana on admission,
pressure o?er the right hypochondriac region gave pain.
The pulse was weak ; the tongue ted and ulcerated, as if
from mercury. When he came in, he had a carbuncle at
the angle of the right iaw, and purulent discharge from
the right ear; The carbuncle was opened. For a time he
improved ; but muttering delirium came on (such as, it
was reported, he was wont to have during his bilious at¬
tacks), and he sank, and died December 12th.
Post-mortem examination.— The contents of the thorax
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October t, 18H
and cranium were natural. On opening the abdomen, all
the viscera were found matted together. The gall-bladder
was full of gall-stones, and numerous perforations of the
bladder had taken place. Communicating with these per¬
forations was an abscess, lying between the liver and the
hepatic flexure of the colon; the contained pus being very
yellow, owing to admilture of bile. The common bile-
duct was natural and pervious. The duodenum was much
thickened, and presented a deep ulcer close to its com¬
mencement at tne pylorus; another similar ulcer was
found at the commencement of the transverse colon ; and
the intestine was congested in patches at other parts. No
cause was found for these ulcerations. The kidneys were
healthy, excepting a large cyst in oue of them.
A large pendulous tumour, having the structure of the
prostate gland, projected from the upper part of that body
into the neck of the bladder.
Cass XVIII. — Tumour in the hypochotidriacand epigas¬
tric regions , caused by an enlarged liver , occupied by masses
of a peculiar fibroid nature.
Sarah G., rot. fifty, was admitted December [25, 1844.
She had been subject to spasmodic cough for seven years,
which had latterly become worse. About eight months
before admission, she had constant pain at the epigastrium,
accompanied by frequent nausea, occasional sickness, loss
of appetite, and great thirst. She now noticed the stools
to be occasionally very black and fluid, and passed at
times with pain. On admission, there was a perpetual
sense of sinking at the epigastrium, and gnawing pain
about an hour after eating, though food, when first taken,
cave relief. A small circumscribed tumour could be felt
in the right hypochondriac and epigastric regions, appa¬
rently about tne pylorus of the stomach. The vomiting
had become almost constant, and she still passed blood by
stool. In spite of remedies she sank, ana died January
18th.
Post-mortem examination.— Indications of slight pleurisy
existed ; otherwise nothing was noticeable in the thorax.
On examining the abdomen, the omentum was found
tucked up and adherent to the right lobe of the liver, and
old adhesions united the upper and under surfaces of the
liver to surrounding parts. The right side of the liver
was towards its lower margin contracted, and veiy much
puckered on its surface, with great thickening of its peri¬
toneal coat, which presented a cartilaginous appearance.
On cutting into this part, several circumscribed tumours
were found, varying from the size of a nut to that of an
egg, contained in distinct and thickish cysts, formed from
condensed areolar tissue. The cut surfaces of the tumours
were of a yellowish colour, and apparently homogenous;
their structure was elastic and nrm; in some places it
was of a pinkish colour, and evidently contained vessels.
The liver-tissue around the smaller tumours was conges¬
ted ; the remainder of the liver was coarse and congested,
but not otherwise diseased. The gall-bladder was thick¬
ened, and contained a largish calculus. The pyloric end
of the stomach was adherent to the liver, ana the first
part of the duodendum was compressed and flattened by
the tumours in the liver. The stomach was healthy, but
the mucous membrane of the small and large bowels was
venr inflamed. Both kidneys were diminished in size,
and mottled.
Microscopical examination .—After maceration for many
years in spirit, I found that the yellow deposit consisted
of amorphous and granular material, along with a slight
amount of fatty and occasionally slightly fibulated
material, and a few delicate small cell-formations. Where
the parts had undergone softening, much fatty material
was found. The surrounding fibrous structure presented
the usual elements of firm fibrous tissue.
Case XIX. — Tunmr at the lejt of the ensiform cartilage ,
evidently containing fiuid , which proved to be oicing to a
large collection of pus between the liver and the dia¬
phragm ; smalt abscesses in the liver , <£c.
Peter L., aged thirty-three, was admitted Nov. 1,1852, in
a state of great depression and destitution, complaining of
having suffered much from shivering, which was treated as
ague, and from pain all over, but chiefly on the right side.
Tiiere was a small rounded tumour at the left edge of the
ensiform cartilage, which bore handling wdl and evi¬
dently contained fluid, the seat of which was thought to
be the substance of the liver. Vomiting and great depres¬
sion, with increased quickness of pulse, came on: and the
enlargement was opened by trocar; when above two pints
of pus were evacuated, unmingled with serous fluid, and
only occasionally streaked with blood. The patient
gradually sank, and died November 21st
Post-mortem examination. —Pus and fibrinous material
were found in the pericardial cavity, and fibrinous exuda¬
tion in one of the pleural sacs.
The liver was lirtoly and extensively adherent to the
diaphragm, excepting at one part, where was a large
collection of pus, surrounded by shreddy walls, formed
bv the adhesions. The liver contained several abscesses
in the neighbourhood of the adhesions. On examimng
them microscopically , I found that some of the smaller
ones consisted almost entirely of fatty graular matter, as
if the contained pus had undergone fatty alteration.
The preparation of part of the liver and diaphragm,
showing the position of the pus contained between them
is in the Museum of St. George’s Hospital.
Case XX.— Large abscess of the liver , containing a con¬
siderable collection of biliary calculi , apparently set up
by ulceration of the qall-bladder ; communications between
the abscess and the duodenum and bile-duct.
The patient, William G., was attending as an out¬
patient with jaundiced skin, and whilst in the waiting-
room, July 28th, 1852, he had a desire to empty the
bowels; and when at the water-closet died quite suddenly.
Nothing further of his history is known.
Post-mortem examination. —I found that the pericardial
sac was dilated with clear amber-coloured fluid, and much
recent fibrin in the pleural sacs, as also patches of lobular
pneumonia. The heart’s cavities were dilated and their
walls were thickened. The root of the aorta and mitral
valve-flaps were slightiy thickened, and the cerebral capil¬
laries were in a hignly atheromatous state.
On examining the abdomen, the liver was found to U
enlarged, the right lobe at its under surface being very
softened and of a dark livid colour, and to this part ol
the duodenum and transverse colon were adherent: and
this part of the liver and the adherent duodenum formed
part of the boundaries of an abscess, whose walls were
very shreddy and offensive in odour, and which, besides
a quantity of dark foul pus, contained a number of
polygon-shaped biliary concretions, agglomerated and re¬
tained together by inspissated mucus and bile, forming a
mass equal to a hen’s egg. This mass had evidently been
formed in the gall-bladder, which had undergone so much
ulceration that no traces of it could be found. Two
rounded and ulcerated openings existed between this
abscess and the interior of the duodenum, which was (as
before said), attached to the duodenum, and a similar
opening between the abscess and the interior of the com*
mon bile-duct, the largest of them being equal to a four-
S enny-piece in diameter. The inner surface of the dno-
enum and gall-duct were otherwise natural. The cystic
duct was natural, and could bo traced into the abscess ol
the liver. The other parte of the liver were in awry
fatty state, and the various arterial branches of the cwiac
axis were verv atheromatous. The kidneys were very lar#
(weighing together 16oz.),soft and congested, having much
fat about their pelves: and their surfaces were granular.
Other abdominal organs were not examined.
The preparation, which was shown to the Pathological
Society, is described in the St. George’s Hospital Catalogue,
Series ix. No. 292.
Case XXL — Tumour formed by a distended
whose walls were the seat of carcinoma, am tchose duct
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October 7,1868. 307
was obstructed by a gall-stone. Carcinoma of the liver and
lymphatic glands.
William H., eet. thirty-eight, was admitted October 25,
1865. He had been ill nine weeks, beginning with pain
in the back and over the liver. Two weeks later a tu¬
mour below the right ribs was noticed, and eix weeks
later he became jaundiced; the motions became light-
coloured, and the urine bile-tinged. On admission the
tongue was furred, the skin yellow, the pulse quiet. The
urine contained no albumen. In the region of the gall¬
bladder, close under the ribs, an oval tumour was felt, of
the size of a large walnut, which was painful and tender,
and altered with change of position : to a certain degree
the hand could be passed under its edge, and it was
thought to be a distended gall-bladder. The patient had a
cachectic look, and the jaundice increased : the appetite
failed, and “ cramps ” came on in the abdomen and back.
The skin became dry and itching, and the evacuations
were rery light-coloured. He became of a deep-olive
colour, and very emaciated. He gradually Bant:, and
died, conscious to the last, January 3rd.
Post-mortem examination. —Excepting slight thickening
of the aortic valves, the thoracic organs were natural.
The diaphragm and other parts were closely adherent
to the liver, which was deeply charged with bile. The
gall-bladder contained three large stones, and of these
one waa impacted in the mouth of the cystic duct. The
gall-bladder was greatly distended with bile, and its coats
nearly uniformly thickened by a layer of carcinomatous
material, taking the place, as it were, of the mucous
membrane, the serous coat being unaffected. The liver
also contained one or two small nodules of encephalold
substance, and the glands of the small omentum were
occupied by the same. The bile-ducts were generally
very dilated.
Cask XXII.— Enlarged and indurated pancreas.
James 8., set twenty-eight, admitted November 3,
1841, with hypertrophy and disease of the heart and
valves, and congestion of the lungs. He died December
29th.
After death, in addition to the state of the thoracic
organs, the pancreas was found to be much hypertrophied.
It was also much condensed; so much so that it “ cried ”
when cut into with the knife.
In reference to this, Dr. Ogle remarks that condensa¬
tion of the pancreas may be attendant upon ulceration of
the stomach as illustrated in the following case :—John
L, set fifty-two, was admitted into our hospital October
17,1865. He died November 15, with ulceration of the
stomach, producing perforation of the walls of that
organ. The ulceratea opening at the posterior part of
the stomach was blocked up by an adnerent pancreas,
which was very hardened and thickened, and at the part
of an unusually white colour.
Cask XXIII.— Hard substance below the ensiform cartilage,
which proved to be the pancreas exposed by displacement
of stomach.
James 8., ®t. thirty-four, was admitted Jan. 31, 1851,
suffering from anaomia and emphysema. The urine was
healthy, but he had some pain in micturition, and com¬
plained of palpitation. For the time he improved, but
became affected by sickness and vomiting, though without
pain; and at this period a fulness and hardness could be
felt just below the ensiform cartilage. He became more
exsanguine; more pain of head came on, and eventually
coma, and lie died February 11.
Post-mortem examination. —Much clear fluid existed in
the snb-arachnoid tissues, and the ventricles were quite
full of the same. In addition to emphysema, there was
old tubercle of the lung. All the abdominal organs were
▼«y bloodless, but all were quite healthy, excepting the
left kidney, which contained a few cysts. The stomach
was displaced, and larger than it should be ; so much so
that the lesser curvature was below the pancreas, and
this organ could be easily seen and felt without displacing
any of the viscera.
Case XXIV.— Soft masses of carcinomatous (f) growth
connected with the peritoneum , pressing on the common
bile-duct; no similar growth elsewhere.
Robert T., oot flfty-tnree, was admitted Oct. 7, 1862,
having been ill only one month. In a day or two he
had become jaundiced. His abdomen had swelled, and
great pain now came on in that region, along with
diarrhoea. The pulse on admission was weak and skin
cold. The liver extended below the ribs lj inches ; no
fluctuation was found in the abdomen. The evacuations
ware pale and offensive. The urine was high coloured,
but in other respects natural. He got weaker, and on
the 16th became drowsy and confused in manner. The
abdominal pain became acute, and much headache came
on, and quickness of respiration. Complete coma came
on, and he died October 18th.
Post-mortem examination. —Much fluid existed in one
pleural cavity, and the lower lobe of the lung on the
same side was solidified. The heart [was natural, except
slight thickening of the aortic and mitral valves. The
liver was large and congested, and full of bile, but other¬
wise natural. The gall-bladder contained a small quantity
of bile. The ducts, dissected out, were founa to be
natural in themselves, but attached to the peritoneal
covering of the pancreas were two soft rounded mosses
which had obviously pressed on the common bile-duct
near the duodenum. These were rather larger than wal¬
nuts. Microscopically examined , they were found to con¬
sist entirely of globules much resembling those of pus,
but more irregular in shape, and showing, after the addi¬
tion of acetic acid, for the most part only one nucleus in
addition to granular matter. The tumours were supposed
to be carcinomatous, though nothing of the kind existed
in any other part of the body. Substance of pancreas
natural.
Case XXV.— Encephalold carci?uma of the lymphatic
glands of the abdomen and mediastinum. The various
viscera free , executing the duodenum, which was at one
point only slightly affected.
Elizabeth G., set. eighteen, was admitted Feb. 4, 1846,
having for three or four months been losing flesh and
strength; the catamenia had been absent five months.
She had lost appetite and become restless, having a slight
hacking cougn. Latterly the legs had swelled in an
evening.
On admission she had some dyspnoea and some degree
of pain in the epigastrium. The chest was pretty re¬
sonant on percussion, and only slight crepitation with
respiratory murmur was heard. Heart natural, but its
sounds diffused more than they should be. The abdomen
was somewhat tympanitic, but nothing positively wrong
could be felt She was often sick, but not particularly
after taking food. Bowels confined ; skin hot and diy ;
urine free from albumen. In spite of counter-irritation
to abdomen, and of tonics, profuse perspiration came on
aud diarrhoea, and by degrees she became much jaundiced.
Slight cough existed, but no expectoration. A dull pain
continued in the abdomen, but no fresh symptoms arose.
She became weaker, and died April 10th.
Post-mcrtem examination. —Thorax. The lungs ware
partially hepatised posteriorly. Heart healthy. A chain
of enlarged glands, infiltrated with encephalold carci¬
noma, existed in the posterior mediastinum, and lying on
the large vessels of the part
Abdomen. All the various viscera were natural. The
peritoneal cavity contained a small quantity of dark-
coloured serum. Behind the peritoneum , and surrounding
and pressing upon the greater part of the abdominal aorta
and upon the vena cava, was a large mass of encephalold
cancer. The pancreas was lying on this mass, but was
not affected by it. The large branches of the portal vein
and the ductus choledochus were imbedded in the mass.
The duodenum surrounded two-thirds of the tumour,
upon which it was partly lying; but it was not involved,
except in one small portion, where there was a slight pro¬
jection into the cavity of tne bowel, which was, however
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308 The Medical Press and Circular. FOREIGN MJSPJCAL LITERATURE.
October 7,1888.
still covered by healthy mucous membrane. The rest of
the intestines and the vessels were natural.
Case XXVI .—Large fibro-cystic tumour connected with
the right side of the uterus , thought to be ovarian dropsy,
Mary G., cet. forty-five, was admitted February 21,
1844, with anasarca of the legs and fluctuating distension
of the abdomen. She said the disease began with a solid
tumour in the left iliac region. The abdominal swelling,
which from its situation and fluctuation was thought
to be ovarian dropsy, continued to increase, and tapping
of the fluid had to be resorted to, when about eight quarts
of a thick brownish fluid were evacuated. Afterwards a
solid tumour could be felt low down in the abdomen.
Symptoms of low peritonitis set in, and she died April 12.
Post-mortem examination. —The lower two-thirds of the
peritoneal cavity were occupied by a large tumour, which
came up from the pelvis. The tumour was united by ad¬
hesions to the anterior walls of the abdomen. The upper
part was composed of large membranous cysts, of a dark
colour and inflamed, and containing a quantity of dark-
coloured fluid. The lower part was composed of solid
substance, containing an enormous number of cysts, which
varied from the size of the minutest network to that of
an orange. All these cysts were filled with clear serum,
which contained a large amount of albumen. The con¬
nection with the uterus was by means of a pedicle two
inches in breadth and one and-a-half in length ; it was
formed by the muscular fibres of the uterus, which were
traced up the sides of the tumour to some distance, and
then lost. In various parts of this tumoiuswere large
growths of solid structure, not containing any cysts what¬
ever, which looked like encephalold cancer; these growths
were found to be of a fibrous nature. In the body of the
uterus there was also a small white tense tumour, of the
size of a French bean, which also outwardly resembled
encephaloid, but was in fact fibrous. None of the glands
were affected. The liver, kidneys, spleen, &c., were
natural The preparation of a portion of the tumour is
described in our Pathological Catalogue. See Series xiv.,
No. 71.
- + -
£mi%\x gpfoM §ibnrta.
RECENT CONTRIBUTIONS TO THE THEORY
OF the INNERVATION OF the HEART AND
BLOOD-VESSELS,
(Rbpobtbd by Db. Christian Lovbn.)
Translated from the Hygiea for March and April, 1888, by
V r. D. MOORE, M.D.Dub.et Cantab., M.R.I A., L.K.Q.C.P.I.
gpNORARY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIANS ? OF
THE NOBWBQIAW MEDICAL SOCIETY? AND OF THE ROYAL MEDICAL
SOCIETY OF COPENHAGEN? SECRETARY FOB SWEDEN, NOBWAY AND
|U|NM4Bf, T£R EPIDEMIOLOGICAL SOCIETY OF LONDON.
(Continued from page 281.)
Cyon’s and Ludwig’s researches respecting the nervus de¬
pressor have been fully confirmed by Dreschfeld,* who has
repeated and extended their experiments in v. Bezold’s
laboratory. The author, in the introduction to his essay, en¬
deavours, as v. Bezold himself has also done in another
place,* to vindicate the priority of the letter in the disoovery
in question, as he so early as 1863 had observed “ that a
central irritation of the vagus, even after the sympathetic
nerves had been divided in the neok, and the cerebrum had
been removed , always produced a lowering of the pressure of
the blood.”*
Of the results at which the authors arrived, the following
ought to be mentioned :—central irritation of the nervus
vagus produces, when the cerebrum has been removed, a
1 "Ueber die refleotorische Wirkung das Nervus Vsgus auf den
Blutdruck." Untera. aus dera Phys. Laborat. in Wiirzburg II p. 328 .
f “ Ueber die physidogischen Wirkungen des es-bsauren Veratrin’s."
Von A. v. Bezold und Dr. Ludwig Dirt i Dnters. aus dem pl»y«.
Laborat. in WUrzburg. Bd. I., p. 108.
8 v. Bezold: "Untersuchungen iiber die Innervation des Herzens "
**• AbthaiL p. 281. The author, in a long note, whieh It is scarcely
necezaarr to reproduce here, bripgs forward his masons for believing
that v. Behold s claim to priority is not very weii founded.
diminution of the arterial blood pressure, which is commonly
more considerable (this, however, does not distinctly appear
from the experiments communicated by the author), than that
occurring on irritation of the nervus depressor. Direct irrita¬
tion of the stomach produces, both when the cerebrum is un¬
injured, and when it is taken away, and when the vagi, the
sympathetics and the depressors are preserved or divided,
in most cases a considerable lowering of the blood pressure, in
some instances no effect, and in others a slight increase of
pressure. Direct irritation of the lung has, under similar
circumstances, no effect. Direct irritation of the heart
always produces diminution of the blood pressure, and this
equally if the apex or base be irritated ; the frequency of the
pulse is at the same time usually increased, but only on slight
irritation.
As I have above stated, the errors in the experiments by
which v. Bezold thought he had established the presence of a
special exciting cardiac nervous system, proceeded from im*
perfect knowledge of, and consequent inability to eliminate,
the influence of the vaso-motor nerves. But after this void
in our knowledge had been essentially removed through the
investigations already described, it was to be anticipated that
the principal question itself, of the innervation of the heart
from the cerebro-spinal central organs, would be at once again
taken up. Accordingly, it has almost simultaneously been in
two places the object of investigations, which seem to have
been decisive.
The brothers M. and E. Cyon have instituted, in Professor
du Bois Reymond’s laboratory in Berlin, a series of experi¬
ments in this direction, which seem to bear at once upon the
question, and they have communicated particularly definite
result8.l The authors sought first to ascertain a point con¬
nected with the subject, with respect to which very conflicting
opinions still prevailed—this was the question of the influence
of the pressure of the blood upon the number of the cardiac
pulsations. Thus, on the one hand, Ludwig and Thiry had in
their experiments found in most cases the frequency of the
cardiac pulsations to increase in the same proportion as the
pressure of the blood was augmented, for example from com¬
pression of the aorta j on the other, PokrowBkyj had, in an
investigation carried on under Fick’s direction, constantly ob¬
served diminution of the frequency of the pulse under such
compression, and also MareyS had laid it down as a fixed lav,
that the heart beats more slowly the greater the resistance it
has to overcome. Like Ludwig and Thiry, the authors ob¬
served in most cases increased frequency of the pulse to attend
compression of the aorta, though in others diminution of tho
same took place. In some of the latter instances the diminu¬
tion was changed to increase on dividing the vagi and depra-
sors, in a few it continued notwithstanding.
In their subsequent experiments on the innervation of the
heart from the spinal cord the authors started from the hope
based upon the investigations quoted above, that by means
of dividing the splanchnic and sympathetic nerves in the neck
they should be able to exclude the influence of the spinal cord
on the vascular muscles. In all the experiments the animals
were poisoned with curare. The vagi, the depressors, and the
sympathetic nerves were first cut across. The spinal cord was
then divided on a level with the atlas—the blood-pressure sank
and the pulse became slower ; but electrical stimulation of the
cervical portion of the spinal cord caused both the blood pres*
sure and the frequency of the pulse to rise again very con¬
siderably. Alter both of these had returned to the value they
had immediately after the division of the Bpinal cord, both
splanchnic nerves were cut across, which was followed by a
further diminution of the blood pressure (from 10 to 20 mm.)
and of the frequency of the pulse. The spinal cord was then
irritated anew, and at first no increase whatever of blood-
pressure occurred, while, on the oontrary, the rapidity of the
cardiac pulsations was considerably increased, and was often
even doubled. It was not until the irritation was continued
for a long time that in some few cases a slight increase of the
arterial pressure took place (from 2 to 5 mm.)
That the aoceleration of the pulse did not depend on this
slight augmentation in the pressure, was shown partly by the
fact that this occurred only rarely, and partly because the two
1 Central blatt. far med. Wiss. 1808. No. 51. (Vorlaufige
lung.) "Ueber die Innervation des Herzens vom Rttokenmarke tin.
Reicherts und du Bois-Reymond’s Archiv 1887. No. 3. p. 889.
2 " Ueber das Wesen der Kohlenoxydvergiflung, Beitrag zar Phy¬
siologic der Herzinnervation." Reicherts und du Bols-Beymoad *
Archiv 1888. I., p. 69. ,
3 11 Physiologic mOdioalc de la Circulation du Sang.”
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Tbft Medieal Fms And Circular.
FOREIGN MEDICAL LITERATURE.
October 7, 1868. 309
changes did not stand in any proportion to one another, thus,
for example, in one case the blood-pressure rose after long-
continued irritation from 10 to 11 mm., but the frequency of
the pulse from 28 to 48 in 15 seconds. That the increase of
pressure did not depend on the acceleration of the pulse is
shown, on the other hand, partly by its later occurrence, partly
by its instability, partly also by a fact which shall be hereafter
communicated.
The authors consider that in these experiments they have
for the first time afforded an unassailable proof of the fact
that irritation of the spinal cord, even independently of altera¬
tion of blood-pressure, may produce an increase of rapidity of the
cardiac pulsations , and as the vagi, the depressors, and the cer¬
vical sympathetic nerves were in these cases divided on both
sides, this acceleration could be produced only by means of the
nerves passing from the spinal cord to the heart through the last
cervical and the first dorsal ganglion. This latter the authors
proved also directly by extirpating the ganglia just mentioned,
which can be done in the angle between the carotid and the
subclavian, without opening the thorax. This extirpation in
itself exercises no influence on the blood-pressure and fre¬
quency of the pulse, but after it has taken place irritation of
tne spinal cord is no longer capable of producing an increase
of the latter. But even in the animals so operated on, per¬
sistent irritation of the spinal cord produced a Blight elevation
of the blood-pressure (probably dependent on stimulation of
still uninjured vaso-motor nerves), which further proves the
lAtter to be independent of the frequency of the poise.
The authors consider that they have further, through these
experiments, demonstrated both that the diminution in the
frequency of the pulse observed after the division in the spinal
oora or of the sympathetic nerves, depends on the simultaneous
lowering of the blood-pressure, and also (contrary to v.
Bezold), that there does not exist (either in the brain or in
the spinal cord) any centre which constantly accelerates the
pulsations of the heart.
The authors next pass to an experiment to ascertain of what
nature the influence of these nerves is, and in what manner
irritation of the spinal cord can be regarded as accelerating
the pulse, and on these points they find three possible cases
conceivable :—
1. These nerves are simply motor nerves of the muscular
structure of the heart, which, innervated from a motor oentre
of the brain or spinal cord, constantly excite the heart to con¬
traction ; against this view a number of convincing arguments
are adduced, of which on]v one, as being of special interest, may
be quoted. It is, namely, that the intensity or amplitude of
each cardiac pulsation, on irritation of the spinal cord under the
circumstances just mentioned, does not increase, but it on the
oontrary diminished, simultaneously with the increase of the
number of the cardiac pulsations. 2. These cardiac nerves
may be reg« rded also as vascular nerves for the blood-vessels of
the heart. Prof. L. Traube has attempted such an explana¬
tion ( Klin-Woclunscikrift, No. 51), which is, however, rendered
inadmimi hie by the fact, that complete closing of the coronary
arteries does not exercise any immediate influence on the fre¬
quency °f the pulse.l 8. The authors themselves are inclined
to adopt a third hypothesis, namely, that these nerves pass to
the mo tor ganglia of the heart. They cannot, however, com-
munio&te these properly motor impulses, for then the sum of
the heart's motor work ought to increase on irritation of the
spinal cord, which the authors nevertheless have shown not to
be the ase, as only its division in time is altered. We must
therefore suppose the function of the nerves in question,(in
case they terminate in the motor ganglia, to be such, that they
diminish the resistance, which the regulating mechanism (the
restraining apparatus) opposes to the setting free of the tensive
fortes developed in the motor centres , and that, therefore, if we
look upon the function of the vagus as increasing this resist¬
ance they are direct antagonists of the nervi vagi.
In an “ Appendix ” with a separate title, “ Chi direct Irrita¬
tion of some Cardiac Nerves," the authoro communicate both
a description of the anatomical arrangement of the sympathetic
cardiac nerves, and the results they obtained on stimulating
some of these nerves. Excitation in the rabbit of the third
(reckoned from within), in the dog of the first of the nerves
passing to the heart from the last cervical ganglion produced
acceleration of the pulse, without the slighest change in the
pressure of the blood, The excursion height of each cardiac
1 This fact, which had been previously experimentally proved by
Panum (1869), has been recently confirmed by a number of experiments
instituted by v. Beaold (Unters. aus d. Labor, zu Wdrzburg. ff. p. 266).
pulsation diminished at the same time, just as on irritation of
the spinal cord, after the splanchic nerves were divided.
About simultaneously with the investigations of the brothers
Cyon, similar inquiries have been instituted in the physio¬
logical laboratory in Wurzburg, by v, Bezold [and several
of his pupils. The final result has been the same, although
the method was somewhat different, which must, of course,
still further strengthen oar confidence in the correctness of
the former.
In an essay under the title : Of the Influence of the Intra-
cordial Bloodvessels upon the frequency of the Cardiac Pulsa¬
tions. 1 Stezinsky and v. Bezold communicate the results of
their experiments upon this question. In them they started
upon the conviction, that it was necessary for the explanation
of the direct relation between the frequency of the cardiac
pulsations and the blood-pressure, that the heart should be
under the control only of the nerve-centres situated in its own
substance. Accordingly all these experiments were instituted
upon rabbits, which were slightly poisoned with curare, and in
which the cervical portion of the spinal cord, the vagi and the
sympathetic nerves were divided. In animals operated on in
this manner the authors observed a remarkably constant both
frequency of the pulse and blood-pressure—the former 42 to
48 in 15 seconds, the latter (lateral pressure in the carotid) 18
to 24 mm. of mercury. To increase the blood-pressure, three
different modes are employed : raising the back of the body,
whereby the great abdominal veins are emptied into the
heart; compression of the great vessels in the neighbourhood
of the heart ; and, finally, injection of calves’ blood into the
arteries. With some few exceptions (2 to 3 times in more
than 30), a constant augmentation of the frequency of the
pulse was observed on increase of the blood-pressure, provided
the latter did not exceed a certain limit, for in such cases the
quickness of the pulse again diminishes ; this limit is lower,
the lower the temperature of the blood is, and the more the
heart has been previouly fatigued. The relation between the
rapidity of the pulse and the blood-pressure seems also, under
the conditions mentioned, to follow a definite law, so that we
can almost d priori determine, what rate of pulse shall cor¬
respond to a certain blood-pressure. In a couple of experi¬
ments, instituted with a view to ascertain the influence of the
venous blood-pressure on the pulse, the authors found that its
elevation does not directly alter the frequency of the latter,
but only mediately through secondary filling of the left side of
the heart.
In another series of experiments v. Bezold 3 investigated the
changes the frequency of the pulse undergoes in haemorrhage,
that is, in diminishing arterial pressure. In this case, two
rabbits were employed, in which the vagi and sympathetic
nerves were divided, and which had been poisoned with curare.
The author started on the hypothesis that the diminution in
the frequency of the pulse observed on dividing the cervical
medulla, depends on the diminution of the blood-pressure, and
to a certain degree on an internal haemorrhage in the dilated
and paralysed abdominal vessels. But in this operation both
the vaso-motor nerves and the hypothetical “ exciting cardiac
nerves" are maimed at the same time. It was therefore of
the utmost importance for the decision of the question of the
existence of the latter, to ascertain what influence an external
hemorrhage, in which the heart is constantly in physiological
connection with the cerehro-spinal central organs, exercises on
the pulsations of the heart. If no spinal exciting cardiac
nerves exist, the number of pulsations must, on diminution of
the blood-pressure, fall according to the law communicated
in the foregoing essay ; if the latter be not the case, some
factor must be found in the brain or cervical medulla, whose
influence is destroyed by the division of the medulla.
The experiments instituted constantly showed that in the
commencement of the haemorrhage, while the blood-pressure
sinks, the frequency of the pulse rises to its maximum within
a certain limit ; if the blood-pressure now sinks still lower, the
frequency of the pulse also diminishes very rapidly. The
maximum of rapidity of the pulse (72 to 80 in the quarter-
minute) occurs ordinarily at about 20—26 mm. lateral pressure
in the carotid. Now, as when the cervical medulla is divided
this blood-pressure corresponds to from 44 to 48 pulsations in
the quarter-minute, and when the medulla is preserved to
from 72 to 80 beats in the same time, the additiou of from
24 to 36 beats must be caused by mere connection between
the brain and spinal cord, and can scarcely be due to anything
1 Unters. aus dem physiol. Labor, tn Wlirzburg.XL p. 195.*
2 Untersueh. aus a. Labor, in Wurzburg, n. p. 215,
Digitized by v^ooQle
310 The Medical Press and Circular.
FOREIGN MEDICAL LITERATURE.
October 7,18*
else than the presence of distinct cardiac nerves accelerating
the pulse. The diminution of the frequency of the pulse ob¬
served when the blood pressure sinks beneath a certain limit,
is easily explained by the fact that the cerebrum, or the cen¬
tral organ of the accelerating nerves, is paralysed by imperfect
nutrition. This is corroborated by some experiments, in which,
from the very commencement, both carotids were tied, and the
nutrition of the brain was consequently considerably compro¬
mised, the rapidity of the pulse then sank on bleeding imme¬
diately, without previous increase, and the same took place in
a series of experiments, in which, previous to bleeding, the
sympathetic nerves passing in the connective tissue between
the aorta and pulmonary artery to the heart, were destroyed
by galvano-caustic.
The author considers that from all these experiments with
bleeding he is justified in concluding—1. That the brain,
through the spinal cord, but in the indirect way of the vaso¬
motor nerves, can also act as a direct accelerator of the cardiac
pulsation; 2. That this takes place through the nerves passing
in the connective tissue between the aorta and pulmonary
artery to the heart; 3. That there consequently actually exist
spinal “ accelerating ” nerves of the heart, whose centre is
situated in the brain ; 4. That these nerves may be excited
from the brain by psychical irritation ; 5. That through their
increased activity the depressing influence which the diminu¬
tion of the blood pressure in the aorta exercises on the fre¬
quency of the pulse, may be over-compensated to such a
degree that the number of pulsations corresponding to a
certain intra-cardial pressure is almost doubled, and raised to
the maximum generally observed ; 6. That by the galvano-
caustic method (as employed by Ludwig and Thiry), all
spinal pulse-accelerating nerves may be burned away.
To ascertain how far these nerves also increase the intensity
of the cardiac pulsations, von Bezold has, in conjunction with
Bever, instituted a series of experiments, the results of which
are oommunicated in an essay entitled, “Von der Wirkung
der Spinalen Herznerven nach Ausschluss der Gefassnerven ”i
(On the Action of the Spinal Cardiac Nerves after Exclusion
of the Vascular Nerves); and he has arrived at essentially
the same conclusion as the brothers Cyon, though after a dif¬
ferent method. Through their investigations on the splanchnic
nerves, already quoted, the authors had shown that the most
important vascular nerves of the system arise from the spinal
cord, between the second and eleventh dorsal vertebrae ; by
dividing the spinal cord immediately above the first named,
wo ought, therefore, especially if at the Bame time the vagi
and sympathetic nerves were cut through, to be able, as nearly
as possible, to exclude all the vaso-motor nerves. If, now, the
cervical medulla lying above the seat of the division be sub¬
jected to electrical irritation, the action of the pulse-aooele-
rating nerves ought to be nearly unmixed. This was confirmed,
moreover, bv the experiments instituted. The action of irri¬
tation on tne cervical medulla was manifested by a constant
and considerable elevation of the frequency of the pulse, with
no, or only slight increase of the blood-pressure, while a pre¬
cisely opposite effect was produced by irritation on the dorsal
medulla lying below the section. The authors hence infer,
on the one hand, that the spinal cardiac nerves, for by far the
greatest part, arise from the spinal cord above the second
dorsal vertebra; on the other, that their influence consists in
accelerating the pulse, but that at the same time the work
performed by the heart must necessarily be increased. They
consequently propose to denominate these nerves nervi acce¬
lerators cordis , so as, by their name, to indicate their quality
Qf direct antagonists to the nervi vagi.
By another series of experiments the authors endeavoured
to ascertains by what route the nerves in question in the
rabbit reach the heart, and they found that this tak es place
through the ganglion stellatum (cervicale informs) and the
cardiac branches issuing from it. This ganglion the nerves
reach in three ways-—namely, through the cervical sympa¬
thetic and the two spinal roots of the ganglion. Bever, 3 more¬
over, co mmuni cates a special description of the anatomical
arrangement of these nerves in the rabbit
By Ludwig’s and Thiry’s above-mentioned works, it has
been shown what an important part the contractility of the
1 Unters. aus d. Labor. In Wtirxburg ii., p. 226. Bsrerhad previously
communicated the same experiments in an essay : “ Birtrige sur Lehre
vom den Her*- und Gefassnerven M (Contributions to the Theory of the
Cardiac and Vascular Nerves).—Wvirzburger Media Zeitechrift vii. Bd.
S “Von den Bahnen auf welchen die Beschleunigungsnerven zum
tretec,M—Uuter,ttc h* dem physiol. Laborat in Wurzburg, ii
3 Loo. oil, p, 849.
small arteries plays .with respect to the changes of the blood
pressure, insomuch—namely, that the contraction of these
vessels in the course of the circulation creates so considerable
a resistance that the lateral pressure in the larger arteries is
thereby driven up to its maximum. This is, howevsr, by so
means the only effect which this property of the smaller
vessels exercises upon the circulation. Goltz has already
shown by experiments upon frogs, that the oontractility of
the vessels, at least in these animals, has also the character of
propulsive force, and by this means assists the circulation;
and Thiry has communicated an observation showing that
the same takes place in warm-blooded animals. He observes,
in fact, that, as in rabbits which are suffocated, the heart at a
certain stage of asphyxia stands still in diastole, the right side
of the heart is continually distended with dark blood, a fact
which cannot be explained in any other manner than by the
assumption that the vascular muscles constantly drive the
blood from the smaller veins into the larger.
Von Bezold, now in concert with Gsoheidlen, submitted this
question to a more accurate experimental investigation, in
which the authons proposed, as the object of their researches, to
decide whether, and in what quantity, the blood is, in the con¬
traction of the small arteries, driven back towards the aorta, and
how far it is thereby transferred from the arterial system through
the capillaries into the veins or not. The method employed wai
briefly as follows :—By a suddenly acting means (strong elec¬
trical irritation or ligature around the base of the heart) the
influence of the heart on the movement of the blood was ex¬
cluded, and shortly afterwards (1—1^ minutes) the arterial (in
the carotid) and the venous (in the external jugular vein) blood-
pressures were simultaneously measured, the cervical spinal
cord being either preserved uninjured or divided. Disturbing
influences from muscular movements were prevented by poison¬
ing with curare. In the cases were the cervical medulla was
uninjured, the arterial and venous blood-pressures were found
to be, at the period mentioned, about equal (about 83 mm. of
blood); if, on the contrary, the cervical medulla was divided,
and the vaso-motor nerves were consequently paralysed, the
pressure, after the lapse of the same time, rose in the carotid
on an average, to 86*6 mm., and in the jugular vein to 43*6,
or only half of the former. Hence it follows that in the
former case, when the vascular muscles were in action, so
much blood had, in the short period of from 1 to 1J minutes,
pressed into the veins from the arteries, that the blood-prwsure
in the latter attained the same height as in the former—in
some it was even higher—and this could not have happened
in any other manner than through contraction of the vessels.
The authors subsequently instituted experiments with iniUr
tion of the cervical medulla separated from the brain, the
arrangements being in other respects the same as before, end
they found constantly an elevation of the venous pressure to
an average of 557 per cent, of the value previously observed,
while the arterial pressure as constantly sank. The quantity
of blood, if any, which, on contraction of the smaller arteries,
is driven back into the larger, must therefore be extremely
small. The authors regard their experiments as necessarily
requiring the assumption “ that the contraction of the small
vessels progresses in a certain order from the larger to the
smaller arteries, and in this manner pashes all or, at least, by
far the greater part of the blood which was previously fcwd
in these vessels, into the large veins.”
The well-known circumstance, that in the dead body the
arteries are generally found empty and the large veins fuD,
finds in this its natural explanation, especially if we look upon
this transferring of the blood from the arteries to the veins as
a kind of final action of the heart, which, interrupted by
pauses, continues after the heart has ceased to beat. Many
observations make it also probable that this propulsive power
of the vascular walls is also during life in action in sending
the blood in the proper direction, and if tills be so, the v o m eb
of the abdominal cavity must, especially those from which
the vena ports receives its supply—the mesenteric arteries, so
variable in their diameter and so abundantly supplied with
muscles and nerves—in this respect have the greatest influence.
Through these contractions the blood is sent with greater
force into the right side of the heart, and traverses the lunge
more quickly; but, at the same time, the resistance in the
arterial current is also increased, on which account the blood
pressure in the aorta is considerably augmented. This in¬
creased blood-pressure again, as has been already mentioned,
stimulates the heart to more energetic contractions, and in
this way the vaso-motor nerves act both directly and indirectly
in accelerating the circulation of the blood.
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Ootober 7,188& 311
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“ 8ALUS POPULI 8UPKEMA. LEX."
WEDNESDAY, OCTOBER 7, 1868.
-«.-
HOSPITAL SHIPS.
Tub absolute necessity that exists for Hospital Ships in
connection with military expeditions is now generally ac¬
knowledged. It was proved during the Crimean war, in
that against China, and more recently in regard to Abys¬
sinia. We now know pretty well all about what the
construction, fitting, and equipment of such vessels should
be; but somehow or other, the administration required
for them is still in as backward a condition as it was be¬
fore Russia was good enough to open our official eyes in
1854 to 1856. As the “ Regulations ” at present stand,
those that are considered applicable to a Hospital Ship on
board of which there is a Transport Officer are the Trans¬
port. Regulations, the Instructions to Transport Officers,
Instructions to Masters, the Queen’s Regulations, the
Medical Regulations, and the Purveyor’s Regulations.
These form a goodly array; but it so happens that, with the
exception of Article 103 in the last-named volume, there
is no special reference to ship3 of this description ; on the
contrary, there are many of those Regulations which not
only contradict each other, but tend to cause difference of
opinion between the officers of the several branches of the
public service doing duty on board, each being very natu¬
rally disposed to interpret all from his own particular
stand-point.
Such vessels are surely what they pretend to be, namely
floating hospitals. It is, therefore, fair to infer that the
instructions which are applicable to hospitals on shore are
equally so to them. The Transport Officer, however, is by
the code of Regulations under which he acts, led to form
the opinion that the ships in question are to all intents
and purposes mere transports ; and he may in this way be
led, really without any desire on his part, to become an
obstruction rather than an aid to the medical officer. The
Master, of course, considers himself strictly amenable to
the Transport Officer, and studies to carry out his views,
it may be, in preference to those of the officer in medical
charge of the sick, for whose accommodation the ship
which he commands was chartered; thus, the Medical
Officer may in some instances be kept without the power
of appeal, at the same time that alterations or arrange¬
ments deemed necessary by him are liable to be over¬
ruled or imperfectly carried out.
But, as if still further to complicate matters, an executive
Military Officer is in some instances placed on board
Hospital Ships, for the ostensible purpose of maintaining
discipline, as if that were a matter of such difficulty as to
require a specially trained person to attend to it alone. The
whole thing is not only a delusion, but by withdrawing an
officer from his own proper sphere—namely his regiment
—takes him from a position in which he may possibly be
of some little use, to place him where he can be of none
whatever. The entire system, in fact, requires to be re¬
considered. If a Medical Officer is to be responsible for
his sick, let him have the entire control of all matters
connected with them, whpther on shore or at sea, whether
those refer to accommodation, attendance, food, clothing,
or medicine ; and let us have a plain and comprehensive
code of rules for their guidance under whatever circum¬
stances they may be placed. Then, and not till then, shall
we get rid of the conflicting authority of Departments ,
under which the real interests of the Service are so often
literally strangled in the meshes of red-tape and routine.
Let military men stick to military matters, naval men to
naval matters ; but let us never forget that sick and
wounded soldiers come within the special province of the
medical man.
- » -
gjftfks 0ii Citrmrf ®0jjks.
The Introductorieo.
The current topic of the week has unquestionably been
the opening of the medical schools. The first of October
has come, and with it the salutations of old friends and
exhortations to new students, which from the traditional
celebration of the season. Of course it is impossible for us
to furnish the whole of these orations in full. They would
extend over too many numbers. We are happy to have
the privilege of giving our subscribers Mr. Critcbett’s
remarkable address in extenso. We have inserted the
whole in one number, as a lecture of this kind is spoiled
by division. We also give abstracts of some other
lectures.
The Dinners.
S everal of the Schools, not satisfied with the inaugural
gatherings assembled for the Addresses, have celebrated
their opening day by the pecular institution of their coun¬
try—a dinner.
The St Bartholomew’s dinner was held at Willis’s
Rooms, Dr. Frederick Fane in the chair, and nearly
one hundred St Bartholomew’s men did honour to the
occasion.
Dr. Francis Hawkins presided over the ninety students
and friends of the Middlesex Hospital, who dined at
St. James’s Hall.
More than one hundred and thirty former pupils and
friends of St. George’s Hospital inaugurated the opening
of the new Medical School by a dinner at the Grosvenor
Hotel, over which Mr. Charles Hawkins presided.
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312 The Medical Prew and Circular.
CORRESPONDENCE.
October 7, ISM.
Prizes.
At several of the schools the prises previously earned by
pupils were awarded at the close of the Inaugural Ad¬
dresses.
Queen's College, Birmingham.
This institution secured an influential layman as lecturer
this year. Lord Lyttleton, formerly Principal of the
College, delivered an Address, which will be read with
a pleasure, only short of that with which it was heard.
Other schools have gone beyond their own staff before
this and we should not be surprised if the practice increases.
A Medical Lecture in a Chapel.
The announcement that Mr. Critchett would deliver the
lecture at the London Hospital, drew such a large audience
of old friends and pupils that there was not nearly room
enough in the large theatre. After a little delay permis¬
sion was obtained to adjourn to the commodious chapel of
the hospital, where the favourite lecturer delivered his
Address. The chapel was quite filled with attentive
listeners. We must admit that the sight of so large an
assembly crossing the garden from the college to the hos¬
pital chapel was one of the most striking scenes of the
opening day of the Metropolitan Schools. The writer is
happy to record public thanks to the authorities for the
use of the chapel, which enabled him once more to listen
to the voice of one of his most respected teachers.
University of Cambridge.
The Professor of Anatomy will commence a course of
Lectures on Practical Anatomy on Monday, October 12,
at One p.m., in the Old Anatomical Schools, and he con¬
tinued daily till the 20th, and after the 20th on Mondays,
Wednesdays, and Fridays, at Seven p.m. The course on
Anatomy and Physiology will commence on Tuesday,
October 20, at One p.m. in the New Museums, and be
continued on Tuesdays, Thursdays, and Saturdays. This
course is intended for students of Natural Science as well
as for Medical Students. Microscopical Demonstrations
will be given on alternate Mondays at Six p.m., commencing
on October 26th. Practical instruction in Minute Ana¬
tomy will be given by Mr. J. Gedge, of Caius College, on
Saturdays, at Eleven a.m., in the Old Anatomical Schools,
commencing on October 17th.
The Fall of the Leaf.
A distinguished botanist, M. Trficul, and others have
lately been engaged in investigating the cause of the
autumnal stripping of trees, and their researches would
seem to point to the conclusion, that in many plants a
phenomenon occurs just before the fall of the leaf, which
is not unlike the process which accompanies the shedding
of horns in animals. It consists in the obstruction of the
proper vessels at the base of the petiole or leaf-stalk. This
obstruction (adds an American writer) is caused by the
multiplication of cells, which first occurs in the parietes of
the vessels. The cells increase and multiply, till at last
the vessels are completely choked up in the neighbourhood
of the insertion of the leaf, and thus a differentiated plane
is formed, across which the leaf-stalk breaks, and the leaf
accordingly Ms.
The Aberdeen and Glasgow Universities
Election.
London, Aberdeen, and Glasgow last week resounded
with rumours that Mr. Moncrieff would probably retire
from the contest for the Universities of Glasgow and Aber¬
deen, and seek re-election for the'city of Edinburgh. Is
there no medical man ready to come forward ? If the
Liberals can find a medical candidate it may greatly aid
them.
Another Medical Candidate for Marylebone.
It is said that Dr. Forbes Winslow is to he seriously
brought forward in the Conservative interest. If a Con¬
servative is to win, let it he a medical man, by all means;
but we believe the Liberals are much too strong in the
borough ; and we hope, therefore, that no medical man
who can conscientiously support Dr. Humphry Sandwith
will desert him for the new-comer. Neither gentleman
has said anything about the questions that most interest
the profession, but Dr. Sandwith, as an advanced Liberal,
could scarcely go wrong. Why should not Dr. Winslow,
if he desire Parliamentary honours, seek a constituency
more likely to support his views ?
Poison in Socks.
An outcry has been raised against the dyes now used as
producing disease of the skin. Mr. Crookes, a reliable
authority, has written to the Times to show the innocence
of pieric acid. He properly mentions that some manufac¬
turers have recently saturated this acid with an alkali,
and warns them that by so doing they produce a highly
dangerous, explosive compound. Mr. Crookes gives some
further notes on dyes, and kindly offers to identify the
agent said to have caused disease should it he sent to him.
We may, therefore, hope soon to have something tangible
in place of sensation assertions.
An Unfinished Infirmary.
An architect writes to the Times, to draw attention to
an unfinished building near Bishop’s Waltham, Hants,
intended for an infirmary, and enjoying Royal patronage.
He says a few hundreds would complete it, and it “ must
have cost several thousands ” as it stands.
- * -
THE LANCET EXPOSED.
TO THE EDITOR OF THE MEDICAL PRESS AND CIBCUUI-
Sir, —Whatever difference of opinion may exist in the
S ofeaeion on Special Hospitals, all will admit that Special
ospitals and the medical men connected with them, are
entitled to fair play in the columns of a newspaper. The
conductors of the Lancet } 'however, most unfortunately—
I mean most unfortunately for the Lancet —think other¬
wise, and act upon their opinion. This I will at onoe
proceed to prove. On the 25th of last July, the 1/smA
contained a sensational article directly levelled at the
Hospital for Diseases of the Throat and its Physicips-
In that article the writer insinuated that the physicians
to the hospital “ arrogate to themselves superior powers
in the treatment of certain diseases, and parade their
claims to superiority in a most offensive and unjustifiable
mann er.” He catechised Sir Wm. Fergusson, the Conauh*
ing Surgeon, and SirWm. J enner, the Consulting Phytioian
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The Medic* Pratt and Circular.
CORRESPONDENCE.
October <T, 1806. 313
to the hospital, and endeavoured to detach them from it
by suggesting that their connection with it implied an
insult to the great body of surgeon* and general practi¬
tioners. Moreover, he directly stated that the hospital
had been “ advertised and lauded in a way that really
calls a blush on the cheek of those who have the honour I
and welfare of the profession at heart.” This article was
as signal a failure as it deserved to be. Sir Win. Fergus-
son and Sir Wm. Jenner did not take the slightest notice
of it, although the writer, imitating the tailors of Tooley
Street, declared that “ the Profession” were “ looking to
Sir W. Jenner and Sir W. Ferguason for an answer” to
the cateehiam aforesaid. Very uncourteous conduct,
truly, on the part of these distinguished men towards the
expectant and eager Profession, alias the clique of con¬
spirators at the office in the Strand !
The physicians to the hospital treated the article with
contempt. A solitary letter was elicited from some one
who signed himself 11 General Practice;” probably the
writer of the article himself. I was the only person
who took compassion on the article. Although 1 knew
with what freedom of brush and daubs of colour the
Lancet could paint, I thought I might give it credit for
not “ drawing ” wholly “ on its imagination for its facts.”
So having the welfare of my profession at heart, “ and
being grieved to think that objectionable advertisements
about the hospital should have been inserted in the news¬
papers and escaped my notice, as a Member of the Com¬
mittee of Management, I wrote and asked the editor to be
so good as to specify the advertisements which he cen¬
sured as being of a strongly rubefacient tendency. In the
“vermiform appendage'’ of editorial comments attached
to my letter, which was kept back for a week to give time
for tlieir manufacture, the sole justification adduced for
the charge of shameless advertising was a small paragraph,
quite un-official, which was inserted in The Times, and
related to the dinner which had been held in aid of the
hospital. I then wrote the accompanying letter, in
honour of which the conductors of the Lancet held a
council of war, and decided that affairs wore an aspect so
unfavourable that ‘Andialteram partem f which I have else¬
where designated the Habeas Corpus of correspondents to
the Lancet, must immediately be suspended.* Accordingly,
my letter was suppressed. To cover this movement a con¬
gratulatory annotation was inserted, describing the retreat
of the enemy and the complete success of the Lancet's
cannonade. It was all over with the hospital because “ a
board” at the corner of Regent Street had been removed.
This said “ board,’ 5 boldly described afterwards as a “flaunt¬
ing advertisement,” was not a “ board,” but a small plate
of enamelled iron, about a foot long and three-quarters of
a foot deep, attached to the cross-liar of a lamp-post as an
index to those who wanted to find the hospital. The
order for its removal had been given weeks before the
Lancet attacked the Hospital, although its execution was
delayed by the secretary, so that the Lancet need no
longer remain under the delusion that its thunder has
shaken anything at all. In point of fact, the thunder has
lately become so feeble and ill-conditioned that either the
journeyman artist who mixes it must be changed, or a
new Sanitary Commission appointed to inquire into the
cause of its adulteration ana loss of power.
But seriously, Sir, it is greatly to be regretted that the
Lancet should abuse its position, and, abandoning itself
to the arts of trickery, become lost to a sense of decency,
and pay no regard to veracity. Our leading journal, in¬
stead of becoming a misleading journal, should be sans
peur et sans reproche, and respected throughout the pro¬
fession. Instead ot that, its reputation is tarnished, and
all over the country men are “wagging their heads” at it.
Why is this ? Because it is mis-managed by a clique,
and is not honest For several years honesty has been
the last polioy it has thought of pursuing. Few are the
depths of journalistic ,baseness which it has not sounded.
Suppression of letters it cannot answer is bad enough,
but what can one think of suppression, combined with the
mention of the writer’s name, and abuse—untruthful
abuse—of a reply to a gross personal attack ? Does con¬
science smite it! Conscience ! I beg its pardon, It is
too old an offender to be able to say with Macbeth, “ I
am ashamed to think what I have done ; look on’t again
I dare not.” It would do the like to-morrow if it could
do so with impunity. Where there is little or no regard
for truth, there is not much “ virtue extantand that
regard for truth is not a ruling passion at 423, Strand,
the utterances of the Lancet at the last election of Coun¬
cillors at the College of Surgeons plainly show. The
Lancet supported Sir Wm. Fergusson, Messrs. Simon,
Holden, and Gay, and opposed Professor Humphry. On
June 27th, in an article written immediately oefore the
election, and of course intended to influence it and secure
the return of Mr. Gay, instead of Mr. Humphry, it said
(the italics are my own): “We believe that tne gentlemen
who will receive the largest amount of support on the
present occasion, after Sir W. Fergusson, are Messrs.
Simon, Holden, and Gay.Professor Humphry’s
position as a scientific surgeon and as a leading provincial
practitioner will secure him support on a future occasion ,
should he be more explicit in ms views on medical policy.
He has, we believe, been hurried into the field at the
last moment, and has hardly had time to realise his posi¬
tion.” Sir W. Fergusson, Messrs. Simon, Humphry, and
Holden were elected. Nevertheless, in spite of this, the
Lancet had the hardihood to say the very next week
(July 4th), “ the event has confirmed our prognosis , and we
congratulate the body of Fellows on the gentlemen they
have returned, regardless of the pressure which has been
brought to bear upon them in certain quarters,” There is a
strong resemblance here to the effrontery of the racing
prophets. Further on, the Lancet, quotingan annotation
which appeared a month previously, says of Dr. Humphry’s
election: “ The result has only confirmed the opinion we
expressed when we announced Dr. Humphry’s candida¬
ture.” Why did it not add ? “ and belied the opinion we
pronounced last week, when we endeavoured to prevent
Dr. Humphry’s election.” This suppressio veri reminds
me that, up to Sept. 26, it ignored Dr. Prosser James
as a candidate for Edinburgh and St. Andrew’s Univer¬
sities, and omitted his name even when professing (Aug.
29th) to give a list of “ tjie gentlemen who up to the
present time are in the field for parliamentanr honours.”
Why ? Not because it was unaware of Dr. James being
a bond fide candidate, but probably because Dr. James is
the honest editor of an honest newspaper. And now, to
obviate misconception, I have two or three words to say
about the position which I occupy with regard to special
hospitals. I am not, and have not, been connected pro¬
fessionally with any special hospital, and so far as I am
personally concerned, my sympathies would lead me to
range rayaelf on the side of the general hospitals, inas¬
much as I am attached to a general hospital as Assistant
Surgeon and Lecturer on Anatomy, and have charge of a
special department. But I could not shut my eyes to the
disadvantages and delects of large hospitals in a sanitary
point of view, and to their slowness in effecting improve¬
ments ; nor could I ignore the fact that several special
hospitals have sprung up through the failure of general
hospitals to meet the wants of the cases for which those
special hospitals were founded, and that the effects of these
special hospitals have been to cure a number of so-called
“ incurable” cases, and beneficially to stimulate the general
hospitals. The time, indeed, may come when special hos¬
pitals may be no logger needed as isolated institutions,
but may be so grouped, combined, and organised, as to
become of the highest value for educational purposes.
There is no reason why they should not be utilized any
more than there is for the valuable material at our work-
house infirmaries being thrown away. I hope to see the
day when some method will be introduced into our hos¬
pital system, and some reformer who is not abusive will
endeavour to combine the scattered and independent in¬
stitutions in the metropolis for the better training of me-
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314 The Medical ftreaa and Circular.
CORRESPONDENCE.
October 7, IMS
dical students and tbe good of the community. But so
long as things remain in their present condition, J claim
for others as well as for myself the liberty of independent
action on an independent judgment, and immunity from
those bitter personal attacks inspired by personal jealousy,
which convince no man, effect no alteration, and greatly
lower the medical profession in the eyes of the public at
large.—I am, Sir, your obedient servant,
Oct 3, 1866. Walter Rivinqton.
P.S.—It may be as well to mention that I have omitted
two sentences from my letter to the Lancet because they
contained a personal allusion to a friend.
COPY OP L IT T ER TO THE EDITOR OP THE LANCET.
Sir, —It ought to be distinctly understood that the Com¬
mittee of Management of the Throat Hospital are not a whit
more responsible for complimentary notices in the Times and
other newspapers than they are for adverse articles in the
Lancet. The paragraph which formed the sole basis of your
charge—that the “ hospital had been advertised and lauded in
a way which really calls a blush on the cheek of those who
have the honour and welfare of their profession at heart”—
did not emanate from the Committee or any one connected
with the hospital, and was not an advertisement at all.
Judging it from the cautious extracts of the Lancet , it seems
an innocent production and quite undeserving of the wrath
which it has provoked. What is the necessary inference from
these circumstances? That the charges made against the
management of the Throat Hospital completely fail, and that,
inasmuch as these charges reflect injuriously on honourable
men, their withdrawal would be an act of justioe and of grace.
But it so happens that in a paper containing information
about the hospital, and issued with the sanction of the Com¬
mittee, the Registrar-General's returns are quoted. Why?
On good and unexceptionable grounds. The Hospital for
Diseases of the Throat avowedly receives cases of croup and
diphtheria. It is not and was not intended to treat only local
affections, pure and simple, but also, with a few necessary ex¬
ceptions, all the diseases which make the throat the seat of
attack. And, therefore, to point out the prevalence of these
complaints is to adduce the needed proof that a hospital spe¬
cially devoted to them would have abundance of work to do.
To lay stress on the fatality of these diseases is to indicate the
necessity for providing increased ac. ommidation for them that
they may be treated under the nnst favourable conditions,
with a view, if possible, of ultimately diminishing their death-
rate—that is, the extent of the application of these returns.
None but the alienated oould possibly infer, or attempt to
make others infer, from a quotation of this kind that all the
fatal cases would have been saved by admission into a throat
hospital.”
But the fresh charge is now made by the Lancet, that
“ every advertisement or paragraph about throat hospitals
only impose upon the ignorance and credulity of individuals
suffering from laryngeal affections a* the product of blood
poison, or the eonoomitant of pulmonary phthisis, syphilis, or
hysteria; when it deceives them into ignoring a grave consti¬
tutional disease, by the exaltation o', it may be, some insig¬
nificant outlying ailment.” By parity of reasoning, indivi¬
duals with small-pox, or scarlatina, or syphilitic psoriasis, or
Addison’s disease, seeing advertisements about skin hospitals
would be deceived into the belief that they were merely suf¬
fering from a skin affection. Happily the fallacy of this logic
Is easily demonstrated. Before the Throat Hospital was in¬
stituted many a patient with laryngeal phthisis or syphilis has
been under the impression that he had merely caught a slight
cold. And now, in this age of paragraphs about throat hos¬
pitals, patient* still take a favourable view of their cases.
But suppose that while they were in this condition, never
having heard before of the Throat Hospital, their eyes lighted
on a paragraph or advertisement about the Hospital for Dis¬
eases of the Throat, and they decided that it might be worth
while, as they were poor men, to go there for an opinion.
What then? What dreadful deception is practised on them?
This. The physician at once undeceives them, and applies
the appropriate remedies. And let it be observed, that laryn-
phthisis, syphilis, and hysteria, especially the two latter,
are often far more effi jaci-msly treated, and far mire speedily
cured, at this depreciated Hospital for Diseases of the Throat,
than they would have been at any general hospital. I am
speaking strictly from the book, and if the statements be
doubted, let the matter be submitted to a fair commission of
inquiry. Some high medical authorities on syphilis and ner¬
vous diseases have sent cases of this kind to the hospital,
cases which had resisted treatment, but which yielded in time
to remedies applied with the aid of the laryngoscope. One of
the most effective remedies for hysteria and narvo-mucoUr
affections of the larynx is the direct application of galvanism
to the parts affected.
But while repudiating the idea that patients are deceived
through the working of the Throat Hospital, we do not deny
the occasional existence of abuses at special hospitals. Abuses,
however, are neither confined to special hospitals nor any
necessary part of their organisation, nor greater at the special
than at the general hospitals; and though it may be true, as
you say, that “ these abuses would not have been tolerated for
a moment by the physicians and surgeons of a past genera¬
tion,’* it will tend to a just estimate of the merit of these emi¬
nent men in the reformation of abuses, if the fact be recalled
that at their own hospitals they tolerated abuses so grosa a»
to call forth from the Lancet the most vehement denunciation!
of the prevalent corruption, monopoly, and nepotism.
The next argument advanced against the Hospital for Dis¬
eases of the Throat and special hospitals generally, amounts
to this: that patients should only go to certain privileged, or
as it is euphemistically put, “ accredited” institutions, in order
that they may be examined by students who have made pri¬
vate pecuniary arrangements for that purpose with the me¬
dical officers. Subscriptions, dinners, and dukes being im¬
proper for special hospitals ought to be enjoyed only by the
general hospitals.
This argument has a disagreeable flavour of monopoly and
rotection, principles of a bye-gone time; for no one of “truly
beral” views would admit that one hospital has a greater
right to exist than another; and political economists would
denounce attempts to check by arbitrary means the over-mul¬
tiplication of hospitals. Evils of this kind cure themselves, for
any institution not really useful to the public will either die
or sink into insignificance for lack of support. Besides the
carter has no occasion to call upon Jupiter to get his wheel
out of the mire. The general hospitals have the remedy
against the encroachments of special hospitals in their own
hands, and cannot in justioe complain of the fruits of their
own sluggishness and failure to make adequate provision for
special cases. I will illustrate this from the London Hospital.
Special departments for the eye, ear, and skin were not insti¬
tuted till 1867, yet there were indications for them years ago,
and the strongest indications for an eye department The
Moorfields Ophthalmic Hospital hod been founded early in
the present century, and was filled with eye patients, while
the London Hospital was almost destitute of them. Seversl
years ago, much to his credit, Mr. Critchett endeavoured to
obtain an eye department, bat without success. Three yean
ago it would have been impossible to obtain special depart¬
ments ; a throat department would have been equally unat¬
tainable.
Well, Sir, the experience derived from the working of the
special departments at the London Hospital clearly showi
that by the adoption of liberal measures a general hospital
may insure abundance of material for training its students in
the diagnosis and treatment of special diseases. Eye cases
will be found in the eye department in spite of ophthalmic
hospitals; skin diseases will swarm in spite of skin hospitals;
aural cases will not bs led away by ear dispensaries and ortho-
phonio insfcution*. .Patients will go to the nearest hospital, if
the arrangements are convenient and the officers have reputa¬
tion.
With regard to special hospitals diverting funds from general
hospitals, it must be recollected that the money subscribed to
special hospitals is subscribed because they particularly com¬
mend themselves to the donors, and that the money, if nut
given in this way, would be likely to continue “ to fructify in
the pocket”
The statement that there are advertisements and placard*
at the corners of streets directing patients the way to the
Throat Hospital seems a bolder use of the figure Hyperbole
than is to be met with out of the classics. There are no
“placards” or “advertisements,” in the ordinary sense of
these terms; but the approach to the hospital being somewhat
intricate, one or two small plates, with an indicating hand,
neatly executed, and the words, “ To the Hospital for Diseases
of the Throat,” have been placed at one or two of the turn¬
ings. They are a convenience to persons wishing to find the
hospital, are quite inoffensive, and can only be obnoxious to
the hypersesthetic.
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INTRODUCTORY ADDRESSES.
October 7, 1888. 315
Having now replied to all the arguments and charges con¬
tained in the comments appended to my letter, I most retire
from this discussion, whatever fresh charges may be adduced.
There are obvious objections to a prolonged controversy with
an Editor in his own journal; but in order that my silence
may not be attributed to any exhaustion or consciousness of
weakness, and in order to set this matter at rest, I am fully
prepared, and should indeed be pleased, to discuss the subject
before any professional tribunal, impartially constituted, with
the Editor of the Lancet or any member of the staff who may
happen to endorse his opinions. I can name no better jury
than a meeting of the Metropolitan Counties Branch of the
British Medical Association ; and very confident I am that,
after hearing both sides of the question, such a jury would not
condemn an institution “ founded to facilitate the employment
of the laryngoscope among the sick poor,” within whose walls,
since its inauguration, at least 10,000 patients have been ex¬
amined with that instrument—an institution whose practice,
freely open to members of the profession, has been attended
by 200 or 300 medical men, and which affords to general prac¬
titioners the greatest facilities for acquiring, without payment ,
the use of the laryngoscope, to instruction in which the libera¬
lity of the medical staff devotes one afternoon in every week.
—I am, Sir, your obedient servant,
Walter Rivington, M.S.Lond.,
Aug. 10, 1363. Assistant-Surgeon, London Hospital.
Copy of Postscript to Letter of August 10.
P.S.—It is worthy of note that the identical paragraph about
the Hospital for Diseases of the Throat, which appeared in the
Times , and which has been so stigmatized by the Lancet , was
subsequently inserted in the Medical Times ami Gazette.
Evidently the Editor of the last excellent journal took an
entirely different view of the paragraph from that taken by
the Lancet. This paragraph I have had an (opportunity of
seeing since writing my letter. The only sentence in it to
which any possible objection of a reasonable kind can be raised
is this:—
“The necessity for an institution of this kind is amply
shown by the returns of the Registrar-General, from which
it appears that in 1866 no fewer than 24,000 deaths occurred
from croup, diphtheria, and other throat diseases.”
The objections which may be raised are two: it may be
denied that these returns are sufficient to prove the necessity
for a special hospital; and it may be said, as the Lancet says,
that diphtheria is not a throat disease. Both of these points
are questions, not of taste, but of opinion. For my own part,
I do not think the necessity for the Throat Hospital amply
shown by the returns of the Registrar-General, and the Com¬
mittee of Management have never put forward that view.
The necessity for the hospital is based, in onr opinion, on the
inade quate provision made at the general hospital for
the employment of the laryngoscope. But, on the other hand,
if any one thinks with the reporter of the Times , he is quite
entitled to hold his opinion without censure, if not without
criticism.
With regard to the second point, I for one should certainly
be inclined to call diphtheria a throat disease, whether infec¬
tions or uninfectious, and whether due or not due to a mias¬
matic poison. This may be heresy; but heretics, it is gene¬
rally admitted, ought not to be burnt or branded; the only
weapons that may be employed against them are the weapons
of polite argument, addressed without heat to their under¬
standings, and the heretics have the right of defending their
opinions in a similar way. This gives the heresy a fair chance
of being ultimately engrafted on the orthodox creed.
The foregoing remarks have been rendered necessary by the
course pursued by the Lancet. What we complain of in that
course is that it has fastened on an unofficial paragraph in the
Times , censured it as an advertisement , and made it a basis for
a sensational attack on the Throat Hospital and those con¬
nected with it It has treated matters of mere opinion as
matters also of taste; and, having assumed that its own
opinion is right and the opinion of the profession, it has de¬
nounced the opposite opinions as unprofessional and as provo¬
cative of the blush of shame on the loyal cheek. This course,
we fearlessly assert, is calculated not to convince but to annoy,
is not the course to heal the breaches, or to produce harmony
and unity in the profession, and is tantamount to directly
singling out individuals not agreeing with the Lancet, and pur¬
suing, as they have a right to pursue, their own judgment as
to special hospitals, ana endeavouring to make these indiri-
imahi the objects of professional distrust and Reprobation.
August 11, 1863. W. R.
Introductory Address
DELIVERED AT
THE LONDON HOSPITAL,
OCTOBER 1st, 1868,
By GEORGE CRITCHETT, Esq., F.R.C.S.,
Late Surgeon to the Hospital, and Professor of Surgery and Ophthalmic
Surgery; Surgeon Royal London Op' th&lmic Hospital, Ac.
At the kind and flattering request of your Medical Council I
appear before you to-day for the third, and I fear I must add
for the last time, to inaugurate the winter session by an In¬
troductory Address. As my mind travels back through the
long vista of years since I commenced my career as a medical
student at this hospital, I cannot but feel deeply and solemnly
impressed with the changes time has wrought. Of those who
then held the foremost rank at our hospital, and in our school,
and of whom, in onr retrospect, we seem constrained to say,
“ There were giants in those days,” how many have passed
away from us; one indeed still remains, our much loved much
respected Dr. Billing, but he has left the east where he rose
so brightly to accomplish a glorious setting in the west. Bat
though our Blizards, and our Headingtons, and other great
ones have passed away, though these ancient worthies who
made so high a reputation for our hospital and who created
our school, are gathered to their fathers, the spirit that
animated those great and good men, and earned for them their
high renown, has lived in their successors. If those mighty
spirits of old could revisit the scenes of their former labours
they would find that the germs of thought sown by them had
fallen on a rich and fruitful soil, and that much which seemed
to them as hopes and dreams and possibilities of future pro-
gre is had been transformed into solid and beautiful realities.
They would still find the dear old hospital, with its fine
ancient body, but how changed it would seem with its grand
expanded wings, and its separate wards for diseases of the
eyes and for syphilis, seeming to suggest that it claims, and
justly claims, to soar as high in usefulness, benevolence, and
in science as any similar institution in the country ; they
would find their school expanded into a college, and well fur¬
nished with every modern appliance, and illumined by a body
of professors, who, for zeal, science, and high reputation in
their respective subjects, may fairly challenge comparison with
those of any other school; and though last, not least, that
which gives life and spirit and usefulness to all schools, and
which constitute their most legitimate pride, they would find
a large and ever increasing body of intelligent, diligent, and
high-toned medical students. To create such a school, and to
diffuse the benefits of the hospital throughout the length and
breadth of the land, was the thought that filled the minds of
our Fathers in Medicine and Surgery, and I may perhaps be
permitted to mention here for the encouragement of the
pupils, that there is a scholarship of £20 for first year’s stu¬
dents for human osteology; also of £25 for first Year’s students
for anatomy, physiology, and chemistry ; also the Duckworth
Nelson prize of ten guineas and three Scholarships of £20 for
proficiency in Clinical Medicine, Surgery, and Obstetrics
respectively. The vast gathering assembled within these
walls to-day would seem to them, as it does to us, in token
that the wish of their hearts has been accomplished. All
whom I see around me are doubtless associated with the
London Hospital. There are some, it mav be, who have well
nigh run their course, some who are in the meridian of their
active career, and some who are just commencing their Medical
studies. To one and all, in the name of the Medical Council
of this Hospital and my own, I beg to gi ve you a hearty welcome.
It is good for us all to meet together in this way from time to
time. Some of you came here to-day to see old familiar faces,
that you have long welcomed and loved, to grasp the warm
hand of friendship, to renew old associations, or to show the
keen interest and confidence in the Alma Mater by placing
some of the rising generation, in whose welfare yon are most
interested, under her fosterihg wings ; and some it may be, he
who now addresses you is vain enough to hope, may have come
to hear his voice once more, some who perhaps remember him
as their fellow pupil or as their former teacher ; for he cannot
forget how many of his warmest friendships have been formed
at the London Hospital; how proud he feels when he heart of
the success of his old colleagues or of his old pupils ; and gen¬
tlemen, rest assured that the warm interest he has ever felt in
the welfare of the London Hospital and its college, can only
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316 The Medical Press and Circular.
INTRODUCTORY ADDRESSES.
Ofetob«M»*
cease when his voice is hushed in silence, and when his heart
beats no more. But amid the various feelings and emotions
that an occasion like this excites, I must not forget that it is to
those who are here for the first time to-day, and that are about
to enter as students of medicine, that I have chiefly to address
myself ; they are essentially the heroes of the day, and it is
my privilege and duty to introduce them to their newly
adopted profession, to give them some faint sketch of the path
that is before them. In carrying out this object I shall en¬
deavour to give you my young friends a few general principles,
that it may be useful for you ever to keep before your minds,
as explaining the object and aim of all your various studies
and lectures. The end to be obtained is the knowledge of
disease ; that man occupies the highest pinnacle in our pro¬
fession, and marches in the first rank, who is the most inti¬
mately acquainted with morbid action, its cause, its history,
the tissue changes resulting from it and its treatment. How
to arrive at this 44 consummation so devoutly to be wished,” so
rarely reached, there is but one road ; you may lay it down a3
a law that, the accuracy with which you are able to estimate
disease, (and by disease I mean every possible departure from
the normal standard) will be in exact proportion to your know¬
ledge of the form, structure, and function of each organ, and
of the various tissues and organs of which the body is made
up. This knowledge comprises anatomy, (general and minute)
and physiology. Thoroughly and practically to acquire this
should be the very main object of your early studies here. Let
me give you a few illustrations of the truth of what I am now
insisting upon. The London Hospital as you well know is re¬
nowned as a surgical school, and more especially for the num¬
ber and endless variety of accidents that are pouring in. It
will be your privilege to see and to assist in the management
of these cases, but most of them will be unintelligible to you
until you have learnt your anatomy, but the man who has
thoroughly mastered this science may defy any variety of acci¬
dent to puzzle him. But we may go yet a step further, and may
say that a minute and accurate acquaintance with the form,
structure, and functions of any organ will enable you to pre¬
suppose the diseases to which it is obnoxious, by presupposing
every possible deviation from the normal conditions, and that
which you presuppose or hypothesize will, in most instances, be
found merely to anticipate and predicate that which actually
occurs in morbid phenomena. I beg your special attention to
this point, because it very much facilitates the comprehension
and simplifies the grasping and arrangement of diseases, be¬
cause it has been the means of leading up to many brilliant
discoveries, and opens up a new method of enquiry that may
lead to great results. Allow me to illustrate my meaning by
a few examples taken from the subject with which I am the
most conversed, viz., some of the abnormal conditions of the
eye. We will consider some of the essential conditions in re¬
gard to the anatomy of the eye. We will take in the first
instance the form or shape of the eye. It is as you are aware
globular ; it is made up of the segment of two circles, the an¬
terior fifth rather smaller than the other ; but for practical
purposes it may be considered round. Now, let us presuppose
deviations from this form. Let us suppose the eye to be
elongated in its antero-posterior measurement, and let
the elongation be in the posterior part of the eye, and let
this vary in extent almost ad infinitum. Now what we have
presupposed, we find in fact in all well-marked cases of
miassin or Bhort sight, or we may presuppose the elongation
to be in the front of the eye instead. This also occurs in that
condition known as 4i conical cornea.” Now it would seem to
be an almost inevitable result of finding our suppositions in
this direction so exactly verified by fact, that we should pre¬
suppose in the opposite direction—viz., a diminution in the
antero-posterior measurement, and here again our hypothesis
is verified by numerous examples. This peculiar form of the
eye is termed hypermitrassin ; it gives rise to a series of very
important and distressing symptoms, that are now much un¬
derstood, and that are capable of complete relief, but the
details of which would be unsuitable to an occasion like this.
This brilliant discovery is comparatively recent, and has
proved A blessing to thousands, but if the idea I am now in¬
sisting upon had prevailed in investigating disease, it must
have been brought to light long ago. £et us now briefly con¬
sider another quality of the eye equally essential to its health,
viz., the amount of elasticity that it possesses. It is, as most
of you are aware, composed of an external, firm, unyielding
case containing fluid. Now it is essential to the healthy per¬
formance of its functions that an exact balance should exist
between the containing and the contained. By careful mid
delicate digital examination, the elasticity or amount of ten¬
sion in the globe of the eye can be most accurately measured,
and thus a normal standard can be fixed. Let ns presuppose
a departure from this standard in both directions. lit ns
suppose that the eye may become either too soft or too hard.
When we seek to verify our suppositions, we find abundant
proof at hand. It is constantly happening that under the in¬
fluence of certain forms of deep-seated disease the eye be¬
comes soft, evidencing a low degree of vitality ; and on the
other hand, there is a most interesting and important group of
morbid changes, in which the tension or hardness of the eye
becomes increased. This increase may vary almost infinitely
in degree, and seems to be the starting point and cause of
other serious changes. This increase of tension may come on
suddenly, and dcvelope the most intense and agonising symp¬
toms, and destroy all sight in a few hours, Mate glaucoma; or
it may be more gradual, chronic glaucoma ; or it may very
Blowly extinguish the sight in the course of years, without the
development of any other symptom to excite the suspicion of
the patient or the medical attendant. It was the accurate
elimination of the cause of all these varied symptoms,
the tracing them up to one common origin, that enabled
the genius of the great German Ophthalmologist to de¬
vise a remedy (iridectomy) which has brought this for
midable disease under control, and has thus enlarged the
domains of the healing art, and lifted another burden off
our suffering humanity. The same rule holds good with
regard to the laws that regulate the curve of the cornea; aber¬
rations occur that have led to the discovery of 44 astigmatism,”
at which I can only glance. The laws of the eye may be in¬
vestigated upon the same principle ; its two specialities are its
density and its transparency. We may presuppose every pos¬
sible change in respect of both these conditions, and we shall
find, in fact, an almost greater variety than our utmost ima¬
ginings could compass. The density of the lens steadily in¬
creases from the cradle to the grave, and its morbid changes
under the generic term of cataracts are almost infinite. It
may be softer or it may be harder than the normal standard;
thin softness may even amount to a fluid condition ; this hard¬
ness may be of a bony consistency; and between the two
there may be every variety, or part of the lens may be soft
and part hard ; it may vary in colour, from black to white,
with every gradation of colour between the two. The opacity
may be distributed in every form ; it may be striated or flocu-
lent, or dotted, or uniform, homogeneous, and capable of ana¬
lysis ; it may commence in the centre or the extreme margin,
or both at once, leaving a clear interval between the two, or it
may involve the centre only, and never extend to the margin;
it may form in a few hours, or may occupy several years; it
may commence at any period, from the womb to extreme old
age ; and thus I might go on multiplying varieties of abnormal
manifestations and behaviours almost aa infinitum. In study¬
ing the obscure phenomena connected with the moving power*
of the eye, if we get an intimate and correct knowledge of
the exact position, attachment, and function of each muscle,
and of their combined actions, and if we then presuppose every
deduction from that, we get an insight into those obscure sod
difficult problems connected with strabismus, insufficiency of
muscular power, Ac. I have now dwelt at sufficient length
upon these points to show how wide-spread is the application
of the principle I am endeavouring to explain. That which is
true of one organ is doubtless true of another, and of the en¬
tire body, as an aggregation of organs. To consider the various
developments of disease from this point of view simplifies and
facilitates their comprehension. The range of study is now
so great, the subjects so numerous, and the knowledge pos¬
sessed upon each so varied and so extensive, that it scarcely
comes within the scope of any human intellect to grasp them
all ; but it is very desirable that your knowledge should
be accurate and complete as possible upon those par
tions of medical lore to which you are able to give your
attention, as much of your success xprill depend upon the
correctness with which you can make out or diagnose *
case. You are joining our ranks at a time when physic
diagnosis has made vast progress, and is ass umin g the
character of an exact science. Every sense is enlisted in the
service and should be carefully cultivated. Our scopes are
multiplying in number and increasing in accuracy, and tiie
body is gradually becoming more diaphanous under the iun-
urinating influence of the lamp of science: each disease is
found to have its special physiogaoiay, and the experienced
observer learns to read as in a book the nature of the malady
with which he has to cope. I will now conclude this part m
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INTRODUCTORY ADDRESSES.
October 7, im. 317
my subject with a few words upon treatment. It will be
necessary for you to become acquainted with the various
agents that modify, control, or cure disease, and the various
conditions that favour recovery. But let me remind you that
your success in this respect, which perhaps, after all, may ap¬
pear to you as the great aim and object of your professional
life, will be in exact proportion to your knowledge of disease
and the correctness of your diagnosis. It is only when you
are enthroned upon the seat of medical science in its wide
expanse and lofty elevation, that you are qualified to bring the
varied armoury of remedial agents to bear. The most success¬
ful practitioner of medicine does not owe his pre-eminence to
the possession of any unusual amount of remedial agents. The
machinery with which he works is composed of elements com¬
paratively limited and simple. He excels rather in the correct¬
ness of his aim than in the amount of his ammunition ; in his
exact adaptation of the means to the end ; in his careful co¬
operation with the laws by which nature gradually modifies
and controls diseased action ,* iu the self-reliance which enables
him to wait and abstain from doing possible harm where he
does not see his way to doing positive harm ; in the prescience
with which he foreshadows the course of a disease, and thus
deservedly obtains public confidence. Thus, if a true scientific
foundation has been laid, if there be a thorough knowledge of
the structure and functions of each organ, and of the body as
a complex organ, and if every departure from the normal
standard, whether in structure or function, be mastered, then
tbe treatment will be based upon solid and simple principles,
and all that science has yet discovered to prevent, to arrest, to
palliate, or to cure disease, will bo accurately adjusted and
applied to each case as it presents itself. In these few Words
are comprescd the task that lies before the medical student,
and the work that I invite you gentlemen to commence to¬
day. And now, having introduced you to your work and
endeavoured to give you some insight into its nature, though,
I admit, very partially and imperfectly, I will in the next
place introduce you to that professional body to which you
aspire to belong, and endeavour to give you some idea of the
work that is being accomplished and of the men who are now
carrying it on. Were I to depict the character, to describe
the labours even of the most gifted amongst us, I should give
but a faint and partial idea of the varied powers and forces
that are combined under the designation, “ the Medical Pro*
feesion.” It may rather be compared to a vast army composed
of different elements, but combining Tor a common cause; and
making up one grand and harmonious force that is ever at war
with disease and suffering; like the fabled St. George, ever
doing battle with the numerous dragons that still infest the
world, and after some brilliant victory over an enemy, still
marching on to greater achievements. In analysing the com¬
ponent parts of all this machinery we have first of all the main
central force, composed of that large class known as the gene¬
ral practitioners, men who really do the hard work of the
profession, who are quietly and unostentatiously labouring
wherever disease claims'^their presence, whether it be in the
midst of poverty, in the courts and alleys of our crowded cities,
or traversing wild districts in spite of rain or frost and snow
to succour some poor sufferer, as I said when speaking of the
same class on a former occasion. “ Picture to yourselves the
medical practitioner in the full tide of his professional career,
what a stormy anxious unrest it is ; what exorbitant exactions
are made upon his resources, what exaggerated expectations
are formed of his powers, what unthinking demands are made
upon his time and upon his vital energies. By day and by
night, for rich and for poor, with or without recompense, he
must obey the summons of suffering humanity. He must be
ever ready to encounter accidents, disease, and death in all
their most appalling forms ; when friends are paralysed with
fear, and when contagion carries panic to the stoutest heart,
he must be there, calm and unmoved. Life may be ebbing
fast through the bleeding artery, the blanched mother may be
fluttering out her own life at the moment when she has given
birth to another, the victim of cholera may present all the
most hideous features of death whilst yet writhing in vital
agony, delirium and tetanus and hydrophobia may compress
the energies of a life into a few brief racking hours,—and
stm he must be there to gaze on sufferings he cannot re¬
lieve, and to feel that science is impotent ana humbled in the
presence of busy death.** And yet amid all this he has occa¬
sional gleams of sunshine; he knows that his welcome footstep
and his kind voice bring comfort to many an anxious sufferer ;
a smile awaits him in the hall of the wealthy and in the lowly
cottage of the poor ; and the history of his disinterested, self-
denying life and labours is written on many a grateful heart.
At his approach complaint grew mild,
And when his hand unbarred the shutter,
The parched lips of fever smiled
The welcome which they could not utter.
Would that my very feeble voice could command language
worthy to trumpet forth the merits of thiB too-often forgotten,
ill-requited, over-taxed section of our professional body! Then
we have those who are set apart to do the work of our hos¬
pitals and of our schools,—men whose aim and object it is to
make those great institutions subserve the double purpose of
ministering to our suffering poor and advancing the cause of
medical science and education. It is difficult for ambition to
aim at a higher position than that of a medical officer and
successful teacher at one of our hospitals. Surrounded by a
class of intelligent students, he explains case after case as
they present themselves in their endless variety ; he must be
prepared to meet and unravel each complication as it arises ;
he must expound and practically illustrate every method of
diagnosis that modem science brings to his aid ; and he must
be able to bear the test of the young, keen, inquiring minds by
which he is surrounded, and often the yet severer ordeal of poSJ-
mortem revelations ; and as he grows up out of all this to be
the trusted physician or surgeon, to whom the profession and
the public confide the anxious cases and their dearest interests,
we may be sure that this important element of onr force is com¬
prised of the true metal, and sheds a bright lustre upon the en¬
tire body. It is from this section that we mainly form our colleges
and obtain our several boards of Examiners ; gentlemen who
jealously and wisely guard the portals, and allow none to
enter who are not well furnished with the pass-word, and who,
by the wise reforms they are introducing into their own
method of election, are gaining more and more for themselves
the confidence of the profession, and by insisting upon a good
preliminary education for students, they are raising the stan¬
dard of our profession ; and by making their examinations
more and more practical and searching, they are protecting
the interests of the public. Nor must I in fairness altogether
omit to allude to a section of our profession who devote them¬
selves, more or less, exclusively to one department of our art,
or to some solitary organ of the body. In some instances, the
term specialist is applied, and not always in a complimentary
spirit. It would be unbecoming in me to dwell upon this
topic. I may, however, urge on our behalf that there seems
an increasing tendency in the profession towards specialism.
The public demands it, and the very wide field to be travelled
over justifies and explains it; greater scientific accuracy is
obtained by it, and important discoveries have been made by
limiting the attention to some one organ. What has been
lost in width has been gained in depth ; and in considering the
profession as composed of various elements, I think that jus¬
tice requires us to acknowledge that the little regiment of
specialists adds to its force and efficiency. Then we have
other great and important influences giving character and
dignity to onr profession ; we have those medical sappers and
miners, our Sanitary Officers. To estimate the work they are
carrying on, we must travel back a few years and consider the
condition of things ’ere they were called into existence.
Twenty years ago, in my first lecture, I spoke as follows :—
“ It is to our profession belongs tbe praise of pointing out the
fearful social evils resulting from crowding together breathing
masses of humanity, from defective drainage and imperfect
ventilation, from heaping up the dead amid the living, from
infecting and fevering the atmosphere with the noxious va¬
pours of corruption, making the churchyard and the charnel
house supply their own victims, and be, not alone a receptacle
for the dead, but a vast reservoir of disease for the living. It
is by their heart-stirring reports, that a nation has been
awakened from its lethargy, by their scientific researches and
reiterated remonstrances that a sluggish Government has been
roused into action, and that Sanitary Reform has become an
inevitable thing/* What a change has now come o*er the
spirit of our dream. These gentlemen are the great disin¬
fectants of England: they are gradually uprooting every
preventable source of disease, and checking the igno¬
rant self-immolation of the lower strata of society. With¬
in a* year after these words were spoken the first sanitary
act was passed, to be succeeded by numerous others, the last
having been passed during the last session of Parliament. In
i the same year the first sanitary offioer was appointed. There
are now forty-seven medical officers of health for the metro-
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INTRODUCTORY ADDRESSES.
October 7,1868.
polit&n district alone, and every large town in England has its
officer of health. Twenty years ago the mortality of the City
was 30 per 1,000, now it is 18 per 1,000. Truly their labour
is noble and disinterested, and their tendency is gradually and
steadily to promote our profession from their present function
as combatants against disease to the higher title of presidents
and guardians of health. I should be doing violence to my
own feelings, as well as to yours, did I not avail myself of this
opportunity of bearing testimony to the long, zealous, and suc¬
cessful labours of your eminent Professor of Chemistry, Dr.
Letheby, in this noble cause. And then we have had from
time to time some great and gifted one who may have been in
advance of his age, or who has been in the scientific outskirts
of the profession, who has dropped a few rich pearls of original
thought amongst us, or has opened up some rich mine of
scientific wealth. Such men are ever leading us on to higher
and better things ; they are like the pillars of cloud by day
and of fire by night, to guide us onwards and upwards ;
where our path seems darkest and steepest they are the heroes
that we may safely worship, men upon whom, as Thomas
Carlyle the greatest of modern thinkers, and the man who has
made the deepest impression on his age, has taught us, depends
the progress of the world. And last, but not least, we have
the Medical Press, that widespread influence that makes the
thoughts of the few the property of the many, that fosters
young and rising talent, that watches over the interests of the
profession and causes its voice to be heard and its influence
felt in the councils of the nation ; that has led the way in all
sanitary movements, and that is the constant and consistent
advocate of reform in our Corporate bodies ; and if there be
one thing more than the rest that reflects honour upon the
Medical Press of this country, and in which they have recently
achieved such signal triumphs, it is in their strenuous and
disinterested efforts to ameliorate the condition of our paupers.
A thrill went through the heart of England when she learnt,
by means of her Medical Press, of the abuses and cruelties of
our workhouse system of pauper nurses,, of neglect and
overcrowding, of the lunatic, the epileptic, and the idiot
in the same ward with the sick and dying pauper,
truly the poet had long since pleaded his cause in touching
accents—but in vain :—
“ Here, too. the sick their doom receive,
Brought here 'mid scenes of grief to grieve ;
Here sorrowing they each kindred sorrow scan,
And the cold charities or man to m.v,
Whose laws indeed for ruined age provide.
And cold compels on plucks the scrap from pride;
But e'en that scrap is brought with many a sigh.
And pride embitters what it can’t deny.
" Say, ye oppressed by some fantastic woes,
Some jarring nerve that baffles your repose,
How would ye bear in real pain to lie,
Dospised, neglected, left alone to die T
How would ye bear to draw your latest breath.
Where all that's wretched paves the way to death V
Yet the poop poet wasted his sweetness on the desert air: the
pauper suffered on, his condition became even worse thah
when the poet wrote. It was not until the Press espoused his
cause that an improved system was initiated ; that the work-
house infirmary was remodelled upon the plan of our hospitals,
and the treatment of our sick poor place d upon a wise and
' benevolent basis. Whilst England is loading with honour
those brave sons who have recently shed so much lustre on
her arms, let her not be quite unmindful of those who have so
nobly fought the battle of her despised, neglected, ill-treated
paupers, and who have shown such zeal and courage in oppos¬
ing and neutralising the sordid efforts of official boards, and
have succeeded in removing from our beloved country a
national disgrace. I have now concluded my brief and im¬
perfect sketch of the various elements of which our profession
is composed. It is only when we regard the medicinal body
in all its vast combinations, and in all its varied details, with its
literature, its museums, its lectures, and its press that we
realise the power it represents. This noble army of workers
is ever marching on, doing battle against disease and suffering
in every form ; ever the determined and persistent enemy of
quackery and superstition; always in the van-guard of civilisa¬
tion, of enlightenment, and of large and liberal thoughts, both
in politics and religion. It is to this vast and noble army that
I introduce you gentlemen this day : you are here to enlist as
recruits into its ranks. Much earnest work has to be done
before you are qualified to become one of it soldiers. Strive
to brace yourselves for the task, the life-long task, that lies
before yon—realize the dignity of work, of noble, self-denying
work. As the poet Bays—* _
*• Get woik—be sure ’tfs better.
Than that you work to get"
Ever bear in mind the achievements and high character of the
profession ; feel as if its future position and progress depended
upon your individual efforts upon your high moral, and mteUec-
tual acquirements. Carry the banner bravely onwards and up¬
wards, let each, the youngest amongst you, feel that the honour
of the profession is in his hands. You are joining us at a
moment of great progress and of still Sweater promise.
Twenty years ago on a similar occasion to this, I “flowed
forth this progress as follows“ There are those who delight
to summons up before their creative fancy the inhabitants of
former times and to dweU amid the customs and modes of
thought of a bygone age ; but if imagination be allowed to
spread its wings, I would rather soar onwards into the future;
movement and progress seem to be amongst the great laws
that pervade the universe, and who shall venture to give to
science her boundaries or set limits to the achievements of
human genius. Do we not already see the elements and
forces of nature chained down and made subservient to the
will of man. Pictures are painted for him by the sun, manual
labour is accomplished and distance is almost annihilate! by
steam, and his thoughts are made to span the world with the
rapidity of lightning. And is it too presumptuous to imagine
that these wonderful physical results of human energy are batw
bo many bright heralds announcing man’s future triumphs in the
intellectual and moral world ? already we may see the dawning
of a brighter era. Man is beginning to leam how much of
mental and physical suffering is due to the infringements of
some law ; and from this germ may spring up results fruitful
with blessing and happiness to humanity.” During there
twenty years how grandly has the profession fulfilled and more
than fulfilled all that I then ventured to shadow forth.
What an elevated plateau it now occupies compared with that
period ; but though much has been done, much, very much
yet remains for us to do. May the next twenty years hymn
forth as glorious an epic as the past; may it tell of the
triumph of mental and moral law over the civilised world,
whereby Nature’s idea of health and happiness may be
realised ; may it tell of all preventable diseases being stomped
out ; may it tell of the downfall of priestcraft and bigotry,
and the triumph of a broad system of Christianity that har¬
monises with the progress of science and of modem thought;
may it tell of peace, of plenty, and of goodwill towards men,
and, my young friends, when another twenty years hasi passed
over your heads, a period that must be pregnant with great
events to all, may your retrospect be a bright one, and may
you be able to feel that you have devoted the last years awl
energies of your life to advance the interests of our noble
profession and of our common humanity.
ABSTRACTS OP THE INTRODUCTORY
ADDRESSES.
KING’S COLLEGE.
The main subject of Dr. Guy’s Address was that of Education,
Illustrated by our medical usages and experiences.
He pointed out that medical education, as we see it at tbe
present day, was the result of u gradual growth. There had
been continual, steady growth in every part of the tree,
although accompanied at times by the pruning of decayed
or decaying branches, or the grafting of new and vigorous
Bhoots. He then continued
11 It will certainly bo interesting, it may be useful, to jus¬
tify these statements by examples. . •
“I will begin with the examining and licensing hod»»
Well, exactly three centuries and a half ago (in 1518 ), jue
College of Physicians was founded, the Barber Surgeons having
been incorporated more than half a century (1461), an
Surgeons just six years (1512) before them. H n^i le * r ^rp h v-
how liberal the founder and first elects of the College ofPhy
sicians were; how they brought their learning and theotogf
from Oxford, their physic from Leyden, Padua, and Boiogw.
and their wealth from church livings and prefermmtoj ^
grants of abbey lands; how dearly they loved
how tenacious they were of their rights over barber aarg^oDa
and apothecaries, insisting ou directing the opereUons w w
one and conduotine the examinations of the other, no ,
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INTRODUCTORY ADDRESSES.
October 7,1806. 319
the forty-first year of their existence, they graciously forgave
Dr. John Geynes on his humble recantation, his heresy in im¬
pugning the infallibility of Galen—(strange leeson this in the
matter of infallibilities)how they received a Royal visit,
and enrolled among their Fellows a Marquis of Dorchester and
the Dukes of Montagu and Richmond ; in a word, with what
dignity, gravity, authority, they comported themselves, may
be found written in many a page of authentic history.
“ This, then, appears to have been our first examining body.
I shall shortly have to speak of their relations with the barber
surgeons; but at present shall content myself with showing
that the three existing representatives of the medical pro¬
fession, in a comparatively rude and undeveloped state, could
be found consulting together and co-operating within a century
of the foundation of the College. We see them assembled
round the death-bed of Prince Henry, eldest son of James 1.,
and we learn that 4 Physicians, chirutgeons, and apothecaryes’
were dismayed and perplexed, and driven as a last resort to a
local application in the shape of a 1 cock cloven by the backe and
applied to the soles of his feet' I beg you not to forget that
this happened no less than two centuries and a half ago—in
the year 1612, just six yean before the publication of the first
London Pharmacopoeia. Bat that you may not carry away
with you too unfavourable an opinion of the consultations of
the Faculty, and the resources of physic, let me remind you
of soother occasion on which—his Majesty King William the
Third being the patient, and the munificent Dr. Radcliife the
physician consulted—the doctor was able to suggest a line of
treatment which succeeded so well that a few months after¬
wards the king was able to fight and win the battle of the
Boyne.
“ Between the two ancient corporations of Barber Surgeons
and Surgeons it would seem that such intimate relations had
C n up as to give some importance to an event recorded as
eningin 1745 ; I mean the dissolution of their alliance.
At or about this date (about a century ago), we have indi¬
cations of great activity on the part of the surgeons, thus
happily emancipated; and we are not surprised to find that,
in 1729, Parliament bought and consigned to their vigilant
and skilful keeping the noble museum of John Hnnter, or that
the Crown grafted them a charter in the year following.
14 If I add that the Society of Apothecaries, in 1815, ob¬
tained those legal powers of which they have made, like the
Allege of Surgeons, such good use for tne promotion of sonnd
medical education ; and ifl farther reraina you that a charter
was granted to the University of London in 1837, and that at
length, in the year 1858, the whole profession obtained a cen¬
tral representative and controlling authority in the Medical
Council, I shall have sufficiently shown by what a gradual
process of change and development our examining and licensing
bodies have come to be what they now are.
44 If you have found this sketch of the progressive develop¬
ment of our examining and licensing bodies interesting or in¬
structive, I think that a similar quick survey of the nse and
progress of instruction by lectures will prove acceptable.
“ 1 have already intimated that the first teachings by lecture
or demonstration were given by physicians, and that their first
subject was anatomy. It was in tne year 1540 that Dr. Cains,
the founder of Cains College, Cambridge, was deputed by the
College of Physicians to give anatomical lectures in the Hall
of the Barber Surgeons—a place chosen for this, among other
roasons, that that corporation had had conferred upon them
the right to claim every year the bodies of four executed
criminals. A more formal appointment appears to have been
made'by the College in the year 1596, when Dr. Paddy was
chosen reader of the Anatomy Lectures, and from this time
forward to about the middle oi the eighteenth century, a suc¬
cession of physician-anatomists, with snch names as Harvey,
Glisaon, Mead, Willis, Lower, William Hnnter, and Matthew
Baillie among them, carried on an unbroken chain of anatomi¬
cal teaching. Meanwhile some provision was made by means
of endowed lectureships at the College of Physicians and
Gresham College for teaching other branches of medical know¬
ledge. Tho Lumleian ‘Surgery Lecture,* founded in 1585,
ana the Gulstoni&n Lectures, best described as Pathological,
1632, and the lectures on Physio at Gresham College, prior to
1615, show that these subjects were not neglected.
44 Coming down to more modern times, we find Dr. William
Hnnter succeeding Mr. Sharpe as Lecturer on Surgery to a
class of naval surgeons. This occurred in 1745, a date of
special interest as it was then that the alliance between sur¬
geons and barber surgeons was dissolved, and Dr. William
Hunter established his celebrated anatomical school. But this
venture of William Huuter*s was by no means the first of its
kind; for Dr. Hunter himself studied at the school of Dr.
Frank Nicholls, who seems to have achioved a high reputation
as a teacher of anatomy at Oxford about the year 1780, at
which date he was admitted to the Fellowship of the College
of Physicians. Of Dr. Nicholl’s teaching we know this much;
that he professed to teach anatomy, physiology, and the gene¬
ral principles of pathology and midwifery, in thirty-nine lec¬
tures ; and we are told that Mr. Bromiield, a distinguished
surgeon and lecturer at St. George’s, comprised anatomy and
surcery in a course of thirty-six lectures; while Mr. Nourse,
at St Bartholomew's, embraced ‘ totam rem anatomicam ,* in
twenty-three.
41 From about the middle of tho last century to the present
dite, the history of medical teaching is one of constant and
rapid development, taking plaoe with accelerated speed from
the first years of the present century, when College and Hall
began to exercise thoir legislative powers, and to prescribe
their respective curricula.
“ 1 have not time to trace the rise and progress of medical
teaching through the establishment of a series of private
schools, founded by men conscious that they possessed special
S ualifications for teaching, competing successfully with the
oepital schools, and, for a time, with the two Colleges, but
succumbing at length to a combination of adverse influences.
They had done a good work, and had had their day; and now
in lieu of them and of the hospital schools with which they
so successfully, competed, we have nine hospital schools, and
two colleges with their hospitals attached,—eleven institu¬
tions in all, with means and appliances of teaching all things
necessary to qualify the pupil tor the general practice of his
profession.
“If time had permitted, I should like to have said some¬
thing of the growth and development of practical teaching m
our hospital*. With regaid to the hospitals themselves, it
may interest some present to be told that the oldest hosnital
in which any clinical teaching could have taken place (a hos¬
pital for the sick was founded at Canterbury as early as the
year 1070) did not oome into existence till about thirty years
after the foundation of the C ollege of Physicians. I speak of
St Bartholomew’s, founded in 1547. Six years later, St
Thomas's came into existence. The eighteenth century wit¬
nessed the establishment of five more (Gay's Hospital among
the number), and the nineteenth of four, of which onr own
hospital is one."
• •«*««»
44 As the subject of medical education is now attracting a
good deal of attention, and as the office of Dean of the Medi¬
cal Department, which I had the honour to hold for a
term of years, gave me some experience, and led me to
form sooio definite opinions on tne subject, l will take
this opportunity of stating what those opinions were and
are. In the first place, I was alive then, and am .still
more alive now, to the objections that exist to the demand
made on the student that he attend more than one course of
the same lectures on the same subject 1 would give one op¬
portunity, and one only, for attendance on the same coarse,
and 1 would make no exception, however important, or how¬
ever hard to learn, the subject may seem to be. In the next
place, I think that there is a grave objection to the immediate
attendance on the practice of the hospital, now demanded of
the student. In the third place, I think that, if possible, the
attendance of surgeons ana physicians at the hospital should
be so arranged that the stuaents who ought to be following
the physicians round the wards shall not be drawn away by
the naturallv superior attractions of surgical cases. But lastly,
and above all, 1 attach importance to a plan which, in former
years, I had many opportunities of recommending—that of
beginning the education of the medical student in tne summer
instead of the winter. This change might be made to har¬
monise admirably with the plans of those who insist that some
subjocts comprised in the present medical curriculum (such as
botany), should be taught to the student before he begins his
medical education properly so called. If, in the three months
of a preparatory summer course, botany, zoology, physics, and
chemistry (such part of inorganic chemistry as might be
selected for the purpose), and with them that part of anatomy
known as osteology, were taught, the student might enter at
once, at the beginning of the following winter session, on the
practical work of the dissecting-room, and the six winter
months of anatomical and chemical teaching, added to the
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320 The Medical Press and Circular.
INTRODUCTORY ADDRESSES.
October 7,1888.
three months of the previous summer, would supply nine
months of instruction in those two important subjects. A
preparatory summer session, with three subsequent complete
years of study, and the abandonment of all duplicate courses,
would give ample time for the deliberate study, by lectures,
of all the subjects (public health, and perhaps medical psy¬
chology included), which it would be reasonable to require of
the whole body of medical students.
“ I must not pursue this subject further; for if I did, I
should leave my programme incomplete. 1 have yet to say
something of education as a comprehensive subject, embracing
medical education as one of its subdivisions. 1 thought that
some light might be thrown on the general subject by this
special form of it; and it was for this reason that I entered
into certain details of the rise and progress of our educational
system.
“ Much is being said just now. about technical education ;
and there is a strong feeling abroad in favour of training all
men alike in the principles of the art which they are about to
practise. The designer, it is thought, should not take his
lessons from one who may himself have contracted habits at
war with every suggestion of good taste ; but he ought to be
carefully instructed in the principles which should preside
over and direct every work or design, as well as in the most
approved methods of procedure in tne special art or manufac¬
ture to which he intends to devote himself. And in order
that the art-designer may be so educated and trained, there
must be museums of raw material, of manufactured articles, of
successful and unsuccessful works of ornament. Taking this
as a specimen of technical teaching, we say that our profession
affords the oldest and most perfect example of such teaching.
Or, if we turn to the art and business of the pharmaceutist—
one entailing duties and responsibilities similar to our own,
we can point to our old and approved educational system and
methods of procedure generally, as worthy of the attentive
study of those who are to constitute the examining body
under the new Act. To those professions which have esta¬
blished voluntary examinations (1 speak of the professions of
the architect and actuary), and those which (liko the civil
engineers) have not yet instituted any examination at all, we
think that we hold out an example worthy of imitation. We
have long since recognised, and acted on, the principle that
the public must be protected against ignorance and unskilful¬
ness on the part of those who practise a profession, or follow
an occupation, involving serious risk to life, by a good tech¬
nical education and a searching examination. But we go
farther than this, and pronounce in favour of a large and
liberal education. When we prescribe a course of Botany,
wo do not allege that the practitioner of medicine will have
constant, or even frequent, occasions of making practical
application of his knowledge of plants at the bedside ; but
we look upon botany as a key which unlocks other knowledge,
and as an admirable training for the faculties—so important
to the physician—of observation, methodical arrangement,
and lucid description : and just as we demand of the student,
before he begins the study of medicine at all, proofs that he
has had the liberal education of an English gentleman, though
little of what he has learnt admit of any direct practical
application, so we require of him, before he enters on the
practice of his profession, a knowledge of science much ex¬
ceeding that for which he can ever find a use. But then, we
want him to be a man of science, that he may receive the
respect of persons of every rank of society. But we have a
better reason even than this : we honour science for its indi¬
rect as well as its direct applications. We do not forget that
it was Edward Jenner, a man remarkable for his knowledge of
natural history and his love of it, who gave to us the great
discovery, and to the world the inestimable boon, of vaccina¬
tion ; and with it the grandest example the world has seen of
that principle and policy of prevention for which the future
has, I trust, great triumphs yet in store.
* * And now that I am near the end of this lecture, and
look hack to what I have said to you, I ask myself whether I
have not been guilty of some abuse of terms in speaking of
education, when I should have used the word instruction. If
so, let me correct myself There are two things which, as
they are more or less associated in schools and colleges, arc
apt to be confounded the one with the other. The process by
wnieh masters and professors teach, and schoolboys and stu¬
dents learn, is properly called instruction; and this, partly
by means of what may be called the incidents of it, and
partly by the wholesome rules and regulations of the schools
and colleges in which it is carried on, becomes education . In
the village school, the child is instructed in reading, writing,
and arithmetic, and the elements of our Christian faith ; iUs
being educated by rules which prescribe cleanliness and tidy
apparel, punctual attendance, the respectful recognition of
teachers and superiors in age and position, just and kindly
dealings with schoolfellows, and the exhortations, reproofs,
and punishments of the teacher. To these the veiy act of
learning, through continuous, silent, painstaking application,
contributes the important element of the childish self-denial
implied in working when the occupation natural to the child’s
age is play. So it is with all good schools, and so with every
institution where young men are trained for any profession
or serious occupation in life. The class-room is a place of
direct instruction in the thing taught; a place of training for
the faculty or faculties exercised in the learning of it; a place
of education in the degree in which any other mode of passiog
the time is preferred to it. It is this wholesome function of
the class-room which is overlooked by those who think that
young men should attend those lectures only that the teacher
can contrive to make attractive. If this were so, Science
would have to put off her sober garb, and exchange her severe
graces for the meretricious adornments of the theatre ; and, in
lieu of many small and manageable classes, we should have a
few crowded audiences very hard to please, and somevhat
difficult to keep iu any kind of order.
There is another word or group of words which I have
often used iu this lecture, and possibly so os to lead to mis¬
conception. I mean the word Science, and its derivative,
scientific. I wish it to be understood that 1 mean by science
what it originally meant, knowledge ; and by a science, a dis¬
tinct and well-defined branch of knowledge : by scientific
teaching , the imparting of real knowledge; by a scientific man,
a man enlightened and well-informed in tho subjects he pro¬
fesses to understand. But, as you are aware, there are some
who pitch the meaning of the word Science so high that they
will not allow Medicine to be called a science. It is not exact
enough, Dot accurate enough, not sufficiently amenable to the
discipline of figures. It lacks the gift of prophecy which
Astronomy has, and the magic powers that belong to Elec¬
tricity and Chemistry. But if it must consent to occupy a
lower rank than these, it has very honourable associates in
Agriculture, Meteorology, and social and economic scieuce;
in all of which events are brought about by many concurrent
causes of very variable intensity ; in all of which, when ap¬
plied to individual instances, we often deserve, where we
cannot command, success.
Be the proper place of Modicine among tho sciences, how¬
ever, what it may, its right to the foremost place among the
arts is not to be questioned. The art of healing, practised in
the lighL of all the sciences which enter into the medical cur¬
riculum, is one of which its votaries need not be ashamed.
To yon who come hero to study it, we (my colleagues and
myself) wish all honour, happiness, and success.
LORD LYTTLETON’S ADDRESS AT QUEEN’S
COLLEGE, BIRMINGHAM.
Lord Lyttleton, after referring to liis former connection
with the College, the many vicissitudes through which that
institution had passed since his connection with it ceased, and
the at length completed amalgamation with it of Sydenham
College, considered the subject of medical education in so far
as it had come under his notice as a member of the Schools
Inquiry Commission. At this point his lordship read extracts
from the evidence of Mr. Paget and Dre. Acland and Gall, and
then continued :—
Now what I have read relates mainly to the intellectual and
instructional view of the question of medical student’s educa¬
tion. It was not chieflv with this in my mind that about
thirty years ago I (and I should expect to find others who
would say the same) first took an interest in this school—as
it was then called—of Medicine and Suigery. It was from a
consideration of the importance of setting an example here,
which we might hope would iu future years be laigely followed
elsewhere, of the practicability and advantage of an institu¬
tion where medical students might receive in toll measure the
humane, the moral, the disciplinary, the social, the religious
benefits of the ancient system of English collegiate education,
that we joined so hopefully in the work. It was from a sense
that, while needing them as much as any or more, those stu-
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October 7,1868. 321
dents were as ill-circumstanced os any students, or more so, in
these important respects. I well remember, in the very early
days, quoting, in the presence of the venerable Dr. Edward
Johnstone, then our first Principal, an injurious—nay, I might
say a ribald proverb, I believe of the middle ages: “ Trcs
mdici, duo athei .” I remember the indignation with which
the venerable man repelled the imputation. But I also re¬
member his acquiescence in what I ventured to suggest—that
unless there were some tendency, according to the evil of our
nature, in medical studies to realise that proverb, much of the
ground of the necessity which we believed to exist for such
institutions as this must be abandoned. Nor should we wonder
too much at the existence of such a tendency. We know too
well the perverseness which has often led men of the highest
ability and the deepest acquaintance with the works of the
Creator, away from the Creator to the cold regions of mate¬
rialism and] abnegation of revealed truth. We know such
cases as those of Laplace aud Buffon. And we thought,
whatever changes the progress of science would involve—nay,
whatever new light may be thrown even on moral truth and
religious doctrine, their broad and ancient foundations at
least,—the principles of the philosopher and of the Heavenly
Teacher—the principles of the ethics of Aristotle and the
Gospel of Christ—were not now to be sought for, but to be
applied. And we held that for these young men, as for others,
the best application was in the collegiate life—the orderly dis¬
cipline, the stated hours, the friendly association with superiors
and with equals, the ^ Oos, the religio loci, the social atmo¬
sphere, the frequent and united worship, the consecrated
chapel. We looked, in so for as we might succeed, for our
full return in the blessings cf parents and the approval of
families.
For if these great principles, this human and divine web-
stratum to all instruction and all education, whatever be its
special destination, bo of moment in any class of life—of
moment to the members of that class, of no less moment to
society,—surely it is so pre-eminently to the medical class.
Where are the men for whom we should more ferventy wish,
than for them, a lofty tone of character, a sense of the dignity
and gravity of their mission, a pious and consistent walk, a
spirit of large observation, a sobriety of judgment, a know¬
ledge of things new and old, and all those many more qualities
which we believe are fostered by a sound and Christian educa¬
tion ? For one, I cannot express more strongly than I feel,
the social importance of a high standaid of character as well
as attainment being set and maintained for the medical pro¬
fession. <c Honour a physician,” says the wisdom of the son
of Sirach in that book which, though we do not reckon it
among our inspired books, assuredly falls not for short of
them in its combination of admirable plain sense with spiritual
insight, the book of Eeelcsiasticus (xxxviii, 1)—“Honour a
physician with tho honour due unto him for the use which ye
may have of him, for tho Lord hath created him.” True was
the instinct, even if pushed too far, which in old times set
apart the science of medicine as something specially super¬
human and heavenly. “Blessed art of healing,” says Mr.
Carlyle of it when in worthy hands, “once again divine !”
Surely it partakes of the value and sacredness, as it has been
called, of the subject with which it deals—the value aud
sacredness of human suffering—“a token,” in the solemn
words of tho writer I am quoting!—“ a token of God’s pre¬
sence, a form of His countenance.” Nor has there been
found, perhaps, for Him, the Benefactor above all benefactors
of the human race, a worthier or more endearing appellation
than this, tho Physician of Souls.
Few indeed there are who, such is our condition here, pass
through life without frequent intercourse with tho family
surgeon or physician. Even of these we may say nearly tho
same as of others. But as to those others, the vast majority
of ns in our hours of anxiety or of agony, for ourselves and
still more for others,—in the slow-wasting consumpt ion; in the
ungovemed delirium; in the unrest and sleeplessness of pain;
in the crisis of hope and fear, the verge of maternity; in the
sudden and perilous accident, turning in a second the placidity
of age and the meiriment of childhood into the tumult of tre¬
pidation and the haggardness of suspense ; in that trial of
which none will make light of but those who know it not, cause¬
less nervous or mental depression,—in these, and so many
more I could name, who is it for whose approaching footstep
we so long, on whose every word we so depend, hoping when he
Dr. Posey ; Hermons by Contributors to "Tracts for the Times/' iii,
bids us hope, despairing when at length his hands hang down,
when the resources of his craft are exhausted, aud he too has
to confess that he is but the secondary instrument in the
power of tho Unseen Disposer? Let not poor human nature be
too hastily blamed, if at such seasons it may sometimes foil to
hold with due firmness its sense of Who it is in whose hands
really are the issues of life and of death, of sickness and of
health, aud lean too much on His delegated ministers. Who
is there again, I ask, whom after and because of such inter¬
course as this, we are more disposed to take into the con¬
fidence of our daily life, to make tho friend as well as tho
adviser, the witness and the partner of the joy of recovery as
well as of the sorrow of suffering? Great indeed must often be
the sympathetic grief of the practitioner, if he has a human
heart, in the scenes of woe which he must see without
relieving, or only slightly relieving it; but great also must
often be his sympathetic joy when nis efforts are blessed with
full success,—the joy of simple sympathy crowned with the
consciousness that, in tho hands of Providence, the returning
happiness which he sees is due to his own skill, and is the
reward of his early and laborious culture.
So deeming aud so hoping, I return with satisfaction to a
share iu the administration of this College, and commend its
welfare to the good wishes and exertions of tho inhabitants of
this town and neighbourhood.
UNIVERSITY COLLEGE.
Professor Ericiisen, after some introductory observations,
alluded to the question whether medicine should bo studied
as an art or as a science.
He believed that not only are medicine and surgery based
on certain sciences but that they themselves constitute a
scarcely less certain science of disease. Even in therapeutics,
assuredly the most difficult branch to trace the laws, the art
of medicine need not be wholly empirical We know enough
to serve as a sure groundwork for scientific practice.
Mr. Erichsen continued:—The art and practice of medicine
may be regarded as founded on a tripod—of science, observa¬
tion or experience, aud individual skill. The value of science,
as a foundation for practical medicine, has received a recent
illustration in the elaboration of the antiseptic method of
treating wounds devised by Professor Lister. The second leg
of tho tripod, observation, comprehends not only the recog¬
nition of a phenomena by its signs, but its investigation
aided by tho judgment. The comparison of observations,
especially when reduced to the statistical form, is a means for
the doternination of facts with absolute and mathematical
certainty. Much has thus been done in ascertaining the causes
of disease, and it is in this way, if in any, that the real value
of remedies must be ascertained. Individual skill, the third
leg of the tripod, is highly prized, and with justice, by both
the public and the profession, but at the same time too much
credit must not be attached to the simple possession of it.
The manipulator should not bo confounded with the inventor;
the man, however skilful, who merely applies rules, with the
other who has devised them.
From this it will be seen that medicine fo neither a pure
science nor a simple art, but the art can only bo safely prac¬
tised when its foundations are laid deep in the science of
biology, which underlies the whole structure of the ASscnlapian
edifice. The student should endeavour to be neither wholly
scientific nor wholly practical, but should combine the two
somewhat opposite elomonts of science and of art, of learning
aud of experience, of thought and of action, ever remembering
the advice of Bacon,—“They be the best physiciaus who,
being learned, incline to the traditions of experience, or, being
empirics, incline to the methods of learning.”
The speaker then glanced at the different methods of learn¬
ing, by books and lectures, in which were epitomised a know¬
ledge—the result of the labours of generations—which the
student could not possibly gain afresh for himself. They were
to observe a due proportion in their studies, and not to devote
themselves too exclusively to any one deparment. They were
to trouble themselves less about what they did not know than
about what they did know.
In conclusion he urged strongly upon his hearers tho im¬
portance of clinical wort and the recording of cases, as an aid
to which ho recommended them to cultivate, especially the arts
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MEDICAL SOCIETIES.
October 7, m
of writing shorthand and of drawing. The latter was especially
useful in fixing details in the memory, while by the former—
an art easily learned and valuable in numerous ways to the
medical student—thev were enabled to record observations as
rapidly as they could be made.
GUY’S HOSPITAL.
Dr. Moxon, after alluding to the strong varieties of cha¬
racter which are brought out by necessary habits in the
several branches of social usefulness, laid this down as the
distinguishing character of a profession as contrasted with a
trade, that every member of a profession directly uses general
principles in the practice of his profession. A medical man
especially must be capable of exercising judgment when deci¬
sive and conclusive motives are not present. Hence he
strongly urged on them the necessity of maintaining their
minds free and capable of independent action, for the licensing
bodies now demanded a vast extent of knowledge in candidates
for diplomas, and much knowledge cast hurriedly into the
mind would be too likely to smother young intellects, as too
much fuel smothers scarcely kindled fires. Men were a pre¬
posterous race, doing things hind side before : they first talked,
and then they learnt grammar—they first reasoned, and then
learnt logic. They learnt much before they thought what
sort of a thing it was to learn. He would have them now be
beforehand, and as they were to plunge into so many sciences,
consider what it was to learn. First, it was not storing into
capacities, although many of their expressions implied that it
was so, and some young men sought a reputation for implied
capacity, which was very foolish, since the mind was never
greater than what it held. Secondly, it was not receiving
seeds of knowledge, for the function of the receiving mind
was active—it was receptive activity. The mind received
learning as a germ received pollen, and then arose new living
thought, varying in different minds, and improving and pro¬
pagating itsdf. On the question whether there are “ sciences
of medicine and surgery,” he said these sciences were of three
classes, and took as a type of the first mathematics, which is
pure reasoning ; of the second chemistry, which is reasoning
from the facts of the chemical elements ; and of the third
zoology, which is mere classification. He compared the so-
called 14 science of medicine ” with each of these types. It was
not like mathematics or chemistry, because each of these was
constructive —the first of the elements of thought, the second
of the elements of nature, and they had no constructive know¬
ledge of diseases. They did not know how these elements
were put together. It aimed to be like zoology, but was dis¬
qualified because they could not define a disease, and their
knowledge of them was not comparable knowledge, for when
one disease was a pain in the leg, and another disease was a
growth in the stomach, and another a spider in the skin, they
compared together as the solar spectrum and the key of C
major with essence of peppermint. Some people erroneously
called anatomy and physiology sciences, but they were no more
than common narratives of fact. The practical result of these
reflections was that medicine should not be studied in books as
sciences were studied. They should learn diseases as facts in
nature. They should know them, not as the geologist knows
his genera and species but as the hunter knows his leopards
and wild boars. No writer or speaker could describe a disease.
The best attempt was only like a landscape taken from a rail¬
way; or like a print of a glorious battle where live struggle
is chilled into dead shape. They must see individual cases for
themselves, and so know the history of disease from its
biography. But should they then discard science ? Assuredly
the very opposite. If there were no discipline in the facts,
they must bring discipline in their minds. Like a colonel of
irregulars, the physician must be a genius of discipline over
his disorderly facts. This was the true theory of medical
education: they must have minds disciplined yet free, and
those opposite reauirements must be supplied from opposite
sources. The Meaical Council would discipline them, cutting
their garment of learning to their regulation model of a doctor.
They carried their discipline too far. They filled every hour of
the student*s day ; yet what could they in their curriculum offer
them in plaoe of that self-help for which they left no time ?
Their course of study would be in stages ; layers of learning
would have to be deposited on them like geological formations,
or coats of paint, or like a plaster image they would be put
together, the logs and body crumbling while they made the
head. Meanwhile, the students must take care of themselves.
Let them see that they grasped firmly the principles of know¬
ledge they gained, though they could not retain the details.
Let them not cram for their examinations. The <nr*minatin»i
was not their real trial; they only gave bail there to appear
before society, from which there was no appeal. This know¬
ledge of principles through details could only come slowly, for
their acquiring intellect was a point that traced enough lines
on that vast chart by which they must pilot their future
patients. He urged them to learn to observe well, to study
anatomy practically, for that afforded the best practice or
observation. Medical literature could only give them the
meanings of names, their eyes must show them the nature of
things. When medical literature went beyond what they could
all see, it got contrary and uncertain. There was only one
way in which they could avoid being deceived by it, and that
was by observing for themselves, so that they could keep a
check upon the writer, and follow this rule, “ Never trust a
man for what he cannot know,” which would do away with
opathies and theories. Faith might lead them, but reason
must guide them. The place of reason was above and beyond
faith, for their oracles were uninspired. As to medical pro¬
gress, there was no such thing as progress, except for convey¬
ance from place to place. Au improvement was development
Thev must not leave what was behind, and they must have no
mark to press to. It was because physicians prewed after
great aims that they made so little advance in their develop¬
ment, for when the facts they saw did not promise to fulfil the
aims they had, they turned away from the past, guessed their
way towards the aim, and called the guesses “ theories," to
make them respectable. Let them beware of medical theories
—they were images made out of a little dust of facts, into
which some one breathed a little puff of himself, a breath of
life that was not divine, and they fell to pieces when they hid
served their master’s purpose, and were blown about the desert
dust of medical literature. Don’t guess, said Dr. Moxon, a
g uess is the Baueak of reason oppressed by doubt—it no more
elps reason than cries lessen pain. Be patient under doubt;
don’t let it make "you guess in haste. Remember the danger
of generous minds, which is this—that in striving to know
what cannot be known, they leave unknown what they might
know. ' We live not to an aim, but to a duty of observation
and guidance—the aim at cure spoils oar social reputation.
Those minds that are shaken by sideness or bv anxiety suppose
that we cure them, and we allow the supposition. But when
they come to themselves they change their view, and give
nature the credit, and despise us as pretenders, just as their
day-enlightened forefathers drowned those very witches whom
they shuddered at m the dark. The public will not forsake
you. It is not hope, bnt fear, that caters for the doctor. Let
us patiently discharge our noble duty of observers and guides,
striving to be to each individual sufferer under our care all
that a man can be to his fellow man in sickness, and no more.
We shall try to make yon learned, a vir doctimmus el oma -
tissimus el clarissim us. Now remember, while you are gettmr
all the fashionable learning that the newest patent clarifiea
candle may give no better light than a well-managed dip, and
you live to do duty, not to be admired. Get firm possession
of that sort of knowledge which your daily usefulnea will
keep bright by activity, and add to it all the accomplishments
you can acquire. In yonr noble profession no personal excel¬
lence is lost, but rather will help you in your wide range of
duty which requires you to create faith and hope and fresh
interest for the weary of life, and not merely to know things
of which other people are ignorant.
- «•
Rleteiil Irate.
ARMY MEDICO-CHIRURGICAL SOCIETY OP
PORTSMOUTH.
Deputy Inspector-General Dr. 0 . A. Gordon, C.R* in
the Chair.
Some remarks by Dr. Beedin
ON DELIRIUM TREMENS .
were then read, their object being to point out that In
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MEDICAL NEWS.
October 7,1868. 323
opinion the same decrease in the prevalence of that disease
and other affections of the nervous system has not taken
place, that recent improvements in the condition of the
soldier have effected in some other maladies to which he is
liable.
The Chairman then read some extracts from a report iust
received from Staff-Surgeon Roch, in which that medical
officer gave an account of the voyage of the ship Golden
Fleece from Annesley Bay to Portsmouth, rid the Cape, with
invalids from Abyssinia.
On the 5th of last Jnne, 119 sick soldiers and fifteen sick
officers embarked on board that vessel. Of the former, eight
died daring the voyage; and on the arrival of the ship at
this port on the 1st of September, 111 were sent to Netloy.
Of the fifteen officers embarked, fourteen were under medical
treatment during the voyage; one disembarked at Aden,
and thirt« en at Portsmouth for Netley.
Among the troops, the prevailing diseases at the time of
embarkation were dysentery, diarrhoea, and hepatitis. There
were also two men who had suffered from insolatio, two from
fracture, and five from gunshot wounds. The officers were,
like the soldiers, chiefly affected with hepatic diseases, two
laboured under the effects of insolatio, three from diarrhoea,
and two from rheumatism.
The heat in the Bed Sea was intense and oppressive, and
two soldiers died of heat apoplexy before the ship reached
Aden, at which place it arrived on the seventh of tne month.
Three other deaths—namely, one by continued fever, one by
hepatitis, and one by chronic dysentery, occurred between that
date and the 14th of July, on which day the Golden Fleece
made Simon's Bay. On the following day a soldier died from
cancer in the stomach ; on the 16th one from a relapse of dy¬
sentery, and on the 19th one from diarrhoea and general de¬
bility, after which no further death occurred during the
passage.
After leaving the Cape the more severely ill among the
men were separated from the less severely affected, the Tatter
being all accommodated on the lower deck. Parades took
place three times a week for the examination by tbo medical
officer of the men not actually confined to bed ; and on the
16th of August, at one of the parades so held, a soldier was
found affected with scurvy in a slight degree. A minute in¬
spection of the invalids was held the following day, and a
general tendency to the disease detected, although only appa¬
rent in tbo state of the gums, and most distinctly so among
the convalescents on the lower deck. The numbers who had
in the first instance been allotted to that part of the vessel
were diminished; pickles, lime jnice, and fresh meat were
liberally given from the time that the scorbutic tendency was
observed. On 23rd of August the ship touched at St. Mary’s,
one of the Western isles, at which place a supply of fresh
fruit was obtained. The scorbutic tendency baa, however,
already begun to give way, as the medical officer thinks,
chiefly in consequence of additional space having been given
to the men en the lower deck. He notices the Tact that the
scale of rations had been good, and sufficiently varied through¬
out the passage, and that therefore the cachectic condition
allnded to could not be attributed to any defect connected with
food.
flftiod |Eefos.
In consideration of the numerous victims of
homoeopathic treatment, a decree of the Emperor of Russia pro¬
hibits the practice of homoeopathy in tho entire territories of
Russian America .—V Union MediocUc .
Hydrophobia.— On Friday, a joiner, named El-
kan&h Turner, of Shay-lane, Ovenden, near Halifax, died in a
fearful state from hydrophobia. It appears that about six
weeks ago, a small terrier dog was given to deceased to destroy,
it being a vicious animal. Instead of killing it, he sold it to
a Hr. Smithson, and when on the way to deliver it, the dog
bit him on the fight hand. Next day the limb was inflamed,
and gradually became worse, from which he shortly died in
great agony.
The improvement in the Duke of Brabant’s health
continues, and every day adds to the hope of |his recovery.
He looks better, is more cheerful and animated, and bis nights
are less restless and more free from oppression and cough j so
much so that during the whole of last week the doctors (Wim-
mer and Henriette) do not And it necessary to hold any con¬
sultation with Dr. Spring, who hitherto during the Prince’s
illness has come once a week from Liege, where he resides, to
give his opinion about the malady.— Court Circular .
Thb Military Secretary, India Office, presents
his compliments to the editor of The Medical Press and Cir¬
cular, and begs to enclose a list of the candidates for Her
Majesty’s Indian Medical Service, who were successful at the
competitive examination at Chelsea, on the 10th of August
last. India office, 2nd October, 1868. K. M. Downie. 2,485;
F. M. Mackenzie, 2,240 ; C. R. Johnson, 2,130; W. E. Wrigt,
2.015; A. W. Supton, 2,005 ; W. C. Kiernander, 1,945 ;
F. H. Blenkiusop, 1,910 ; G. Hutchson, 1,870 ; J. Macgregor,
1,850 ; J. Rabb, 1,775. (Maximum, 3,400 marks.)
List of Entries in the Register of the Branch
Medical Council, Ireland, for September, 1868.—1st,
Henry George Hall, 12, Seville Place, Memb. R.C.S., England,
1867, Licentiate 1868, and Lie. Midwifery, 1862, K.Q.C. Phys.,
Ireland; 4th, Henry Frazer, Gilford, Co. Down, Lie. 1868,
and Lie. Midwfery 1868, K.Q. Coll. Phys. Ireland, Lie. R. Coll.
Surg. Ireland ; 8th, Thomas Joseph Aioysins Ryan, Cork, Lie.
Apoth. Hall, Dublin, 1865, Lie. R. Coll. Phys. Edin., 1660,
Lie. R. Coll. Surg., Edin., 1680; 19th, John Laird, Drum-
8borabo, Co. Leitrim, Lie. R. Coll. Surg., Ireland, 1865, Lie.
1860 and Lie. Mid., I860, K.Q. Coll. Phys., Ireland; 12th,
John Col van Sugars, Portadown, Co. Armagh, M.D., 1868, aud
Mastr. Surg, 1868, Q. Un. Ireland; 15th, Edward Joseph
Nugent, 129, Stamford Street, London, Lie. R. Coll. Surg.,
Ireland, 1866 ; 22nd, Albert Johnson Watson, Cooldrina,
Ijeixlip, Co. Dublin, Lie. R. Coll. Suig., Ireland, 1868, Lie.
Fac. rhys. and Surg., Glasgow, 1868; 25th, Robert Henry
Stevenson, Tartaragbam, Co. Armagh, M.D. Qu. Un., Ireland,
1868 ; 29tb, Robert Gage Fleming, Newtownlimavady, Co.
Derry, Lie. R. Coll. Surg., Edin., 1867, M.D. Qu. Un., Ireland,
1868.
The Public Health.—T he Registrar-General,
in his usoal return, states : In the week that ended on Satur¬
day, Sept. 6th, the annual rate of mortality was 25 per 1,000
persons living. The rate was 22 per 1,000 in London, and 28
in Edinbnrgh ; 19 in Bristol, 20 in Birmingham, 31 in Liver¬
pool, 35 in Manchester, 42 in Salford, 23 in Sheffield, 32 in
Bradford, 34 in Leeds, 22 in Hull, 25 in Newcastle-upon-Tyne,
and 28 in Glasgow. The excessive mortality from summer
diarrhoea, principally infantile, which recently prevailed, has
nearly disappeared. The deaths referred to this disease in the
eleven latge English towus, which exceeded 900 both in the
last week of July and the first of Angust, had declined to 228
in the week. Daring the ten weeks the annual death-rate
from diarrhoea in the several towns was 4 per 1,000 in London,
Bristol, and Newcastle, 7 in Bradford, 8 in Liverpool, Shef¬
field, and Hall, 10 in Manchester, Salford, and Leeds ; and
highest, 11 per 1,000 in Birmingham. More than 6,000 deaths
were referred to this disease in these eleven towns during the
ten weeks, thus raising the average annnal death-rate by 6
per 1,000 persons living. The deaths registered in London
during the week were 1,827. It was the unity-ninth week of
the year, and the average number of deaths for that week is,
with a correction for increase of population, 1,285. The deaths
in the present return exceed by 42jthe estimated amount, and
exceed by 507 the number recorded in the proceeding week.
The deaths from zymotic diseases wers 871, the corrected
aveiage number being 397. Twenty-five deaths from measles,
101 from scarlatina, 7 from dypthcria, 20 from whooping-
cough, 62 from fever, and 64 from diarrhoea were registered.
Colour-Blindness.— In an interesting paper re¬
cently laid before the Society of Industrial Sciences at Lyons,
Professor Fournet announced that he had himself a singular
imperfection in the visual organs known under the name of
Daltonism, and which is much more common than is generally
supposed. The defect consists of an erroneous perception of
colours, and is named after Dr. Dalton, a celebrated English
physician, who first discovered the peculiarity in himself, and
found that cherries and their leaves had for him the same tint
M. Fournet knew two students of the Ecole des Mines, who,
having no clear idea of colours, were unable to distinguish the
various minerals, and one of them having to nse a carmine
wash in some drawing, used Indian ink for the purpose. In A
lengthy treatise, Dr. Potton, of Lyons, has ranged in the same
category a large number of shopmen who were obliged to be
dismissed for the simple reason that they could never distin-
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Yfte %tm and (firnttor SPvfrtisw. October?,m
nuffl. \h* various shades of the stuffs which they had to sell.
Ju Xit aberratkm of sight has been the cause of grave errors
m railways, the companies' surgeons at present are most
r in testing on this point the candidates for employ-
a iJtnx. Ur. Favre, at Perrache, stated that the number of
a^bcants whom he has been obliged to refuse because they
w^re LDcaj/able of distinctly telling a green light from a red
was very considerable.— Qalignani,
- ♦ -
APPOINTMENTS.
Pattkiuok, J. H., Esq , M.D., was on Friday last promoted to the rank
of Deputy Inspector-General of Hospitals and Fleets, on the retired
list.
♦
Burxitt.— On September 10th, on hN way from the West Indies, J ohn
M. Burklttt, M.D., L.R.C.8.I., second son of Dr, Robert J. Burldtt,
of Waterford (Ireland.) aged 21 years.
Cookeslky. —On the 23rd tut., at The Grove, Boltons, South Ken¬
sington, J. M. Cookesley, M.D., late of Bonlogne-sur-Mer, aged 58.
Cost.— On the 12th of August, at Mnnmar, near Bombay, T. 8. Cost,
Esq., of Egutpoora, Assistant-Surgeon G.I.F. Railway.
Fisher.— On the 29th ult, at Sittingboume, Kent, James Howard, the
youngest son of Charles Holdrich Fisher, M.D , aged 2 years.
Grbkwbank. —On the 24th of August, at Philadelphia, the Rev. Richard
M. Greenb&nk, A.If., M.D., of Sedbergh, Yorkshire.
Moons.—On the 19th ,ult, Y. J. Moore, M.R.C.8.E., of .Torquay,
aged 41.
Rootes —On the 27th ult, sf diphtheria, at Guy’s Hospital. London,
whers he was one of the House-Surgeons, George Rootes, son of W.
Bymonds Bootes, M.D., of Rots, Herefordshire, aged 24.
♦
NOTIOB8 TO OOR RKSPO NDBNT8.
Mr. F. 8. Garltck, Halifax.—In our next
Mr. W. E. C. Nourse.—O wing to the length of the Introductory
Addresses and pieces of other matter, we are again compelled to defer
the insertion or your letter. We bare given four pages extra this week
to accommodate our frionds.
University of London.— Pass List received with thanks. We regret
that press of matter compels us to postpone the publication of this
List.
The following communications are In type, and shall appear as soon
as possible Dr. Phelan, on “Lying-In Hospital*," Dr. Morgan, on
•* Total Destruction of the Epiglottis,” illustrated. “ Notes on Carbo-
late of Quinta/* by Dr. H. 8. Purdon. “The Forms of Pneumonia,” by
Dr. Octavius Stnrges. “A Lecture on Health and Disease,” by Dr.
Thos. C. Shiukwin, Ac.
Dr. McGricor Croft. —Perhaps next week ; the subject has, however,
been before discussed in our columns before the invention changed
hands.
Mr. R. Tibbott.—T he points in your argument were clothed some¬
what ambiguously; your second letter is eminently satisfactory, for
which please receive our thanks.
The following will please to receive our thanks for enclosures re¬
ceived:—Dr. Booth, Manchester; Dr. Worth, Millbrook : Dr. Dinwoodie,
Appleby; Dr. Dowse, Skelmanthorpe ; Mr. Wm. Hamson, Gar^rane ;
Dr. Nicholas, Wandsworth; Dr. J. Love, Castleacre; Mr. T. Turner,
Manchester; Dr. Attenbnirow, Jersey; Mr. Jackman, Swymbridge;
Mr. Holden, Liverpool; Mr. Thos. Wilson, Leeds; Mr. F. a Garlick,
Halifax; Dr. Jones, Farthingstone; Dr. Johnstone, Darlingon; Dr.
Murphy, Cockennouth ; Dr. Parry, Lydd.
BOOKS, PAMPHLETS, Ac., RECEIVED.
Annual Report of the Medical Officer of Health for the Holborn Dis¬
trict
On Famine, Fever and other Forms of Typhus. By Rudolf Virchow,
M.D. London; WUUams and Norgate.
JTIrduriea and Diseases of the Jaws. By Christopher Heath, F.R.C8.
London: John Churchill and Sons.
Clinical Lectures on Diseases of the Liver. By Charles Murchison,
M.D., P.Rf London: Longmans, Green, A Co.
The British Amy In IMS Third Edition. By Sir Charles K.
Trevelyan, K.CJL London : Longmans, Greta, A Ca
The Journal of Mental Science.
The Pharmaceutical Journal.
Bible Animals. Part X. Longmans 4 Co.
Tbs Practitioner. So. 4: ~ ~
The Westminster Review.
The London Student
OattJMa Oeaette: New Tort
Jew de MMm de Bordeaux, Boston Medical
ROYAL COLLEGES OF PHYSICIANS
AND SURGEONS OF EDINBUBGE
N otice is hereby given, that the prelimi-
NARY EXAMINATIONS in GENERAL EDUCATION by
the Royal Colleges of Physicians and Su rge on s of Edinburgh, daring
the Sessional Tear 1868-69, will be held on the following days, vis.
Saturday. October 24th, 1868; Saturday, November 7th, 1868; Satur¬
day, April 24th, 1869; and Saturday, July 24th, 1869. On cadi occa¬
sion the Examination will be continued on the succeeding Monday.
Information as to the Subjects of Examination, Ac., may be had oa
application to the Offioers of either College.
Intending Students of Medicine are reminded that they most paa*
the above Examination, or one of those accepted by the General Me-
dioal Council as equivalent to it, before they can be registered as Ms-
dical Students.
D. R. HALDANE, Secy, to the Royal College of Phyddaar
JAMES 8IMSON, Secy, to the Royal College of Surgeon*.
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Six Msdals— London, New York, Dublin, and Paris.
NOTICE.—BEST QUALITY ONLY.—SAMPLES FREE
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PHI AT A at the Lowest Prices. London Warehouses, 19, Breed-
street-hill, Upper Thames-street. City, E.C., and 28, Copenhagen-
street, Islington. B. A H. HARRIS and CO., Proprietors.
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The Improved FLINT GLASS BOTTLB8, with Lip, a very snperiw
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8 and 4 os. ... 9s6d per gross, j 10 and 12 os. ... 16s0dpergrms
6 and 8 os. ... 10 6 „ |l«os. ... 19 o .,
Immediate attention to oountry orders. No sail
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N.B .—Orders sent to either establishment will have prompt attentka,
PLEASE NOTICE REDUCTION IN PRICK.—BEST QUALITY OXLY
flreat Saving in the Pnrehaae of New Nediesl
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WORKS, I. ISAACS and COMPANY, Proprietors.-Wtrehoas*.
26 and 24, FTancia-etreet, Tottenham-court-road, London, W.C.
6 and 8 os., any shape, plain or I Clear 4- ^
gndoeted, ( blue UnUd 18-- M.pw |toa.
8 and 4 os. ditto ditto 8 0
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1 os. ditto I Of a vary superior II •
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2 os. ditto ) H (y 0
The Improved FLINT GLASS BOTTLES, with Lip, a vary raperte
article, in 6 Gross Packages, snorted to soli the eonvwniauee of ptf-
chasers, at the following reduced pri c e s
8 and 4 os. - 9s. 6a. per gross. 110 and 12 os. • 16a. Od. per grow.
6 and 8 os. - 10s. 6d. ,, 116 - - 19s. Od. „
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A remittance not required till the goods are received. Psektt*
free. Immediate attention to Country Orders. Goods delivered nee
within 7 miles. Post-offioe Orders payable to I. IBAAC8 A CO., atthe
Post-office, Tottenhamooart-road.—Bankers, Loodoa andOT-tiHa**
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Established upwards of 70 yean.
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P r the Sale of Leeohes and all kindi ef
MEDICAL HERBS. H. POITKRB, Depot, M,
Farringdon-etreet, London, E.O. Hh new priced. Chtalngus ant *>
any address on application. H. F. has on SaleaU kinds of Turkey and
Hoasy-Comb Sponges,
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u SALU9 POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 14, 1 868.
OONTENT8.
ORIGINAL COMMUNICATIONS.
PAOE
Syphilitic Affections of the Larynx. By
Mr. Morgan, F.RC.S.l., A.M., T.C.D. 325
Cases in Illustration of the Value of Chlo¬
roform in Convulsions. By John Dickie,
M.D., LR.C.S.E. 327
Votes on Carbolato of Quinia. By Henry
Samuel Pardon, M.D., L.RC.P. Ed.,
L.RC.8.1. 328
HOSPITAL REPORTS.
Edinburgh Royal Infirmary-*
Cases of Aneurism treated by Iodide of
Potassium, Under the care of Dr,
George W. Balfour .. 329
TRANSACTIONS OP SOCIETIES.
PAOE
Army Medico-Chirurglcal Society of Ports¬
mouth . 830
Medico-Chirurgical Society of Glasgow .. 831
Social Science Congress . 882
LEADING ARTICLES.
The Brotherhood or St. Lore. 834
Barracks . 334
NOTES ON CURRENT TOPIC8,
Medical Auction Bidding. 835
Gas Analyst... 836
Radcliffe Infirmary, Oxford. 336
Unqualified Interlopers. 836
The Societies. 336
Treatment of the Apparently Drowned .. 33#
PAGE
Laying the Foundation stone of the Glas¬
gow University New Building by the
Prince and Prinoess of Wales. 337
INTRODUCTORY ADDREB9BS.
The Liverpool Royal Infirmary School
or Medicine... 339
The Phamaceutical Society or Great
Britain . 341
The Salt-Cure of Reiclienhall.. 342
Medical News, Notices to Correspondents,
Ac. 342
SYPHILITIC AFFECTIONS OF THE LARYNX.
By Mr. Morgan, F.R.O.S.I., AM., T.C.D.,
Burgeon to the Westmoreland Lock Hospital.
Affections of the larynx occurring during the various
stages of syphilitic infection have always been of interest
to the practitioner, and of great anxiety to the patient,
—to the one from the difficulty of thorough inspection
and appreciation of the morbid condition,—to the other,
from the inconvenience of the diseased phenomena.
Since the introduction of the laryngoscope, however, fresh
and more definite information has been gained, and such
facility attained, especially in the local application of
remedies, that I have selected the following cases occur¬
ring in my wards of the Lock Hospital, in illustration of
the increased facility of treatment, showing ulceration of
the laryngeal membrane, whether as the sequel of a
primary infection, of constitutional infection from child¬
bearing, or combined with primary at the time of its
existence. All the cases illustrated were treated without
mercury, and the cure of the laryngeal ulceration chiefly
accomplished by the application of tannin solution, which
I have found particularly to agree with these ulcers,
whether touched directly with the solution, or applied by
the spray producer.
TOTAL DESTRUCTION OF THE EPIGLOTTIS BY SYPHILITIC
ULCERATION EIGHT YEARS AFTER INFECTION.
The accompanying illustration shows the extensive de¬
struction of the epiglottis that can take place with impu¬
nity. Considering the extreme sensibility of this region
and the delioate anatomical arrangement conoemed, it is
extraordinary that so protective and mechanically impor¬
tant a structure can be dispensed with, or that its office
can be supplemented or even entirely supplied by the ac¬
commodation of the parts around.
In Baron Larry's celebrated case of the soldier who had
the epiglottis shot away, the accommodation is well
shown, as the patient was in danger of dying from inani¬
tion, such was the difficulty of swallowing drink or food,
till time effected a compromise, though at first being fed
with a tube introduced into the pharynx, the man was
after six weeks enabled to swallow soft food, and finally
could accomplish deglutition without difficulty,
The subject of the illustration No. 3, A. W., was ad¬
mitted to my wards in the Lock Hospital (ward 1, bed No.
3), June 24th, 1868, complaining of hoarseness and difficulty
of breathing, but specially annoyed by threatened suffoca¬
tion when drinking, and that at night the secretions
trickled down and awoke her with fits of coughing. The
voice was not that of the syphilitic aphonia of Diday,
described by him as a failure of voice on attempt¬
ing high notes, but was peculiar in that, no matter how
she exerted herself she could not increase the tone or in¬
tensity, nor could she speak in a whisper ; on attempting
it, the voice was at once lost. This condition had existed
for nine months. The patient is otherwise in good condi¬
tion and vigorous, affording no symptom of chest affection;
there is no stridor on taking a deep breath, or any very
great inconvenience but in eating and drinking. She gives
the following history : — She is ten years unvirtuous.
Eight years ago she got a primary sore, and in a few weeks
after got an eruption generally over the skin; from her
description it would appear to be squamous,—since which
date she has never had any sign whatever of the infection,
till about nine months ago she became hoarse, and had some
difficulty in breathing. There are no cicatrices, osseous
enlargements, or other signs of any venereal taint. On
laryngoscopic examination, the epiglottis is seen to be com¬
pletely cut away by ulceration, the edge is irregular and
jagged, and two small specks of ulceration still remain ;
the edge is eaten down to the very fraenum epiglottidis,
and the rima is plainly discernible uncovered by the
epiglottis, which is as effectually taken away as the knife
could do it; the arytenoid movements are free, and the
vocal cords are not swollen, but seem rigid and unpliant,
and can only be protected by the accommodation of the
muscles and parts immediately around.
She is compelled to drink in gulps only, but can swallow
solids tolerably well.
The ulcers were treated by applying a jet from a spray-
producer of weak tannin solution, gr. xxx. ad. §j., every
second or third day, the irritability of the opening being
thus considerably diminished. The patient was discharged
much relieved August 3, 1868.
(See illustration, No. 3.)
ULCERATIONS OF EPIGLOTTIS COMBINED WITH PRIMARY
SORES ON GENITALS, AND BUBO.
K. B., aged 24 (ward 1, bed No. 7), was admitted 18th
August, 1868, suffering from patchy soft sores on genitals,
followed by non-suppurating bubo on one side. She is of
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326 The Medical Press and Circular. ORIGINAL COMMUNICATIONS.
October 14,1808.
cachectic appearance, with a murky skin, and of an apathe¬
tic, desponding temperament; unvirtuous for four years,
and had been under treatment in the hospital on two
previous occasions—1st, for eruption, three years ago;
2 nd, for two genital sores, six months ago.
She has no eruption on the skin, pains, or alopecia; she
is hoarse, and has some uneasiness in swallowing, referred
to the upper part of the throat only, but has no inconve¬
nience in dr;nking or tickling of the throat at night.
There is a shade of dulness over the left infra-clavicular
region, but no appreciable stethoscopic signs of disease in
the chest.
On laryngoscopic examination, the appearance of the
epiglottis was remark ible, four little ulcers being visible
on the free edge, three the sizj of a l arge pin’s head each,
and the fourth about the half of a No. 5 shot. The epi¬
glottis Wii3 otherwise heal thy looking and pliable ; the
aryteno-epiglottide.tn folds appeared flabby and pale; the
arytenoid movements were perfect anil very distinct.
Treatment .—The ulcers were well brushed with nitrate
of silver solution, gr. xxx. ad. §j., and tannin solution, gr.
xxx. ad. 3j., applied to the folds, which constringed the
membrane, and caused the healing of the epiglottidean
ulcers. The general treatment consisted of large doses of
iodide of potassium, iron, bitter infusion, and good diet,
with local applications to the sores and bubo, which was
resolved. She was discharged cured September 28, 1868.
(See illustration, No. 2.)
DEEP ULCER AT THE BASE OF ARYTENOID IN A MARRIED
WOMAN INFECTED BY CHILD BEARING, NEVER HAVING
HAD PRIMARIES.
R. D., aged 26, a married woman (bed No. 11, married
ward), admitted August 31, 1868, mother of two children,
one two years old, another born one year since, but died,
when eleven weeks old, of infantile syphilis. Two months
after the birth of the first child she had sore throat and
pains in the head, and in about four months she got a sore
on the head over the frontal bone, which healed after treat¬
ment ; she remained well till after the birth of the second
child, when, in about three weeks, she got sore throat, and
about nine months after got secondary sores on the arm,
chin, eye, and head, over the parietal region; she never
had joint pains or rash, primary sore or bubo ; she is
hoarse now for four months, is losing flesh, and has been
under treatment for these affections for one year and nine
months. The chest sounds are perfect.
On laryngoscopic examination, a well-marked deep
ulcer like a chink is seen at the base of the right arytenoid,
near the attachment of the false vocal chord; the mucous
membrane generally in the neighbourhood is congested
looking and tumid.
Treatment .—The parts around and the ulcer were
brushed wi.h nitrate of silver solution, gr. xxx. ad. §j.,
and every third d ly tom bed with tannin solution, gr. xxx.
ad. 5j. Iodide of potassium in large doses 'administered.
The improvement alter three applications to the larynx
was remarkable, though the ulcer, from the mobility pro¬
bably, was rather refractory.
This case U an interesting example of intermediate in¬
fection by child-bearing, and the more complete affection
of the system after the birth of the second child. She is
now again about four months pregnant. Discharged cured
September 26.
(See illustration, No. 1.)
ULCER OF JHE FALSE CHORDA VOCALIS, WITII FIRST SOP.U3
ON GENITALS, AND ERUPTION.
R. B., aged 23, a patient (bed No. 11, first admission
ward), presented all the symptoms of syphilitic cachexia,
being affected with several patchy soft sores of the labia,
disseminated papular eruption, a murky hue of the skin,
some osteoscopic pains, and suffered much from hoarseness
with partial loss of voice. She dates the initial sore as
occurring about six weeks ago, and that two weeks after
its formation the papular eruption appeared, first in the
ower limbs; and about two weeks after the eruption the
hoarseness commenced, a feeling of obstruction in the
breathing mostly inconveniences her.
She has never before had any venereal affection, and has
been rather poorly circumstanced now, being eight months
unvirtuous. There is no difficulty in swallowing; and on
examination, the chest sounds are perfectly healthy; there
is a slight anaemic bruit in the jugular veins; engorgement
of the cervical glands, and of one under the jaw.
On laryngoscopic examination, the right false chorda
vocalis is distinctly swollen, and sufficiently tumid to en¬
croach upon the opening of the glottis; at its arytenoid
■ extremity an ulcer is seen of a greyish colour, about the
size of a *plit pea, exhibiting not so much the appearance
| or’ a “ mucus patch” as of a distinct ulcer, with well marked
i edges, as ir torn.
| Treatment. —The ulcer was touched on four occasions
; with nitrate of silver solution, gr. xxx. ad. Jj., and Unnin
1 solution, gr. xxx. ad. §]., ten-grain doses of citrate of iron
| and iodide of potassium in bitter infusion, good diet, and
] occasional warm baths dissipated all the symptoms, the
I patient being discharged with completely restored health,
August 4, 1868.
(See illustration, No. 4.)
ULCER OF LARYNX NINE MONTHS AFTER PRIMARY
INFECTION.
M. B., admitted July 31 (bed 6, ward No. 1), married,
aged 31; was infected by her husband nine months pre¬
vious to admission with soft sores, and a vaginal discharge;
for these she was treated in the hospital by topical appli¬
cations chiefly. She remained without any symptom
whatever of the disease till three weeks previous to ad¬
mission, when she became affected by the formation of
“ mucous patches ” about the anus, and slight vegetations
in the vicinity of the urethral orifice; she also suffered a
little from osteoscopic pains. On admission, there was no
hoarseness or difficulty of respiration; but about three
weeks after this date she got hoarse, and gradually the
voice became nearly extinct.
On laryngoscopic examination, an elevation of the
mucous membrane, with ulceration of the surface, could be
distinctly seen in the space between the bases of the ary¬
tenoid cartilages, the appearance being that exactly of a
“ mucous patch” of the membrane in this region.
Treatment .—The “ patch” was touched with nitrate of
silver solution, gr. xxx. ad. Jy., and afterwards on four oc¬
casions with tannin solution, gr. lx. ad. Jj., gr. x. doses
of iodide of potassium in bitter infusion, and local appli¬
cations to the anal patches, effected a cure. Discharged
September 28.
(See illustration, No. 5.)
The occurrence in this case of the 4C mucous patch,” both
at the anus and in the larynx simultaneously, would go
far to explain the cause of the peculiar voice of syphilitic
infant*, as called by Colies, “ tne peculiar hoarse cry,” bo
characteristic a token of infantile infection. The hoarse¬
ness gradu illy comes on, as Rosen remarks, u without
a iy man ful cau*«*/’ and remains till the taint is removed
i by treatment. the formation of “ mucous patches” on
I the clitvk, longue, and lips i* of so frequent an occurrence
in infants it is to be concluded, as in this case, in the
adults (tig. ft), that *' mucous patches ” form in the vicinity
| of the wed cli »nls. 1 luve iuul an opportunity of fully
| and carefully examining, alter death, the fauces of a child
| that die t in the L »ck 11 s^ital, aft *r un existence of six
I weeks in a pining condition fiviu 1 irth. The mother
; was suffering from syphilis at the. time. The infant had
j no noli on the body, but had “ mucous patches” at the
I anus and the coinmisure of the lips : it was impossible to
| see the hark of the throat during life. Alter death, how¬
ever, at the. base of the tongue a patch was to be seen
and another far down on the lack of the pharynx. A full
post-mortem was not admissible, but it is not unreasonable
to conclude that the “ peculiar hoarse cry” was caused by
the existence of a u patch ” in the more immediate neigh¬
bourhood of the vocal chords, as one of the phenomena
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The Medical Fna and Circular.
ORIGINAL COMMUNICATIONS.
October 14,1868. 327
of the earlier stage of secondary infection. This infant
of six weeks old presented the identical symptoms of in¬
fection as did the adult aged thirty-one, furnishing illus¬
tration, No. 5.
The following is an illustration of the severer form of
syphilitic ulceration, extending to the cartilages of the
larynx. A man, stating that he was a scrivener’s clerk,
presented himself last March at Mercers* Hospital, suffer¬
ing from debility, difficulty of breathing, and other signs
of laryngeal irntation; he gave the following history :—
He had syphilis six years previously, had two years
afterwards some slight eruption, which was treated with¬
out mercury; since then ne escaped till one year since,
when he got some pains in the bones and three sores at
successive intervals on the thigh, and within the last
two months the commencement of the present affection;
the chief symptoms being the teazing caused by a dry
couch, especially at night, thin mucous expectoration, gra¬
dually becoming, as at present, pipulent; the patient is
still more alarmed lately oy this being now slightly incor¬
porated with blood; the voice, from being at first a huski¬
ness, has now become inaudible but in a whisper, and that
with considerable effort; the respiration is sibilant and
venr rough over the upper border of the thyroid cartilage,
and considerable pain is felt during the act of deglutition,
which the patient endeavours to relieve by bolding the
larynx steady between his finger and thumb during the
moment of the food passing by, as in the case where the
epiglottis has been completely lost (illustration No. 3).
There is the same difficulty in swallowing fluids, to such
an extent that the sufferer never tries now, but thickens
all fluids with bread or flour; he is also much distressed
by the fetid smell, which is constant, the expectorated pus
giving the foe tor of necrosed bone or pus communicating
therewith; the pus is also unlike the nummular sputa of
phthisis, it is less solid from being mixed with a quantity
of mucus. On percussion, the thyroid region of the larynx
is painful, and the general feel that of ossification; there
are no signs of phthisis to be found.
On laryngoscopic examination, the aperture was to be
seen almost full of tenacious muco pus, which the patient
could clear away by expectoration, and which re-formed,
almost to the same extent, during the space of a laryngeal
examination of a few moments 1 duration. The right ary¬
tenoid cartilage was partially dislocated, so that its inner
edge, denuded of mucous membrane, impended consider¬
ably over the opening ; a large ulceration was to be seen
occupying this angle.
Tne parts were touched with a strong solution of tannin,
oj- »d $j., mid the ulcerated part witn nitrate of silver
solution) 3ji. ad 3j. Iron ana iodide of potassium were
administered in large doses. After three dressings the
secretion had somewhat diminished, and the general health
was slightly improved.
I looked on this case as one of ulceration, combined with
death of part of the cartilage, and hoped to have had a
laryngoscopic drawing, which the patient promised a
sitting for, but unfortunately he has been since lost sight of.
CASES IN ILLUSTRATION OF THE VALUE OF
CHLOROFORM IN CONVULSIONS.
By John Dickie, M.D., L.R.C.S.E.
In 1852, Sir. James Simpson first suggested the inhalation
of chloroform as a valuable remedy m infantile convul¬
sions, and other spasmodic diseases (see Edinb. Med.
Jour nal, 1852). Since that time the remedy has been
sufficiently tested by the profession, to establish it beyond
question, as a therapeutic agent of great value in the
controlling of convulsive diseases, and especially the suc¬
cessful treatment of infantile and puerperal convulsions.
Having hod an unusual number of cases of convulsions
in my practice during the last few months, and having
administered chloroform successfully in every case—
irrespective of the cause of the fit—I would, with your
permission, select the two following cases as the most
remarkable, and lay them before the readers of the Medical
Press and Circular , as interesting examples of the value
of chloroform in the treatment of one of the most dis¬
tressing and dangerous complications to be met with in
general practice.
Case L Puerperal Convulsions , before and after delivery .
—On January 18th, 1868,1 was sent for to Mrs, S—., a
strong, healthy young woman, aged twenty-two, in labour
of her first child. For a week past, she had been tormented
during the night with false pains. She had enjoyed good
health during pregnancy; her present illness commenced
at 6 a.m.,and as she was gradually getting worse, I was sent
for at 4 p.m.; on examination, per vaginum , the os uteri was
dilated to about the size of a shilling, the membranes
projecting slightly during a pain and the head presenting.
As matters appeared to oe going on favourably, I gave a
few general directions, and left for home ; at 10 p.m., I
was again sent for, the pain had been regular and increas¬
ing in strength, the os had opened to the size of a crown-
E iece, was soft and dilating. An hour afterwards the
quor amnii was discharged, and the pains, after a short
interval, became very strong ; I anticipated a speedy de¬
livery. About an hour afterwards the patient complained
of a pain in her forehead, and got very nervous and
restless. She got out of bed to pass water and while
sitting on the night-stool was seized with convulsions,
and fell on the floor; the fit soon subsided, and she was
assisted into bed. She was partially unconscious, and
became so unmanageable that Ihad difficulty in examining
her. I sent off immediately for chloroform, but before
the messenger returned, which was about ten minutes, I
had witnessed two of the most frightful convulsive
attacks possible to conceive—the face was literally black
and frigntsome to look upon, and every muscle in her
body rigidly contracted. The chloroform, administered
from my pocket handkerchief, did its work in a few
minutes, and the patient lay as in a profound sleep ;
meantime the pains continued to come on regularly and
wonderfully strong. By periodical re-application of the
chloroform^ the anaesthesia was kept up for two hours,
by which time the os was fully dilated and the head well
down in the pelvis. Considering it advisable to deliver
as soon as practicable I applied the forceps, and after
half-an-hour s hard work, she was delivered of a healthy
boy. The placenta was expelled twenty minutes after,
by which time the mother nad partially regained con¬
sciousness. She was informed that she was better, and
she appeared quite surprised and asked for her child.
She kept very well for an hour and I had thoughts of
leaving, when I was horrified to hear her give a loud cry,
and immediately she became convulsed. The chloroform
was again administered with success, twenty minutes
after another fit threatened but was immediately arrested
by more chloroform. The fits continued to threaten
whenever the anaesthesia wore off, I therefore made ar¬
rangements to keep her under the influence of the chloro¬
form until they would cease, which was not till the
following afternoon, sixteen hours after delivery. She
still, however, remained partially insensible, but was able
to swallow some light nourishment that was given her.
At my visit the following day I v, as gratified to find her
quite comfortable, pulse ninety, no pom, lochi» moderate,
and a large quantity of urine had just been passed. I
tested it for albumen but found none. She made a good
recovery.
Case II. Urcemic Convulsions, following Scarlet Fever .«—■
Scarlatina has been more than usually prevalent in this
town for nine months, and as usual in such epidemics,
cases, illustrative of the different varieties of the disease
have been observed, some of them exhibiting the mildest
form of scarlatina simplex, requiring little or no treat¬
ment, more than careful nursing and confinement to the
room]; while others were of a more serious nature, indeed,
many were of the most malignant character* The case
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October 14,1M.
which I propose to bring forward is a good example of
scarlatina angenn®.
J. M— ., aged nine years, who was attacked on the 25th
August, 1868. I saw him the following day, he presented
the following symptoms :—Tongue covered with a thick
white fur, pulse 130, skin very hot and dry ; the rash
had appeared over night, and was diffused in bright
scarlet patches over the body; tonsils, uvula, and part of
palate were studded with spots of ulceration, and the
mucous membrane around exhibited a dark velvety ap-
perance, deglutition very difficult. I need not detail
the progress of this case, suffice it to say I treated it
by the ammonia method , with strong escharotics to the
throat.. Ennassen, I might mention that during this
epidemic I have put to the test some of the specifics for
all kiiids of scarlet fever, indiscriminately, such as quinine,
iodine , &c., and their adjuncts, and although the particular
treatment was begun early and determinedly carried out,
yet the result did not come up to my expectations. I
believe no one special mode of treatment is applicable to
Scarlet fever. Its causes are as mysterious and unknown
as those of typhus, or any other fever. Much depends
on the constitutional tendency, unhealthy locality, and
the particular type of the disease.
My case progressed favourably to convalesence till the
twentieth day, when an interruption took place by a
slight attack of anasarca and, subsequently, convul¬
sions. The latter had set in quite suddenly about
3 p.m., and succeeded each other so rapidly and so
violently that at 6 p.m., when I saw him, he appeared to
be moribund, and when I sent off for chloroform I did
not expect my patient would hold out until the messen¬
ger Would return, his state appeared so utterly hopeless,
however, I was disappointed, and on administering the
chloroform the spasms graduallv abated and the patient
began to look more life-like. External heat was applied
ana every means used to get the patient into a perspira¬
tion : a purgative injection was also administered. The
chloroform had to be renewed occasionally during the
night and following forenoon, always with the effect of
warding off a threatened convulsion. The patient con¬
tinued in a dozing state for two days, and during that
time had a smart attack of diarrhoea; ids urine, which
was highly albuminous and almost totally suppressed for
two or three days, gradually increased in quantity. The
dropsy also gradually diminished, and day by day he
improved in strength, and at the present—six weeks after
his first attack—he may be considered convalescent, and
likely to make a good recovery.
NOTES ON CARBOLATE OF QUINIA
By HENRY SAMUEL PURDON, M.D., L.R.C.P. Ed.,
L.R.C.S.I.
Physician Belfast DUpensaiy for Diseases of the 8kin, Assistant-Physi¬
cian Belfast Charitable Institution and Infirmary, Member Ulster
Medical Society, Ac.
Duriot the last five months I have prescribed the carbo-
late of quinia in various diseases, which remedy has been
recently introduced into practice by Professor Bernatzik.
(see* British and Foreign Medico-Chirurgical Reveiw/
April, 1868). In the following brief notes I shall merely
mention the results I have obtained; and, firstly, a few
Words on the preparation of this remedy are necessary, as
itiy formula is Brightly different from that of Professor
Bernatzik.
Take of quinia 120 grains, deliquered carbolic acid 30
minims, rectified spirit 75 minims, evaporate to the con¬
sistence of treacle, and make into pills with extract of
gentian and powdered cinnamon, each pill to contain one
grain of quinine and one-fourth of a gram of carbolic acid.
Tina preparation has been always carefully prepared of
uniform strength for me at Mr. Cantrell's establishment,
in this town. Professor Bernatzik has used the carl>olate
of quinia with success in the treatment of pyaemia, ery¬
sipelas, typhoid and puerperal fevers. I have prescribed
it with benefit in secondary syphilis, furuniculi, anthrax,
as in the cases hereafter recorded;
Carbolic acid as an internal remedy is now becoming
more frequently used, especially in “ blood diseases,” and
the latest example of this agent being successful in a
disease in which other medicines have hitherto proved
useless is in leprosy, especially the anaesthetic variety.
The formula used is carbolic acid, ffijij ; dilute acetic acid,
B. P., $3 $.; rum, Jiij.; syrup, &jss.; water, £jv.; to be takes
directly after a meal, twice daily. (See Review of Dr.
New ton’8 work on Anoesthetic Leprosy, w Journal of
Cutaneous Medicine," No. vi, page 187.1
As an external remedy carbolic acid needs no special
pleading on my part. The practice of Professor Lister, of
Glasgow, founded on the "germ theory” of M. Pasteur
being now well known.
Carbolic acid, especially when combined with a tonic,
as quinine* has been given internally in zymotic affec¬
tions, on the continent, on the principle of its destroying
the femientive process of the so-called blood diseases, m
also I may mention that at a meeting of the Pathological
Society of London, held on Tuesday, March 3rd, 1868,
John Simon, Esq., F.R.S., in the chair, the President
commuicated for Professor Hallier, of Jena, some dis¬
coveries concerning the relation of cryptogamia to con¬
tagious diseases. That gentleman had tiaced, some time
ago, a fungus associated with cholera, and he had now
discovered characteristic fungi in six other diseases, vit,
in the eruption of variola, variola ovina, vaccinia, and is
the blood of typhus, typhoid, and measles. Although
Professor Hallier’e views have not been confirmed in these
countries, still, if correct^ they Would lead us to suppose
that the carbolate of quinia will be a valuable medieiue
in such affections.
Quinine has likewise the property of destroying vege¬
table parasitic growths, and, as well as I remember,!
statement appeared on this subject in some of the medical
journals at the commencement of the present year; end
it is a remedy commonly prescribed in parasitic scalp
diseases of children. Dr. Bence Jones some time aco
pointed out the existence, in the human body, of a sab-
stance resembling quinine in fluorescence and possesaitf
the optical and chemical properties of that drug, sad
Drs. Road and Pepper (Pennsylvania Hospital Keports
quoted in British Medical Journal) have ascertained tbit
a diminution of animal quinine ib produced by malarial
poison, as in ague, and I am inclined to think that te
nave in the carbolate of quinia an excellent remedy
ague and allied diseases.
From the preceding brief remarks, it will be evident that
in combining two such valuable remedies together as car¬
bolic acid and quinine, a combination is obtained whim*
likely to prove a useful medicine in zymotic diseases. 1
have only tried it in a few cases—it has failed two w
three times. The following cases are briefly recorded,
and are selected from out of the number treated fi»
carbolate of quinia.
1. Furunculu —Mrs. Miuford, aged fifty-one, admitted
at Dispensary for Diseases of the Skin, on June
1868, suffering from the appearance of successive crops d
furunculi, duration of disease about two months, hedth
below par, has been taking a good deal of medicine of one
sort or other without benefit Lives as well as her mean*
permit Ordered one pill of carbonate of quinia thntf
daily; on July 15th discharged, convalescent
2. Carbuncle .—A. Ewing, admitted June 10th, for car¬
buncle on back, is thin and delicate looking. No to*
treatment except an occasional poultice. One pill of tbs
carbolate of quinia thrice daily, which after a few days
increased his appetite. Dismissed July 8th, cured.
3. Syphilitic Eruptions, —Mrs. H—®t fifty, admitted
at Dispensary for Skin Diseases, June 27th, suffering fro®
a secondary syphilitic eruption, together with sore Uuw
states that she received the disease from her husband,
taken mercury, iodide of potassium, and sarsaparilla, before
applying at the dispensary. It occurred to ine that 1hi*
would be a good case for trying the carbolate of
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HOSriTAL REPORTS.
October 14,1868. 329
in ; and one pill, thrice daily, gradually inoreased. till six
were taken. No local application. In September she
discontinued attending at the dispensary as she was ap¬
parently cured.
4. Alex. Walsh, admitted for ulcerated throat and en¬
larged glands in the cervical region. His mother informed
me that she formerly had syphilis, accompanied by an
eruption of the skin. The hoy has always been in delicate
health, his teeth were notched, and complains of pains in
the bones at night; had formerly taken iodide of potassium
which gave temporary relief. After taking the carbolate
of quinia pills for some time he was mu<3i improved in
every respect, although a slight enlargement of a few
glflinh in the neck remained.
The above cases might be recorded at greater length,
but I have endeavoured to give only the most interesting
features in each. Carbolate of quinia in all the cases in
which I have tried it—about thirteen—has increased the
appetite, and when fetor of the breath existed, removed it.
I think it will prove a valuable remedy in certain forms
of syphilitic affections, where mercury has been given in¬
juriously, and when the patient cannot take the iodide of
potassium, and are of the poorer cla*s of society, having
to endure hard labour, exposure to the weather, and bad
food. In furunculi it is also valuable. I have not
tried the carbolate of quinia in either erysipelas or fevers,
but shall do so on tne first opportunity, and have no
doubt that it will prove serciceable. And now, in conclud¬
ing these "rough notes,” I hope that some other physician,
whose experience and practice is more extensive than my
own. may be induced to try this medicine and publish the
results of his cases, mine being too few to form any definite
opinion from. Thus the truth will be arrived at. u Ad
major am gloriam Dei."
-♦-
Unaptal l&tparte.
EDINBURGH ROYAL INFIRMARY.
Casks or Aneurism treated bt Iodide of Potassium.
Under the care of Dr. Georoe W. Balpour.
Last summer Dr. Balfour read before the Edinburgh
Medico-Chirurgical Society a paper on the treatment of
aneurism by iodide of potassium. He related several re¬
markable cases. Since then he has had several others of
equal interest. We propose to lay the oases as a series
before our readers, commencing with those which formed
the basis of his paper.
Case I .—Aneurism of the Aorta A—Peter Rice, a mason,
aged 39, admitted into Ward III. on the 29th April, 1667.
Patient has never had rheumatic fever, but for the last
five yean he has been subjeot to rheumatic pains in his
hip, leg, and back, which are generally severe, and are
moet apt to recur in the changeable weather, of spring. He
has been in the habit of drinking pretty freely. About
twelve months before admission, he fancied that he was
overwrought, and when he got home he found that he could
not take a deep inspiration freely; he also felt a sharp pain
at a point about two inches to the right, and a little above
the left nipple. This pain has continued ever since, and
has latterly increased considerably. This pain is stationary
at the part described, but when more severe than usual, it
s p reads upward to the armpit and shoulder, and down the
left arm to the wrist, occasionally extending downwards to
the scrobiculus cordis, and sometimes striking jsharply
through to a corresponding point at his back. It is spe¬
cially apt to be severe at nignt, preventing him from sleep-
1 «n was primarily tinder the care of Dr. Warburton Begbie,
aettns m Profeasor Layoock. and was transferred to my care when
the clinical wards were closed, at the end of the summer session of
1867. The ease is partly ooadsosed from the report in the clinical re-
•onto of Ward EO.
ing, and is very annoying when it affects his hack, as he
cannot lie in any other position than supine. He nas oc¬
casional fits of dyspnoea, and it is always painful for him
to take a full inspiration. He has also some difficulty of
swallowing. He is much troubled with palpitation, and a
distressing feeling of pulsation, and these sensations annoy
him most when the pain is severe. At such times, he ob¬
tains some relief by relaxing the respiratory muscles, by
stooping forwards and leaning against a wall or other sup¬
port, with his hands and arms extended. About a week
ago, his symptoms had increased so much that he was
obliged to cease working altogether. His appetite is good;
his Dowels generally confined. On percussion, the heart
seems of normal size; its pulsations are distinct, and In
their ordinary situation; tne first sound is normal, the
second accentuated. The right radial pulse is fuller than
the left. About three years ago, the patient had muse©
volitantes, lasting off and on for about two years, appearing
only for a few seconds each time; and still at times, lie can¬
not see things at a distance so well as he thinks he ought, the
letters appearing to swim before him when reading. His left
pupil is slightly dilated. Some time ago he also had tinnitus
aurium. His left cheek is often flushed, and at times he
feels it warmer than the other. His lung-sounds are nor¬
mal, but he has an imperfect, hard, clinking cough, without
expectoration. He also frequently perspires without any
apparent cause. There is a slight bulging of the walls of
tne chest, between the second and third ribs, at the left
edge of the sternum, extending into the manuorium etemi,
ana gradually declining all round within an area covered
by that of the month of a tumbler. Over this space, and
for a corresponding distance downwards towards the heart,
there is a aulness on percussion, and a distinct sense of
liquid pulsation. 'Within this region, the heart-sounds are
also extremely distinct, but there is no bruit.
Twenty grains of iodide of potassium were ordered to be
given three times a day. and a belladonna and opium
plaster was applied over the tumour. About a month
after, on the 23rd of May, as the patient fancied he was
not improving, the iodide was omitted, and a precisely simi¬
lar dose of the bromide of potassium was substituted for it.
At first, the patient fancied the change of remedy had done
him good, for he had less pain, and got more sleep; hut
this improvement was apparently of short duration, even
though the dose of the bromide was subsequently increased
to thirty grains thrice a day, for on the 7th of June the
iodide was again recurred to in doses of twenty grains thrice
a day with the addition of one-twelfth of a grain of iodine
in each dose. On the 17th of Jane, it is stated that " there
is more pain over the aneurism, and he feels his left hand
benumbed. The swelling seems to have increased in size
since the 15th inst.” On the 7th of July, however, it is
entered that he “ states that the pain in his breast and
down his arm are not nearly so baa as they used to be, so
long as he is quiet in bed; but when he rises and walks
about, they become even worse than before.” The patient
continued to wear the belladonna plaster, but on the 7th
of July the iodide was omitted, probably on acoount of
coryza, which, though not recorded, the patient has told
us that he suffered from about this time; and on the 8th
the following pills were prescribed;—
R Extr. aloes aquosi, gr. L a
„ colchici acetic, gr. L
Mass. piL hydrarg. subohlor., gr. ij«
Misce fiat piL mitte tales xii
Sgr. one night and morning.
There is no farther record in the books of Ward IH. to
to the iodide being again resumed, and I am not aware
whether it was or not; I believe, however, that it was.
The last entry is on July 18th.—“ Thinks himself easier
to day.”
On the 1st of August, the patient was transferred to
Ward VII., and placed under my care. # He was at onoe
placed upon thirty grain doses of the iodide of potassium
three times a day, and these doses he has continued to
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October 14,1W
take without intermission up to the present date (May,
1868), with continually increasing benefit, and without the
production at any time of the slightest unpleasant symp¬
tom. For several months he also continued to wear a
simple belladonna plaster over the tumour, but at last it
blistered him, and produced so much eczematous eruption
each time it was attempted to reapply it, that it had to be
discontinued. On coming under my charge, he was strictly
confined to bed, and for long he lay entirely on his back,
that being the only position in which he found always
comparative and, latterly, perfect ease. He was only al¬
lowed to get up and move about for the first time about
three weeks before his dismission on the 2nd of April.
He was placed upon fish diet at first—meat being subse¬
quently given when he tired of fish, but he was at all times
carefully warned of the necessity for strict moderation both
in eating and drinking; water, small quantities of tea, and
milk for supper, being the fluids supplied. With all this
care, and notwithstanding the large doses of the iodide
administered, his progress at first was extremely slow, but
it was steady; ana in a clinical lecture given on his case
on the 19th of November last, I find it stated “ there is
no longer anv tumour visible, and it is only on careful
examination that you will discover any pulsation; he is so
far recovered, that he is a little inclined to be rash, and to
move about quickly in bed, or even to turn upon his side;
but upon this the pulsation instantly returns—a sufficient
warning to him that he is not yet cured.” Indeed, it was
not till the beginning of March, in this year, that he was
able to move about freely, without discomfort or any re¬
turn of the pain or pulsation. On the 1st of Apffl, I had
the honour of exhibiting this patient before this Society,
just previous to his discharge from hospital, when you had
the opportunity of observing the complete subsidence of
the tumour described, pulsation being only to be obscurely
felt in the situation where it formerly existed; you also
heard the man’s statement that his pain, dyspnoea, and
dysphagia were gone; and you were able, from his healthy
and energetic appearance, to form some idea of the impor¬
tance and value of this mode of treatment. I may add,
that I have repeatedly seen this patient since his discharge,
and that he still continues to improve, while, from the
active mann er in which he marches through the streets, no
one would suppose that but a year ago he was what might
well be thought a hopeless invalid, afflicted with one of the
most terrible and incurable of maladies. With all this
improvement, however, Rice is not cured; it is doubtful,
indeed, whether, under his circumstances, a poor man ne¬
cessitated to do something for his daily bread, he ever can
be cured. ^ But he has obtained great and incalculable re¬
lief and his case is an encouragement to us in the treat¬
ment of similar affections, and full of hope for those who,
placed in happier circumstances, may yet labour under a
similar disease.
The second case, though more obscure in its diagnosis,
was even more satisfactory in its results.
_ Case II.—John Kerr, a seaman, aged 26, admitted into
Ward VII. on 22nd October, 1867. He states that he
has been ill for eighteen months, dating his illness from
the privations to which he has been exposed when on an
arctic voyage, and the strenuous exertions he was, while
in an enfeebled, condition, obliged to make in hauling the
boats over the ice and frozen snow. While in America he
has been somewhat roughly handled for various diseases
with which he was supposed to be afflicted. At last the
diagnosis culminated in that of aneurism of the abdominal
aorta, and to get relief from this, he crossed the Atlantic,
and presented himself at the surgical wards of the Royal
I nfirmar y here, and from them he was transferred to my
®are. He complained of intense pain in the scrobiculus
cordis extending through to the back, and passing round
both sides. On examination, a tumour could be obscurely
felt a little below the sternum, and just under the edge of
the right ribs; this was more distinctly perceived, falling, as
it were, into the hand on turning the patient over on his left
side; and in the situation referred to, a loud bruit was to i
be heard with the stethoscope. Notwithstanding the ob¬
scurity of the diagnosis in this case, it was considered right
to place this man under the influence of iodide of potas¬
sium, as a treatment likely to be useful, whether the tu¬
mour was solid, or was really an aneurism; accordingly,
he got thirty grain doses of the iodide of potassium twin
a day; he was placed on fish diet, a restricted amount of
fluids, and confined to bed. The result was most en¬
couraging; he got almost immediate relief from the ago
nizing pain, while the uneasy pulsation felt by the men
himself was also at once considerably lessened, and the
force and fulness of the radial pulsations, as observed by
us, seemed to be also greatly diminished. He continued
steadily to improve: in a few months the tumour and bruit
had completely disappeared, and, on the 22nd of January,
1868, he was dismissed at his own request. He considered
himself so well, that he engaged for a short voyage for the
purpose of testing his reacquired health before finally pro
ceeaing to sea. This case is one, the obscurity of which
is patent to all, and I am not disposed to press the diag¬
nosis of aneurism; nevertheless, the symptoms pointed
strongly in that direction, while the success of the treat¬
ment, and the manner in which the relief was obtained,
seem also to confirm it.
fensaxtimis of ^forMirs.
ARMY MEDICO-CHIRURGICAL SOCIETY OF
PORTSMOUTH.
Ootobeb 7th, 1868.
Deputy Inspector-General Dr. 0. A. Gordon, C.R, in
the Chair.
Staff-Assistant Surgeon O’Leart, Honorary Secretary, wad
a paper by Surgeon Porter, 97th Regiment, on a case of
ABDOMINAL ANEURISM,
the subject of which, twenty-nine years of age, and ten yean’
service, was on 23rd of June, 1868, admitted suffering from
debility and sickness after meals. He returned to duty on the
2nd of July, but on the 5th again came to hospital suffering
from the same symptoms, and, in addition, from a sensation of
weight in the epigastrium. He lost flesh. On the 24th of
July his condition was reported to have been very weak; the
irritability of stomach continued, but pressure on the epigas¬
trium was unattended by pain or uneasiness. Careful exami¬
nation of the abdomen was made from time to time, both
before and subsequent to that date, but nothing was dis¬
covered to account for his condition. On the 29th of Augw*
he, for the first time, complained of pain in the back imme¬
diately above the sacrum, and from that date became daily
weaker; was unable to sleep at night, and on attempting to
get out of bed was seized with partial collapse and cold pero¬
ration. On the 6th he was seized with faintness, from which
he could not be rallied, and in about an hour afterwards he
died.
Post-mortem examination revealed an aneurismal tumour,
originating from the aorta, and imbedded in a fibroeerom-
looking tissue, through which passed the duodenum, the ramt
and mesenteric arteries. On the anterior surface of the tumour
was a rent through which its contents had escaped into the
cavity of the abdomen. The tumour, which had its origin at
the anterior wall of the aorta where the cceliac axis com¬
mences, and was found to have been a dilatation of it,
about fourjinches in length ; the communication between it
the aorta being sufficiently large to admit two fingers. Th
gastric, hepatic, and splenic arteries took their origin from the
tumour itself. The case was considered to have the following
points of interest, namely,—
1. That physical examination during life afforded no moans
of making a correct diagnosis ;
2. In the absence of constitutional symptoms of aneurism;
3. In the absence of pain, although the tumour wssom-
braced by the crura of the diaphragm ; and
4. That the tumour was on the anterior wadi of the amt*
where, according to Dr. Stokes, it is seldom met with.
Surgeon Lampbet, 67th Regiment, read Hie following cm*
of
AORTIO ANEURISM.
1. In a soldier of the 85th Regiment, thirty yw» <* *6*
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TRANSACTIONS OF SOCIETIES.
October 14,1808. 331
and nine in the service, who dropped in the ranks while en¬
gaged in running drill on the 8th of June last, and died almost
immediately.
Post-mortem examination revealed a small anenrismal poach
immediately above the aortic semi lunar valves and dose to
the origin of the coronary artery. The size was not greater
than an ordinary marble ; a small fissure communicated with
the pericardium, the cavity of which was filled with fluid and
coagulated blood.
2. In a man of the 67th Regiment, twenty-seven years of
age, and eight in the service, who, while in May last inarching
fully accoutred, from the Curragh to the railway station, was
suddenly seized with alarming dyspnoea. On his admission into
hospital at Portsmouth on 2nd of June, the presence of aneu¬
rism of the aorta was diagnosed. Shortly before his death,
which occurred on the 21st of July, the severity of the
dyspnoea increased to a great degree. There was swelling of
the epigastric region, and puffiness of the face and chest
After death the pericardium was found to be distended
with blood and serum, the blood being evidently but recently
coagulated. The ascending portion of the aorta was dilated
to three times its natural capacity, but only slightly thickened
in its coats, or roughened in its inner surface. Within the left
aortic sinus a small bulging existed, into which the top of a
finger could be admitted. The ventricles were hypertrophied.
3. In a soldier of the 33rd Regiment, thirty-three years of
age, and thirteen in the service, who, on the 1st of September
last, was admitted into hospital suffering from pain which ex¬
tended from the abdomen to the right side of the chest, fol¬
lowed in the course of a few days subsequently by pyrexia,
cough, and distress in breathing. Pleuritis was diagnosed to
exist; a rough blowing murmur attended the first and ob¬
scured the second cardiac sound. On the 5th he began to ex¬
pectorate mahogany coloured sputa, and it was apparent that
his system was in a scorbutic condition. The progress of the
case was very rapid; dyspnoea prevented him from lying
down, and on the 10th of that month he expired somewhat
suddenly.
The pericardium was found much thickened, and inflamed.
Its cavity contained fluid blood, or bloody serum, but no dot.
The heart was slightly enlarged ; its surface red, with some
layers of (lymph deposited upon it. Inside the orifice of the
left coronary artery there existed a large vertical opening in
the corresponding aortic sinus, which led into an aneurismal
sac, capable of containing a large filbert, and occupying the
space between the aorta, left veatride, and pulmonary artery.
Its posterior part presented a lacerated opening. The inner
surface of the ascending aorta was covered with atheromatous
deposit; the fibres of the middle arch were friable and
thickened.
The Honorary Secretary read a paper by Assistant-Surgeon
McFall, 34th Regiment, on a case of
SUICIDAL GUNSHOT WOUND OF THE SKULL.
A soldier, on the 12th of September last, having shot
Mmadf with a Snider bullet, the whole of die flat bones
of the skull were broken by the missile into pieces vary¬
ing in size from an inch to an inch and a-half. The bones of
the face were also broken into several pieoes, and the lower
jaw into three portions. The bullet itself broke into five
pieces, the whole of which, with the plug, weighing in all 471
grains, were removed from the skull. The entire weight of a
Snider bullet is 520 grains, and the peculiarity of this case
lies in the circumstance that the thickness of the man’s skull
not having been particularly great, the missile did not pass
through, but broke into fragments against it.
The Chairman then read a paper by Inspector-General
Lawson on
YELLOW FEVER.
The author described the circumstances under whioh the
disease was in 1793 imported from Bulam into the West
Indies, by means of the ship “Hankey,” and criticised in
detail the views of Chisholm, Bancroft, Pym, and Blair in
regard to its origin and manner of propagation. He believed
that with our present knowledge, we are justified in regarding
yellow fever as distinct from ordinary remittent or intermittent;
but as illustrating his views as to its non-propagation by means
of human intercourse, states that many places are found where
the disease was severe, it may be for months on end, while
there sure others in the immediate vicinity—sometimes as near
aa fifty feet—where for the like period there was scarcely any
trace of it, though the residents were numerous and mix i ng
daily with those of the infected locality. He laid great stress
upon the facts recently ascertained, that about the third day
of the disease the kidneys began to give off albumen and tube
casts, and that a means of diagnosis is thus afforded between
the disease and those of malarial origin. Another of
distinguishing between yellow fever and pure remittent ex¬
isted m the black discharges from the bowels in cases of the
former. The results of his experience lead him to believe that
the malady is not contagious, and such is the general belief in
the countries where it prevails.
Mr. Lawson believed that the immunity of persons from a
second attack had been detected in 1802, when placards were
exhibited in Cadiz to that effect during the epidemic t h«*n
raging. He was of opinion that during the prevalence of
yellow fever as an epidemic, all other diseases give way to it.
As to the question of whether the actual cause of the disease
may after a state of activity become dormant, to lighten up
on a subsequent occasion, the views held by authorities in
regard to it are different according to whether they belong to
the contagionist or non-contagionlst party.
Sir David Deas, K.C.B., made some very valuable remarks
on the paper that had been read. He observed, that in all
that had been written on the subject of the disease, there was
not, with the exception of an unpublished paper by Lalle-
mand, any account of a remarkable epidemic wnich occurred
in the Brazils and Pernambuco in 1848. In that epidemic,
which was the first that had occurred there, no European or
person of European descent escaped ; this was also the case
with the native-born or European African, although the im¬
ported negro escaped. He considered that this epidemic was
without a doubt imported from the coast of Africa. His own
views were in favour of the doctrine of contagion with refer¬
ence to this disease ; but as illustrating the possibility of a
person escaping the disease, although in the midst of it, he
mentioned the case of a ship which had lost four crews in suc¬
cession, and yet one European boy who remained on board
throughout escaped an attack of the disease. With regard to
the liability of a person who has once suffered from yellow
fever to become attacked a second time, he considers that the
same degree of liability existed as there did in a person who
had suffered from one attack of small-pox to another. At the
same time, he added, he had never seen recovery take place in
a case in which complete suppression of urine existed. As to
the modifying influence upon other diseases exerted by an
epidemic of yellow fever, he believed that when it prevails, all
other diseases for the time subside or merge in it. The influ¬
ence upon which it depends may, in his opinion, become for a
time dormant, again to spring into activity ; and he has had
occasion to observe the occurrence of epizootics among the
lower animals, and smut and mildew among the vegetable
kingdom immediately before or during the prevalence of epide¬
mics of this disease in man.
MEDICO-CHIRURGICAL SOCIETY OP GLASGOW.
At the last meeting of this Society held in the Faculty
Hull, St. Vinoent street—Dr. J. G. Fleming, President of the
Society, presiding.
The President having delivered an Opening Address,
Dr. Fergus read a paper on the Sanitary Aspects of the
Sewage Question, and dwelt first on the evils of the present
system of sewage and the causes of the pollution of the river ;
secondly, the failure of the scheme of Messrs. Bateman and
Bazalgette to cure these evils ; and in the third place he sub¬
mitted some of the most feasible schemes which had been pro¬
posed for the prevention of the pollution of rivers. While
giving the authorities credit for wishing to do what was best,
he objected to the scheme of those eminent engineers, who
were already committed, by all their past training and work
to sewage by water carriage, whereas the question was a sani¬
tary-economic as well as an engineering one. He went to
prove, by quoting the case of the Thames and the Tyne, that
water-closets were the sole cause of the pollution of the Clyde,
and that h uman excreta, shut up in the sewers, was a fruitful
source of disease by the decomposing and giving off poisonous
S ses. He quoted the highest authorities in medicine—namely,
re. Murchison, Parkee, Acland, &c., to demonstrate that
gastric fever could in almost every case be traced to the
breathing of Bewer gas. He exhibited pieces of leaden and
zinc waste pipes removed from houses, the sides of which were
perforated on the upper surface, allowing the escape of sewer
gas. These holes were caused by pieces of lime eating through
the lead. Other pipes were perforated on the under surface
from the action of the excreta from within. Dr. Fergus men¬
tioned that he had caused several of these pipes to be removed
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332 Xhe Medical Ftw and Circular*
SOCIAL SCIENCE CONGRESS.
October 14,1868.
from hornet in the beet localities, the inhabitants of which
were suffering from the inhalation of sewer gas. He also
showed that the scheme of Messrs. Bateman and Bazalgette
would cause an enormous escape of sewer gas at each heavy
shower, as they depended greatly on the impounding capa¬
bilities of their sewers, which, as the water filled, would repel
the gases with a force which no trap could resist. He quoted
Mr. Simon, officer of health of the Privy Council, to prove
t ha t cholera was owing to the taking into the system of human
excrement either by air or by water, and stated that the
whole excreta for Glasgow and its suburbs amounted to four-
hundred million pounds per annum. He condemned the folly
of erecting works capable of conveying 110 millions of gallons
per day to the Ayrshire coast, and showed that when arrived
there the matter would have lost some of its most valuable
manorial ingredients by producing the poisonous sewer gases.
Turning to the question of the commercial value of human ex¬
creta, he showed from high authorities that this had been
estimated at 10s. a head, and that the British nation, according
to that estimate, wasted about ten millions sterling of manure.
Dr. Fergus showed from official documents that the outfall of
the London Main Drainage Scheme was blocking up the bed
of the Thames with decomposing excreta, and went on to
remark that in London, after the expenditure of 80 millions
of money in water carriage, the authorities were at a dead¬
lock ana the public health not improved. This would always
be the case, because water carriage was contrary to nature,
the order of which was from the earth to plants from plants
to animals, from animals back to the earth again, He cited
China and Japan as supporting one-third of the human race
by preserving and using human excreta as manure. He ex¬
pressed the opinion that water closets were contrary to nature
and revelation, and that the only satisfactory mode of dealing
with our sanitary difficulties was, to keep all excreta out of the
sewers and river, and that we would never be right till we had
abolished water-closets, and adopted as our motto the dictum
of Mr. T. O. Ward—“ the excreta to the soil, and the rain-fall
to the river.” He observed that sewage irrigation had never
smoceeded commercially where pumping was required, and
affirmed that loud complaints of the smell arose from the
people living in the neighbourhood of the irrigated land. He
exhibited an example of Mr. Monies' earth closet, and recom¬
mended it highly for mills, hotels, asylums, hospitals, country-
houses, and villages. He also produced drawings of Captain
Lienur's pneumatic system, which he thought would be very
much improved by the manufacture of the excreta into porta¬
ble manure. He mentioned Mr. Stanford’s system, who pro¬
posed also to remove the excreta by pneumatic pressure, and
to destroy foetid gases by the use of seaweed charcoal He ex¬
hibited a model and drawings of Mr. Hoey’s plan. Hie latter
proposed to leave us the comfort and convenience of our pre¬
sent water-closets, but to disconnect these from the waste-pipe,
and to convey the excreta to a reservoir underground, thence
to be removed by atmospheric pressure and converted into
guano. Any of these schemes would be better than our
present system, and could all be tried by our authorities at a
■mall outlay, to ascertain which was the best
Dr. Fucking, after referring to the able and lucid paper
which Dr. Fergus had read, suggested that as the evening
was somewhat advanced, the discussion on the paper should
be postponed for a fortnight
This was agreed to; and on the motion of Dr. Andrew
Buchanan, a vote of thanks was given to Dr. Fergus, and the
meeting separated.
-»■
SOCIAL SCIENCE CONGRESS.
The Twelfth Annual Congress of the “ National Association
for the Promotion of Social Scienoe,” has been held at Bir¬
mingham.
Toe Earl of Carnarvon's address, as President, was occupied
with muoh that interests the profession, and accordingly we
give an abstract of it
Having first referred to the general scope of the Congress
and the details of its programme, the noble Chair m a n entered
on the subject of Sanitary Science, and remarked that: To
its manifold functions, and even to its importance, it would be
impossible to do justice on such an occasion as this. Its litera¬
ture alone is so voluminous that, as one of its most distinguished
advocates has recently said, there is sometimes a possible risk
that its value may be injuriously exaggerated. But this merit,
at least, it has, that not only does it affect the very life of the
nation and the preservation of the race in its physical strength
and vigour, but that, as a practical science, it is singularly free
from all uncertainties. It is, of course, impossible for any
science or human vigilance to make the life of a large town as
healthy as that of the country ; but how much can be achieved
even in unfavourable circumstances is shown by the fact, that
of the great cities of England the health of London now stands
the highest, and, if I mistake not, next to London ranks that
of Birmingham. Of the scanty legislation of the last session
of Parliament on this subject, it is right that I should briefly
call your attention to the Pharmacy Act, the Vaccination Act,
the Act for the Improvement of the Dwellings of Artisans
and Labourers, and lastly, the Poor Relief Act. The Phar¬
macy Act was due to the exertions of private members of both
Houses, and may, I hope, prove of considerable value. The
Vaccination Act was a Government measure, but it is one
pronounced by the Committee of the Medical Association to
be so clogged by restrictions, that they anticipate but little
increase of public vaccination under its provisions. The Act
for Improvement of the Artisans and Labourers' Dwellings,
introduced and carried by private members, was referred to a
select committee of the House of Lords, by whom it under¬
went considerable alteration. The importance of its subject
matter cannot be overrated. Strong objections are entertained,
and not without reason, to State intervention in these matters;
and it will, doubtless, be best if the desired end can be secured
by the joint action of the private owners of property and of
the local authorities ; but failing this, the evil is so great, and
goes so deeply down into the roots of society, that larger and
bolder measures may become necessary. The Poor Relief Act
was a Government measure, intended to be the legislative
complement in country workhouses to the Act of 1867, which
had done so much for the improvement of the metropolitan
unions. Recent disclosures, as it will be remembered, had
brought home to us the painful conviction that many of the
unions in the country, which, from a change of dreumstanoes
there as in London, had become infirmaries for the sick and
aged, rather than workhouses in the old sense of the word,
were discharging their new duties very defectively. There
was, in some cases, both an insufficiency of inspection and an
absence of comfort, deoenoy, and of the necessary medical and
surgical applianoes, which were little creditable to our oentral
and our local administration.
His Lordship, having expressed a doubt whether the late
Act could be looked upon as a conclusive settlement, passed to
the subject of Water Supply, observing that, in spite of the
Metropolitan Water Act, we are painfully and gradually
opening our eyes to the discreditable deficiencies of the water
supply of London. Immeasurably inferior to its great type
and rivulet of the ancient world, whose aqueducts, built tier
above tier and striding over the Campegna, still in their very
ruins carry their living waters into the heart of Rome; in¬
ferior to Marseilles and Lyons ; inferior to her own provincial
towns, such as Aberdeen and Glasgow, Sheffield ana Cardiff,
London is provided with a water supply less than health and
domestic purposes require—less than the protection of pro¬
perty from fire may justly claim ; open, in fact, to objections
on the score of quantity, quality, cost, and unnecessary waste.
Without venturing to anticipate, on such a point, the verdict
of Parliament, which will be given in next session, I think
there are some considerations that may be here briefly noted.
1. Though London, from its vast population and gigantic in¬
terests, has a special importance of its own, it is only one of
many towns that suffer from a deficient water supply ; and I
doubt whether the great manufacturing towns of the North
would consent that London, great as she is in her population,
her interests, and her necessities, should intercept ana appro¬
priate that supply which they look upon as their own. 2. The
relative merits of those two rival systems, distinguished by
engineers as the intermittent and the constant supply, must be
brought to a decision. Whilst 160 great provincial towns
enjoy the benefits of a oonstant supply, the capital of England
is dependent upon an intermittent provision. I hope that we
shall, in the disenssioni of the week, hear it fairly elicited by
fact and argument whether or no there is, as is alleged, a
serious waste of water under the constant system ; and, if so,
whether such a waste can be restrained by reasonable checks
and supervision. 8. The question of a proper water supply is
intimately connected with the purification of our riven, and
the restoration of their waters to all the purposes of domsstic
economy. 4. Hardly less important is the liberation and
employment in the service of agriculture of all that matter
which, while present in our riven, poison their waten, but
which, if once extracted, would make the poorest soil rich.
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The Medical Prtn tad Circular.
SOCIAL SCIENCE CONGRESS.
October 14, 18M. 333
The next subject toadied was that of Crime. The noble
chairman thought that penal disci p line should, up to a certain
point, be reformatory, and that the punishment of the criminal
and the security of society could not be overlooked. The
reformatoiy system was chiefly applicable to the young and
older criminals, especially those previously convicted ought to
be dealt with much more severely than they now are. The
law with regard to the vagrant class is susceptible of improve¬
ment ; but of the various suggestions which have been made
for dealing more effectually with them, none holds out a
reasonable promise of reformation, as regards the criminal, or
of material relief to society. Unpalatable as may be the con¬
clusion, his Lordship believed that very lengthened sentences
are alone likely to be effective. Meanwhile, the difficulty of
the case is aggravated by the fact that some guardians give
relief freely to all who apply for it; others assume a power of
discriminating between those who deserve and those who, in
their opinion, do not deserve relief; here they employ the
police, there the ordinary relieving officer ; in one case their
discipline is severe, their diet spare, their casual wards com¬
fortless ; in another, all these conditions are reversed; and
though numberless circulars have been issued by the Poor-law
Board—many differing widely in their recommendations—no
distinct regulations have been laid down in a form and with
an authority binding upon guardians and the officers who ad¬
minister the poor law under them.
Having remarked on the general subject of penal legislation
and approved the abolition of public executions, the noble
chairman turned to the subject of education, which, in view of
the present state of society and recent changes, he pronounced
of the highest importance; not altogether approving the common
school system of America, but admitting that the United States
had been greatly benefited by it. The chairman turned to our
present condition, and said:—Hitherto voluntaryism, self-
government, denominational, Mid consequently religious in¬
struction, with a certain amount of State aid and inspection,
have been the accepted principles of English primary educa¬
tion. Speaking cautiously, but looking to the circumstances
and feeling, as well as the wants of the country, I hardly see
how we can altogether dispense with any one of these princi¬
ples. We may perhaps add to them, we may recombine them,
but the uniform conversion of a voluntary into a compulsory,
of a religions into a secular system, are neither necessary, nor,
I think, at present desired. Though yon have proposed for
discussion, the distinct question how far compulsory education
is desirable, and under what conditions, I will not enter further
upon this grave subject than to observe that the equally grave
question of religious instruction—with all its subsidiary consi¬
derations of the when, the how, the where, the what, the how
muoh—is inseparably blended with it. It will be ultimately
found impossible to consider one apart from the other. Primary
education is but one, though the most pressing, branch of this
large question, but Parliament will have before it next year
the consideration of those middle-class educational endowments
of which, with Borne great and noble exceptions—as, for in¬
stance, King Edward's Grammar School in this town—there
has too often been a misappropriation of revenues and a mis¬
application of studies. Nor is the question of national educa¬
tion exhausted with the discussion of onr primary and middle-
class schools. The great public schools to whom so many
generations of famous Englishmen have owed a career of
honour and usefulness have been brought under revirion.
Happily, however, this task does not now rest on Parliament
The reorganisation of their revenues, discipline, and studies
has been taken out of onr way by the Act of last session, and
has been delegated to an able commission, which I trust will
knowhow to do justice to conflicting claims and considerations,
and to reooncile the necessities of a nineteenth-century educa¬
tion with the grand traditions of the past. Finally, I cannot,
here in Birmingham, the centre of such great manufacturing
and artizan life, pass by, without one word of recognition, the
increasingly serious question of what is termed technical educa¬
tion. For my own part, I believe that that great race of in¬
ternational industry and skill is too close and severe to justify
ns in throwing away any chance that we can command ; and
though I have every confidence in English qualities, I doubt
if our natural and uncultivated strength lies in those speci¬
alities of taste which have become necessary for many artistic
productions. I will only say of all technical education—whether
of the higher grades of professional life, or of those lower paths
with which the manual labour of the individual artisan is
concerned —that its basis must be laid in sound principles of
elementary instruction; and that the latter teaching is de¬
pendent upon the earlier. I dare not here enter upon the
question of State interference. I can only say that, within
oertain limits to be carefully defined, the State may, I think,
afford aid Mid facilities for such a culture as I have indicated.
At the same time the principles laid down by a recent Frenoh
commission, that the pupils should be mainly out-of-door
pupils, that payment should be the fundamental rule, that
gratuitous admission wholly or partially the exception, and
that the course of instruction should be for not less than two
years, seems to me substantially sound and right principles.
Turning to the subject of trades unions, reorganizing the
law of demand and supply, as true in practice as well as theory,
the chairman also acknowledged the value of mutual help and
brotherhood, bat expressed a belief that the artisan can secure
the advantages of the unions by a better and more economical
agency, and that the real interests of employers and employed
can be conciliated by gentler and more civilised expedients, than
by the rough and ready mode of strikes and lock-outs, whioh es¬
sentially belong to the organisation, and the raison d'etre of trades
unions as now constituted. There are probably more ways than
one to attain this end, but we should be strangely insensible to
the snooess which has already been achieved by the principles of
arbitration and co-operation if we failed to give them a still
further trial But, fortunately, we need not look to arbitration
alone for a solution of that labour question which seems some¬
times so perplexing a problem in our present phase of modern
commercial life. I have great faith in the sister principle of
co-operation, if fairly and prudently applied ; by which I mean
both the union of workmen amongst themselves primarily and
principally for the sale and purchase of articles of consumption,
and the union of workmen and capitalists for the purpose of
industrial partnerships. In England co-operation has stood
free from State interference on the one hand, and from dema-
gogism on the other. It has, in fact, reflected some of the best
of onr English qualities—good sense, and the practical adap¬
tation of available means to the ends desired and the neces¬
sities of the time ; it is accepted by most reasonable men of all
opinions; it is at variance with no principle of political economy,
no instinct of human sympathy; and it promises, I think,
before long to give to the working man many of those comforts
and luxuries which have hitherto been only within the reach
of a far wealthier class. Whatever be our point of view, one
may cordially wish it well, and accept it as one, at least, of the
means granted ns towards a solution of a most difficult
problem.
Having touched on several other subjects, his lordship thus
concluded his address *—
More than ten years have gone by since the foundation of
this society, which was intended by its authors to become to
moral and political science, iin the widest acceptation of the
word, what for so long the British Association has been to
mathematical and physical science ; and it now happens that
the self-same town in whioh its career was inaugurated wel¬
comes back its members to the keeping of their eleventh anni¬
versary. The Association has travelled, and seen mufch. It
has received hospitality in the capitals of Scotland and Ireland;
it has studied the commercial greatness of Liverpool, of Glas¬
gow, of Belfast; it has discussed the problems of modern life,
amidst the venerable traditions of York; it has numbered
amongst its friends many who have left their mark upon the
history of their time. Some of these are with us still—with
us, to render good service, by act or word, to their country;
some have passed away. But of these, none can ever hold in
the memory of this society so memorable a place as its founder,
its president, and its constant friend, Lord Brougham. In
the wide range of your discussions Ids restless intellect de¬
lighted to expatiate, and he, whose ardent mind neither the
toils of his early yean could satisfy, nor the infirmities of
advancing age could tame, found within the cirole of your
studies a oongenial field of labour in “ the spent hour-glass of
his passing life,” to use the expression of Lord Bacon with
regard to himself, long after the time when men are entitled to
repose. Eminent in many things, and in none more than this,
he never ceased to hold out to his country the living principle
of constant work. It is a lesson which may possibly, in some
few cases, be carried too far, but which is not without its
value in an age of, perhaps, too much self-indulgence; it is a
lesson which those, of whatever class or nation who aspire to
rule or influence, must never weary of learning. Of any im¬
perfections that may have marred that bright genius, it is not
our place here to speak* It is, as the great German historian
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334 The Medical Press end Circular.
BARRACKS.
October 14, IMS.
truly said, but a miserable temper that cares only to discover
the blemishes in the character of great men or great periods ;
and when every allowance has been made to human infirmity)
there will remain enough in the life of Lord Brougham for
Englishmen to admire and to imitate. In the history of a
great people there is room for ability of more, than one kind,
and, like the Homan Pantheon, it may contain every virtue
and high quality that can ennoble ana consecrate the life of
the nation. English history is rich in its almost endless
variety of great men. For centuries they stand along every,
walk of public and private life, holding out to each man sepa¬
rately the encouragement or warning which he individually
may need, and filling the mind of the nation collectively with
the traditions and instincts of all that is worthy. Such lives
are the heritage of a people—heirlooms that connect the pre¬
sent with the past, and even help on the increasing purpose of
the future—safeguards, which, when idle fancies are mistaken
for substantial truths, or when rational morality is lowered by
an idolatry of wealth or success, or when high qualities are in
danger of passing into mere wind and wordiness, utter a pro¬
test that can be silenced neither by force nor flattery ; raise
the wavering standard of public principle ; in prosperity main¬
tain the dignity of the country, and in adversity make disgrace
impossible.
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 14, 1868.
-+-
THE BROTHERHOOD OF ST. LUKE.
As sensation paragraphs have been going the round of
Medical and other journals regarding a society styled “ The
Brotherhood of St. Luke,” and as criticisms, for the most
part conceived in entire ignorance of the subject, have
been freely lavished on the u brotherhood ” aforesaid, we
have taken the trouble to inform ourselves regarding it;
and we hereby beg to set before our readers all which can
be known about it from the most authentic sources.
Many appear to have thought that this society had some¬
thing to do with lunacy, because a London hospital for
the insane happens to be called St. Luke’s; and having
put the name of this brotherhood and the name of the
hospital together, they have hastily given expression to
jokes about the “ brotherhood,” probably consisting of
lunatics also; forgetful of the fact that St. Luke was u the
beloved physician,” and of the other fact, that he, perhaps
because he was a physician, accurately distinguished, in
his gospel, between those possessed of demons, and lunatics
properly so-called, and that to this circumstance, in all
probability, is due the peculiar association of his name
with the London hospital above mentioned.
“ The Brotherhood of St. Luke the Physician and
Evangelist,” for such is its title, was founded in London
in 1864, with the object of promoting and defending the
Catholic faith, as held in the Church of England, amongst
members of our profession, by means of “ frequent and re¬
gular communions, intercessory prayer, personal influence,
and promotion of works of mercy.” It consists of students
and members of our profession who are communicants of
the English Church, and is governed by a Provost, &
Warden, and a Master. The present Provost and Master
are well-known London surgeons, and the Warden is per¬
haps the best-abused English clergyman at the present day.
He, and all concerned, appear to be identified with what
is popularly called “ the High-Church party.”
This u society ” has set before it, not as rules, but ai
“ recommendations,” some such as the following, in addi¬
tion to the “ means” above adverted to:—
“ To say daily the prayers of the brotherhood, to devote
half-an-hour daily to devotional reading and meditation,
the Holy Gospels always forming part of such reading; to
strive continually to remember the presence of Almighty
God, and to offer up all our actions to Him; to avoid all
idle and questionable conversation; to speak or repeat ill
of no one, especially of our superiors, unless necessary
from love to others; to keep a strict guard over the eyes,
hands, and thought, especially in the discharge of profes¬
sional duties; to treat reverently the dead body, which
may have been a member of Christ.”
Such are some of the “ recommendations * set before
the members of this brotherhood, and they are accom¬
panied by others of equal worth and moment to members
of our profession, as well as to men of other callings.
Now, it is not our business to preach sermons, or even
to moralise to medical students; but it is as plain as
possible, that, looking at the matter merely from a worldly
point of view, the wide extension of societies, based on
some such principles as these, will not only not affords
theme for the ridicule of the ignorant and the sceptic, bnt
will tend greatly to raise the moral standard of our calling
in the eyes of men, and to increase the usefulness of our
profession, especially among our poorer brethren.
BARRACKS.
From the days of Brocklesby until the present the
subject of barracks has at intervals cropped up among the
writings of authors on Military Hygiene. There was, in
the first place, a discussion as to whether or not such build¬
ings were necessary; then protest after protest by Army
Medical Officers against the construction, site, and internal
arrangements of those that were erected. By way o
economising space, but in total disregard of the health
personal comfort, or moral well-being of the soldiers, tier*
of shelves, one above another, were arranged along e
walls of the rooms in these buildings, and on them th e
men had to dispose themselves at night, as best they
could; the sick as often as not being, in the absence of hos¬
pitals for their reception, ranged alongside the healthy,
until the latter in their turn became affected with one or
other of the diseases that, under such conditions, s**!*
them away like a perpetual pestilence.
Early in the present century the attention of the pa
became alive to defects and horrors which the represen
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Ootober 14, IMS. 335
tions of Army Surgeons had been powerless to mitigate,
far less remove; jet no sooner had the subject of accom¬
modation in barracks been so taken up, than the written
opinions of our more eminent military brethren suddenly
obtained a degree of attention that had not previously been
accorded to them. It was under such conditions that the
views of Jackson, and after him of McGrigor, were
seriously entertained. They had not only urged upon the
military authorities the evils to health and efficiency that
were produced by the barbarous way in which our soldiers
were thus, amidst disease and dirt, huddled together, but
impressed upon them the fact, subsequently confirmed by
experience, that for the requirements of health it was
necessary that the number of men in each room should be
diminished; that each should have a separate bed, and
that the number of beds in each apartment should bear a
certain reference to its superficial and cubic area. After
much delay these arrangements were partially carried into
effect; but in so doing, a barbarism was introduced of a
nature so horrible that we need have no wonder at the
social evils to which it gave rise. No accommodation
having been provided for such of the men as were married,
it was until quite recently the custom to have at each of the
corners of a barrack room the bed in which a man, his wife
and children, if they had any, slept; a flimsy curtain, which
during the day was taken down, being the only means of
separation that existed between them and the single men
in the same room. It is unnecessary to enter into further
particulars in regard to such a state of matters. Suffice
it to say they do not now exist; yet it is considered
that a good deal still remains to be done in order to place
the soldier, in regard to accommodation, under circum¬
stances the best calculated to ensure health and morality.
There are few barrack rooms in the United Kingdom, if
indeed any, in which more than twenty-five soldiers are
accommodated. The great majority are only intended to
contain eighteen, while some are only estimated for twelve,
and a few for four or five men each. Now, it has by some
persons been assumed that if in a large room there should
happen to be two soldiers of vicious habits, their in¬
fluence is more likely to be baneful among their comrades
than the existence of one such person would t>e among the
smaller number; and it is moreover assumed that the
majority of good soldiers would much prefer to occupy
rooms containing the smaller number, while a few would
go even further and desire to have a small recess for their
beds, and [into which each could retire whenever he de¬
sired to be alone. We must never forget that for conditions
such as those under which our army exists, measures of an
administrative as well as those of a hygienic nature can
only be effective when directed for the good of the mass ; |
so in regard to the present question, we should look not so
much, perhaps, to what would best meet individual tastes
and desires as to what is likely to ensure the largest amount
of military efficiency. The difficulties that most distinctly
present themselves in regard to these two measures have
reference to the extent of buildings that would thereby
become necessary to the preservation of cleanliness; to the
maintenance of what is called discipline; and last, but by
no means least, to the subversion of insubordination or
other sentiments that should not exist in the military
machine.
But why should the experiment not be tried at some of
our large camps or stations in the United Kingdom, of
haring a certain number of soldiers accommodated
in the smaller description of rooms such as have been
mentioned ; certain other portions being accommodated in
the ordinary sized rooms, along the sides of which each shall
be provided, by means of half partitions, with a recess
properly lighted, in which he may, whenever he wishes to
be alone, read or work at such manual occupation as
he may desire. Let the experiment be tried for a year;
the results as regards crime, health, and self-improvement
noted. The desirability or otherwise of extending the
measure to barracks in all our temperate dependencies
might then be considered. It is feared that for the tro¬
pics, neither measure is adapted.
■+-
ifohs Current S^gics.
Medical Auction Bidding.
It is no part of our duty, os medical journalists, to quarrel
with the value which any man puts upon himself and his
services. It is seldom, however, that we find a medical
man clamorous to be placed by his own estimate in an
inferior grade to his fellows, and we cannot deny such
of our brethren the publicity which they desire for
their modesty. It will be remembered that some
months ago the medical officers of the Birmingham General
Dispensary memorialised the Board for an increase in their
salaries out of the surplus income which the committee of
management were embarrassed to dispose of. This remune¬
ration was surlily refused, and the medical officers at once
resigned, ta masse, feeling most justly indignant that, after
they had given their labour to the Dispensary during 15 years
of adversity they should not have been refused some return
when the funds were admittedly too large for the objects
of the charity. The means for which the committee hoped
to carry on the Dispensary without the services of the
medical officers, was to appoint a single paid consulting
physician, and a single paid surgeon.
The medical officers at once held a meeting, at which
all were present, and a mutual and unanim ous under¬
standing was arrived at that these appointments should
not be accepted by any of those present without previous
consultation with his colleagues. At this conference Dr.
Anthony was present, and in the arrangement distinctly
acquiesced. The medical officers did not exact any further
pledge than that the contemplated appointment should
come again under their consideration before it was accepted,
for they felt that it might be inadvisable to throw it into
other hands byrefusing it withoutfirst ascertaining the views
of the profession in the matter. The medical officers had
gained a substantial advantage in securing that in future
the medical officers should be remunerated, and they did
not wish at once to throw away this gain by pledging
themselves to a refusal.
What was their surprise when they learned, for the first
time, through the daily papers, that Dr. Anthony had
accepted the offer, and was actually appointed consulting
physician at 100 guineas a year.
We will, for the moment, go no further than this fact.
That Dr. Anthony did accept, and now occupies, the office
which was created by the ousting of six of his colleagues
is undisputed—that he did so in defiance of a well-under¬
stood compact, to which he was a distinctly consenting
party, we should hesitate to believe on less convincing
authority than that on which we write. If we hesitate to
believe the latter statement we cannot escape front the
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NOTES ON CURRENT TOPICS.
October 14,1868.
former, and we declare that our profession is discredited
by such a proceeding. If the ex-medical odicers had
never m et at all, or had never arrived at even an implied
compact, still it would have been the duty of any member
of the profession, notably that of a colleague and confrere,
to the effect of his conduct on his brethren
before giving his countenance and encouragement to the
committee of the dispensary. But even these circum¬
stances are not the worst of the affair. When Dr. Anthony
became consulting physician, the committee, being em¬
boldened by his hot haste to snap up the office, determined
to administer another snub to the ex-staff. They went
back from their original intention to appoint ajconsulting
surgeon on the same footing as Dr. Anthony, and, without
offering the appointment to any of the ex-medical officers,
they directed their resident surgeon, when his and Dr.
Anthony’s surgical powers proved insufficient, to call in
the senior surgeon of the General Hospital Thus, Dr.
Anthony becomes responsible for having acquiesced in
the insult which was put upon the ex-surgeons of the dis¬
pensary because he unhesitatingly associated himself with
another surgeon to their complete exclusion.
We add no comment to the entire transaction, which j
we well know the profession will estimate as it deserves.
If members of our profession be screened in their enjoy¬
ment of the cast-off clothes of their brethren, which (willing
persons ever ready to jump into them) should be replaced
by more becoming attire, our brethren must be content
to occupy for ever the beggarly livery which their em¬
ployers are always too ready to force upon them.
Gas Analyst.
Dr. Lethebt has resigned the office of gas analyst to the
Oity of London. The Commissioners of Sewers, at their
meeting on the 6th instant, resolved to give him a vote of
thanks for his invaluable labours as their referee for the
last seventeen years in elucidating the many questions
connected with photometry and gas analysis, and their
practical importance in recent parliamentary legislation.
This expression of their thanks they have resolved to pre¬
sent to the learned doctor, emblazoned on vellum, at a cost
of twenty guineas.
We understand that while retiring from the more
arduous post, Dr. Letbeby has accepted the appointment
of chief gas examiner for the Metropolis, under the Board
of Trade, in accordance with the provisions of last year’s
Act.
The Metropolis is to be congratulated on securing the
services of, unquestionably, the most competent authority
on the questions that will come before him.
Radoliife Infirmary, Oxford.
Attention has been called to a plan of giving the out¬
patients of this institution refreshments while waiting. To
meet the fatigue and exhaustion which are, not seldom,
the result of “going to the infirmary,” an apparatus has
been supplied, by which, for the small sum of one penny
all out-patients can receive, before they leave, within the
walls of the infirmary, a basin of hot nourishing soup and
a piece of bread. Tables, spread with neat white table-
eloths, are laid; basins aud spoons, with salt-cellars at
Intervals, and plates for the bread further furnish the room
where the soup is supplied. The soup is made in a large
boiler in the same room.
Unqualified Interlopers.
Some ill-natured remarks have been made by some of the
papers in reference to the case of interlopers, upon which
we have commented. How uncalled for they were to
manifest from the following:—
Conviction of Unqualified Medical PRAonnovm
—At the Hales Owen Petty Sessions, on Tuesday, Thorny
Holland, an unqualified medical practitioner, residing in Bir¬
mingham street, Oldbury, was charged with holding an ap-
S )intmont of surgeon to a Friendly Society, held at Langley,
Idbury, he not being duly qualified. It was given in evidence
that the defendant attended members of the society, end pro*
feased to be a medical roan. It was also found that the
defendant had been, nominally at least, assistant to Dr.
Dempsey, who was the official medical man of the society.
The bench held that the charge and another of a similar
character had been made out, and ordered the defendant to
pay fines amounting in all to £20, with costs. He had been
previously convictea. Peter Norman Webster, of Blackheatb,
was then charged with holding an appointment of surgeon to
a society called the “ Loving Brothers,’* held at Causeway
green, Oldbury, he not being a qualified medical practitioner.
The case was similar to the foregoing, and the Bench, after
hearing all the evidence, inflicted a line of £5 and costa, aa
this was the first case against him,
The Societies.
The various medical societies are again at work, and
we are able to state that a goodly number of interesting
papers will be read. We hope that discussions may be
more full than ever, sinoe this is the breath of life of these
societies. The mere reading of papers can accomplish bat
little good. The Press o&n communicate them to far larger
numbers, but is quite unable to supply the place of free
discussion. Those who have the societies most at heart
should do all they can to enoourage expressions of opinion
by the^many able listeners who are frequently present.
Treatment of the Apparently Drowned.
In the current number of The Life Boat the journal of
the National Lifeboat Institution, are interesting pap* 1 *
on the rescue of drowning persons, and the restoration of
the apparently drowned; from the latter paper we make the
following extract, which has been forwarded to us with
the expression of a hope that it will receive everywhere
the prompt and earnest attention of medical men
u There is one point to which we think it most important
that attention should be drawn in the replies in the two
oases above quoted, vis., that involved in the answer to
Query IS , 1 in each case ; and we think it the mors im¬
portant, inasmuoh as that the two Codes of Instruction!
now prominently before the public, and each largely cir¬
culated, viz., those issued by the National Lifeboat Insti¬
tution and those promulgated by the Royal Humane
Society, are divergent on that point: we allude to the
discharge of fluid from the mouth at intervals, and which
is often oontinued far a long time after the body has been
taken out of the water.
u Other striking cases have come to the knowledge«
the National Lifeboat Institution where such has been the
case, and notably that recorded in No. 55 of this journal for
January 1865, when Dr. Trollope, of Hastings, found Dr.
Silvester’s system for promoting respiration utterly
until, by placing his patient in the prone position, or fa*
downwards, the latter was relieved, at intervals, of the
large quantity of water which he had swallowed whilst
immersed.
“ It is at this moment, we believe, an unsettled point
with medical men as. to what extent, if any, water finds
1 Two interesting recent oases of suoceastai treatment of t h **W*f*j!2
drowned according to the rules of the institution, which are hsasaSP”
those of Drs. Marshall Hall and Sylvester. The query was *‘1fssWC"
fluid discharged from the mouth, and at what intervals r
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GLASGOW UNIYEBSITY.
October U, 1863, 337
access to the lungs in cases of drowning; but that to some I
extent it does so we think there U little doubt There
can, however, be no doubt that the pressure on the
diaphragm of large quantities of water in the stomach im¬
pedes the action of both the heart and lungs, and must
consequently greatly obstruct and often entirely prevent
the recovery of drowned persons.
“We desire, therefore, earnestly to implore the very
serious consideration of the Royal Humane Society and of
all medical men to what we believe to be a very serious,
indeed fatal, defect in any and every system of treatment
of the apparently drowned which takes no steps to promote
the discharge of the water which has been swallowed during
immersion.
“ Successful treatment, in the interest of humanity must
be equally the paramount object of one and all of us ; and
we cannot but feel it to be a grave evil that two Codes of
Instructions, differing on so important a point, should be
thus placed in the hands of the public for practical use/'
Mr. Sydnby Jones lately removed the entire scapula
at St. Thomas's Hospital, but the patient died on the fifth
day. Our readers will remember Sir William Fergusson's
case, reported in a recent volume of the Medical Press
and Circular.
Mr. Sampson Ganges lately removed the entire tongue
of a patie nt in the Queen's Hospital, Birmingham,
A Government Inspector has been sent to investigate
the epidemic of fever near Liverpool.
A new hospital has been opened at Alloa. Fever cases
will be admitted.
A curious instance of the craving of our medical con¬
temporaries for popular notice, on which we have often
commented, is seen in a statement made in the Time* last
week respecting poisonous socks. A correspondent of the
leading journal asserts that months ago he sent to a medical
contemporary a full account of a case with an analysis of
the dye by a well-known chemist, but nothing was heard
of hia communication until Mr. Webber’s statement in
Court drew the attention of the daily press to the subject.
Our contemporary then immediately rushed into the held
with a meaningless annotation on the very subject on
which it had so long withheld facts in its possession.
Clearly the only object of that paragraph was to get it*
quoted or referred to in the general press.
Birmingham has no Medical Officer of Health. At the
late meeting of the Social Science Congress it was clearly
shown how mnch one is needed, in spite of the favourable
mortality returns of the Midland capital. Mr. Godwin,
whose knowledge of th ese subjects is equal to any one's,
and whose efforts at amelioration are beyond all praise,
described some of the courts and alleys he had visited, and
brought on a discussion which, we trust, may lead to
action.
Mr. Nobel has brought out a preparation of nitrogly¬
cerine said to be far safer, but quite as effectual as the
ordinary substance. It is called dynamite.
Dr. de Beauvoir dh Lisle, of Guernsey, died on the
27£h ult., at the ripe age of 62.
Sir William Ferousson, Bart., is expected to preside
at the General Meeting of members of the Medioal Club,
to be held this afternoon (Wednesday) at two o’clock.
Notice of change of address, &c., should be sent at once
to the Registrar of the General Council, in order to secure
alterations in the Register for 1869, which is to be ready
early in January next.
A special meeting of the Council of the Royal College
of Surgeons of England is snmmoned for to-morrow, to fill
up the vacant examinership.
We have to welcome a new journal, the California Me¬
dical Gazette , which promises well, and to which we wish
success.
-♦-
LAYING THE FOUNDATION STONE OF THE
GLASGOW UNIYER8ITY NEW BUILDING BY
THE PRINCE AND PRINCESS OF WALES.
Last Thursday this imposing ceremony was performed
by their Royal Highnesses in the presence of an immense
and enthusiastic assemblage. The departure of the royal
party fron Edinburgh was signalised by a display of
loyalty only eclipsed on the arrival at Glasgow, where
general holiday was kept, and the streets were decorated
with arches and the houses with flags, Everywhere the
initials, A.E., the Prince’s motto, ich diox , and feathers
met the eye.
A procession was formed from the station at Glasgow
to the city hall, It was superb, consisting of twenty-
nine carriages. The royal carriage was drawn by four
magnificent greys. The liveries were scarlet for the
postilions of the royal carriage, green for the city au¬
thorities, blue for those of tne university. The state
harness is said to have cost £200.
The Freedom of the City was conferred and addresses
read, to which the prince read a suitable reply. The
procession then re-formed and proceeded to Gilmore Hill,
the site of the new buildings ; the whole of the distance
being accomplished amidst demonstrations of loyalty.
The decorations along the route were truly worthy of a
royal visit of state.
We may here add that the same enthusiasm prevailed
on the return, after the ceremony had been successfully
gone through, and accompanied their Royal Highnesses
to the railway on their return. The arrival at Edinburgh,
where the royal party etayed a short time, was also tne
occasion for another display, and crowds went to see the
Prince and Princess at the station on their leaving for
London.
CONFERRING DEGREES OF LL.D.
The members of the University Court and Senate received
their Royal Highnesses, and the Rector and Principal con¬
ducted them to the drawing-room, where they remained for a
short time till the Senate was constituted. The Senate
having met in an adjoining room, the Prinoe and Princess
entered, along with Prince John of Denmark, the Marquis of
Bute, and Lord John Manners. The proceedings were
opened with a Latin prayer by Principal Barclay. Sir James
Fergusson, as Dean of Faculties, proposed the Prinoe of Wales
and Prinoe John of Denmark for the degree of LLJD. The
proposal was unanimously adopted ; and their Royal High¬
nesses were presented to the Principal in order to receive the
degree. The Principal delivered a short Latin speech, and
conferred the degree, the oeremony of capping being performed
in the usual manner. The Prinoes were then invested with
the hoods (black silk velvet), and signed their names in the
book containing the list of graduates. The Princess having
retired, the Pnnce of Wales remained entering into conversa¬
tion with the members of the University Court and Senate.
Among those present were the following deputations from the
Universities of Edinburgh and St Andrews:—From Edin¬
burgh—Professors Syme, Kelland, Fraser, Balfour, Playfair,
and Turner. From St Andrews—Principal Tulloob, and
Professors S wan and Shairp.
LAYING THE FOUNDATION STONE.
About a quarter to two o’clock, the commencement of the
ceremony of laying the foundation-stone was announced by
two trumpeters, who led the prooesnon from Gflmorehill
e
338 The Medical Press ami Circular.
GLASGOW UNIVERSITY.
October 14,1663
House along a platform to the rite of the stone. The Prince
and Princess took their seats on a dais immediately in front of
the stone, on the right being General Knollys and Major
Teesdale, and on the left Prince John of Denmark, Lady
Belhaven, Baroness Ruthven, and Mrs. Coke. In addition to
the principal foundation-stone there was a “companion stone,”
which was to be laid by the Princess, the two stones forming
the base of a door-way in the central court of the College.
The stones were suspended by tackle with a galvanised wire
rope, attached to an engine working outside the building. On
the entrance of the procession from the Senate Hall, the
Choral Union, which was stationed on the right of the plat¬
form, sung two verses of the Queen's Anthem.
The Lord Rector came forward and requested the Prince of
Wales to receive an address from the Senate of the University, ‘
his royal highness consented, and Principal Barclay read the
following address
“ To his Royal Highness Albert Edward, Prince of Wales, the
humble address of the University of Glasgow :
“ May it please your Royal Highness,
“We, the Principal and Professors of the University of
Glasgow, in Senate assembled, beg leave to approach your
royal highness with feelings of devoted loyalty to her Majesty
the Queen, and of dutiful attachment to her royal house.
“ We offer our warmest thanks to your royal highness for
having graciously consented to honour our ancient university
by laying the foundation stone of its new buildings ; and we
rejoice that the ceremony of this day is graced by the presence
of your illustrious consort.
“ The occasion on which we are permitted to address your
royal highness is of peculiar interest. Our university, which
was founded upwards of four hundred years ago, is now for the
second time changing its rite, and for the third time renewing
its buildings. The university owes much to the liberality of
former benefactors, but their gifts have been surpassed by the
munificence of our fellow-citizens, whose subscriptions, along
with a corresponding grant supplied by the wisdom of Parlia¬
ment, enable us now to rear the buildings of the university on
a scale befitting the magnitude of its objects.
“ We hail the presenoe of your royal highness this day as a
proof of the deep interest which, after the example of your
illustrious and lamented father, your royal highness cherishes
in the advancement of learning, and as a public recognition of
the services which this university has in time past rendered to
science and philosophy.
“ We assure your royal highness that it will be our endea¬
vour, with the mcr eased faculties now placed at our disposal,
still more effectually to promote the objects for which the
university has been instituted.
“That it may please Almighty God to bless your royal
highness and your illustrious consort with length of days and
unbroken happiness, is our fervent desire and prayer.”
“Done in Senate this eighth day of October, one thousand
eight hundred and sixty-eight years, and signed in our name
and by our appointment.”
The Prince of Wales then read the reply, as follows
My Lord Rector, Principal, and Professors,—I thank you for
your address, for your expressions of devoted loyalty to Her
Majesty the Queen, and of dutiful attachment to the royal
family. It affords me the highest satisfaction to become a
member and graduate of your University, and, at the same
time, to visit a city, the close connection of which with you
has become so beneficial to both, as well as to the interests of
learning and knowledge. The presence of so many of all
classes of the citizens of Glasgow around me, and their liberal
subscriptions for the prosecution of the work wo are engaged
in this day, attest the value they attach to its completion, and
their sense of the advantages they and the people of Scotland
derive from your institutions. The interest which my la¬
mented father took in the advancement of every branch of
science and education would stimulate me to follow his ex¬
ample, and promote, by every means in my power, the success
of your University and the objects for which it has been
founded. We may confidently expect that the eminent men
educated here in time past are only the precursors of a long
train equally to be distinguished by every scientific acquire¬
ment. The Princess of Wales rejoices in the opportunity af¬
forded her of taking part in this day’s ceremony, and cordially
thanks you for your kind wishes. (Loud cheers greeted the
Prince at the conclusion of the address.)
Lord Provost Lumaden then officially requested His Royal
Highness to lay the foundation-stone, and the ceremony pro¬
ceeded. . ,.,
Professor John Caird, D.D., offered up a prayer, after which
the stone was lifted from its bod, and the jar deposited in the
cavity prepared for its reception. In this jar were placed
Oliver and Boyd’s Almanac, 1868 ; University Calendar,
1868-69 ; printed lists of students, 1867-68 ; the current coins,
bank notes of the three Glasgow Banks, the Times of
October 7, Punch , October 3 ; Edinburgh Courant, Scotsman,
and Daily Review , Glasgow Herald , North British Mail , and
Morning Journal of tho day, and Evening Citizen of 7th
October ; map of Glasgow ; names of the architect, assistants,
clerk of works, and contractors; vital statistics of Glasgow.
The stone was raised and lowered by a steam-engine outside
tho building ; the signals being made by red flags held up at
the platform. From a misunderstanding, when the Pnnce
had spread the mortar, the stone was raised instead of lowered,
and there was a general laugh as it ascended, in which the
Prince heartily joined. When the stone had gone up about
a dozen feet, the engine being reversed, the block was lowered
to its final resting place. The trowel used by the Prince of
Wales in spreading tho mortar was made by Mr. J. W.
of London. It had a carved ivory handle, enriched with
heavy gold cords, at the top of which was placed the oorouet
of his royal highness in gold and enamel, and jewelled with
precious stones. In the centre of the handle was the garter
in enamel, also the monogram of the Prince—A.E., and on
the ferrule the Prince of Wales’ plume, coronet, and motw,
“ Ich dien.” Supporting this were the arms of the Univer¬
sity, with the national emblem, the thistle, and the motto
“ Resurgat in Gloria,” executed in variegated gold and enamel.
The blade was of silver, parcel gilt, having on the front the
inscription, “ Presented to his Royal Highness Albeit Edward,
Priuce of Wales, K.G., on the occasion of his laying the
foundation-stone of the new buildings of the University of
Glasgow, October 8th, 1868.” The reverse bore an elaborate
engraved interior view of the grand hall of the Univereity.
The trowel was handed to the Prince by the Principal, yd
Professor Allen .Thompson presented the jar, which was de¬
posited by Mr. Thompson, the coutracor. The architect then
handed the level, and Mr. A. Orr Ewing, Chairman of the
Subscribers’ Committee, handed the mallet, with which iw
Prince finished his share in the ceremony.
The Lord Advocate then requested the Princess to Uy
the companion stone. Receiving the trowel from the
Provost, tho Princess advanced to the stone, and made the
requisite application of mortar. The trowel provided for her
Royal Highness was of ivory, enriched with gold; on the top
was her coronet, above a border medallion of turquoise, wuh
the monogram A, in pink coral on white enamelled gronad,
thus forming the Danish colours. The ferrule was enriched
with the plume, coronet, and motto of her Royal Highnem,
mid the arms of the University, with motto, thistle. «&»
enamelled in natural colours. The blade was decorated wun
ornaments of the period of Queeu Anne, and the reverse bow
*a finely engraved view of the exterior of the University,
mallet, square, and plummet were beautiful pieces of vroix,
ornamented with the plume, coronet, and monogram of tbeir
Royal Highnesses, with an inscription.
Tho jar was brought forward by Mr. James A Campbell,
Chairman of the General Council, and deposited by Mr.
Thompson. It oontained a history of the proceedings con¬
nected with the new building, a list of the General Committee,
the Union Railway Act, 1864, containing provisions for w
purchase of the present buildings, list of subscribers to dele,
amounting to £112,000 ; memorial of the Universityto
Government for a grant from the public purse ; letter from
the Lords of the Treasury engaging to propose to Parlinmyi
a grant of £120,000 on condition of a like sum being rawed;
facsimile of list of subscribers for the restoration of the Uni¬
versity Buildings in 1632 ; photograph of the present tlniver*
sity. Mr. Scott and Mr. Orr Ewing again presented the lew
aud mallet, aud the ceremony was concluded by the Prince*
giving the customary three taps upon the stone. At toe
conclusion of the first stone-laying, the 100th Psahn w»*
sung; and on the final act of the ceremony being performed,
the “ Hallelujah Chorus” was sung. Dr. Caird pronounced
the benediction, and the royal party returned by the gangly
to Gilmorehill House. The procession was here re-Jotme^
and on its departure a royal salute fired from guns placed on
the riope in front of tho new building.
--
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4b* Medial Pimi tad Circular.
INTRODUCTORY ADDRESSES.
October 14,1848. 339
Introductory Address
DELIVERED AT
THE LIVERPOOL ROYAL INFIRMARY
SCHOOL OF MEDICINE,
THURSDAY, OCTOBER 1st, 1868,
By FREDERICK T. ROBERTS, M B., B.Sc.,
Lecturer on Botany, and Demonstrator of Anatomy, Physician to the
Northern Hospital, Ac.
It has hitherto been generally considered necessary on these
occasions to speak in defence of provincial schools, but it is
qnite needless for me to follow a similar course, os their influ¬
ence has now been pretty generally recognised and acknow¬
ledged. A leading metropolitan journal makes the following
remarks with regard to them “ We feel strongly that the
utility and influence of the provincial schools are increasing
year by year. The professional staff are thoroughly in earnest
in their endeavours to impart the highest and best amount of
knowledge ; they aim at enabling those under their tuition to
reach in due coarse the highest standard of excellence in
medical science, and to acquit themselves With noticeable
credit. To this end the facilities for observing disease have
been largely increased and gradually improved in the pro¬
vinces, so as to render it possible that they may be brought
in time to the verge of a competition with some of the Loudon
schools.’* All this is quite true, and perhaps evon a little
more ; but I think that with such testimony we may for the
present rest content, leaving it to the future to reveal that
provincial schools may possibly compete, not only with some,
but even with all of those in the metropolis. With regard to
this individual school, I will, however, venture to say, with¬
out comparing it either with those in London or in other pro¬
vincial towns,—that it possesses every means requisite to
make you thoroughly acquainted with what you ought to
know, in order to become conscientious and successful practi¬
tioners. There is no subject required for any medical or allied
examination that is not taught here, with what success the
resalts of the examinations for the past year shall testify.
Without entering into minute particulars, I may be allowed
to state, that since we last met on an occasion like this, no
candidate who has gone lip from this School of Medicine has
been rejected, either at tne College of Surgeons, the College
or Ph ysicians, the Apothecaries’ Hall, or the Scotch Colleges,
and tne results at the University of London have shown a
great advance over past years, are quite as satisfactory as wo
ought to expect^ looking at the difficulties of the examina¬
tions, and will bear favourable comparison with most other
schools. This is not said in any spirit of boasting, but merely
to prove that we are making progress, and to stimulate those
of you who have to passthrough similar ordeals in the coming
year, to put forth every effort to do so successfully ; and see
to it, that the credit which, I think, has beon justly won for
the schools by your predecessors, does not suffer in your
hands, at all events, through any want of exertion on your
part.
I must not omit to mention here that no effort is being
spared to increase as much as possible the usefulness of the
library and mnseum, and we have to acknowledge with much
gratitude a most handsome donation of about one hundred
valuable modem works to the former, which Dr. Inman has
kindly presented.
It does not fall to my lot to allude to the occurrence of any
large number of changes here during the past year ; but it is
with feelings of deep sorrow and regret, shared, 1 am sure, by
all who were acquainted with him, that I call attention to an
event by which one in the full vigour of manhood, and pos¬
sessing talents that must have ultimately elevated him to a
high position in the sphere of labour which he had selected,
was unexpectedly removed from our midst. 1 refer to the un¬
timely death of our late esteemed colleague, Dr. Birkenhead.
To those who knew him, I need say nothing iu his praise ; to
those who did not, I can point him out as an example they
might copy with much advantage to themselves as well as
others, seeing that it was entirely by the exercise of those
mental gifts with which he was endowed that he raised him¬
self to the honourable station which he occupied at his de¬
cease ; while his goniality of manner, kindness of disposition,
and charitable feeling towards others, were such as few attain
to. It is a great satisfaction to us, and one which we could
scarcely have expected, that in his successor, Mr. Brown, we
have one in whom these qualities are also very prominent and
I trust he may long be spared to shed lustre upon our school.
Though rather an addition than a change, this seems the
proper place to mention, that in order to render the course for
the dental diploma complete, a Lecturer on Dent>*l Mechanics
has been recently appointed, in the person of Mr. Stewart,
and we have much pleasure in welcoming him thus publicly,
as a colleague and fellow-labourer.
I would first ask you to examine with me what motives
have prompted you to enter tho medical profession, and seo
whether they be of the right kind ; for it appears to me that
proper views on this point at tho very outset, are of the
greatest importance. There is no doubt that many joiu our
ranks just as they would enter upon any other vocation, with
tho sole object of trying to gain wealth, having no thought or
intention beyond this ; and possibly such may be the feeling
of some of you here to-day. Now, the desire to obtain a com¬
petency in this, like in other calliugs, is, iu my opiuiou, per¬
fectly legitimate and just; nor, judging from observation,
does it seem to l>e such a difficult task as some appear to ima¬
gine : indeed, many, in the strictly honourable performance of
their duty, manage to acquire by no means small fortunes. It
is trne we do not, as a rule, have the opportunity of suddenly
amassing great wealth by the fortauate issue of some medical
speculation, as wo have seen so commonly in other depart¬
ments during recent times, but, as in other walks of life,
snccess in a pecuniary sense will usually follow steady and
persevering application. The general law is, that fortune only
comes with laoour, and our case certainly forms no exception.
Now I think it my duty to observe that there is a danger
sometimes lest we should forget what we owe to ourselves with
regard to money matters. Many of the public seem to ima¬
gine that all kinds of gratuitous work may with perfect justice
be demanded from us, not only for those among tho poorer
classes, but also for those occupying respectable positions—
and it is well to be careful, lest, by doiug too much in that
way, we should encourage such an idea, and thus be unjust to
ourselves. But, I fear me, the converse of this is far more
often the case, and is a source of much greater evil. The
desire for wealth forms the ruling passion, and stifles down
even the slightest tendency towards a good action. If this is
the only, nay, indeed, the chief aim in any man’s life, it will
be but a miserable thing ; but it is especially out of place iu
tho medical profession, as it will prevent its possessor from
performing any of those good deeds which ought to be in¬
separable from it, while it will lead him to the commission of
acts which bring marked discredit upon us os a body. The
evils which the inordinate craving for wealth produces in our
profession are, I believe, both many and serious. What but
this is at the foundation of some (I by no means say alB of
the special hospitals which have been so lavishly established
iu late years, and has led sometimes to the issuing of so-called
“ reports,” which vie with the elegant compositions that ema¬
nate from the vilest quacks, and which cannot fail to arouse a
feeling of shame and disgust in the minds of all right-minded
men ? What but this is, alas! but too often the cause of all
the backbiting and attempts to undermine the reputation of
one professional brother by another ? What but this is the
source of the various species of quackery, which are almost ns
numerous within the limits of our profession as outside them ?
What but this is the origin of the meau, low tricks which
some practitioners indulge in, trying, as it were, to undersell
their competitors, as if they wore engaged in the barter of the
most paltry article of merchandise ? No, gentlemen, if this
be the great end of your existence, I warn you that you have
mistaken your occupation, and aro on the wrong road. The
medical profession is a calling that can give you enough, but
it is not one suited to your tastes, which will most* likely tend
towards actions that will bring anything but credit upon it.
It may be that with some of you one of the objects you
have in view is to raise yourselves in the social scale. Such
an object every man has a perfect right to entertain. Some
appear to imagine that no one is justified in entering our pro¬
fession who is not already in a good social position, and it is
not an infrequent argumeut urged against provincial schools,
that they give too many facilities for those to join our num¬
bers who do not reach up to the proper standard of respecta¬
bility. Without, however, for a moment granting that this
is true, I cannot understand what right we have to exclude
any man from oui profession who has acquired the requisite
amount of general instruction (as evidenced by liis ability to
pass the preliminary examinations instituted by the examining
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340 The Medic*! Press and Circular.
INTRODUCTORY ADDRESSES.
October U, 18*
boards), who has the capacity for it, and is prepared to con¬
duct himself in accordance with its lofty precepts. Certainly
it was never instituted for any particular class, and the mere
possession of wealth or social standing can give no claim to it.
If we appeal to facts, we find in this, in common with other
professions, that many of those who have occupied or do now
occupy its most coveted positions, had to raise themselves,
often from the deepest obscurity, by their own praiseworthy
exertions. Therefore, if any of you are aiming at elevating
yourselves socially, I would nrge you to go on, heedless of
every rude taunt, as well as of every effort made to bar your
progress. But beware of imagining that the mere fact of your
Decoming a physician or a surgeon will raise yon ; that must
depend on your own behaviour in the future. You are enter¬
ing a profession which has that within itself that can raise the
very best of men# but it is only as you endeavour by your
conduct to elevate it that it will do the same for you. There¬
fore see to it, lest instead of it beiug the means of lifting you
up, any of you should, by your actions, assist in bringing it
down from that high position which, from its very nature, it
ought to occupy among the professions of the world.
The desire tor fame is a motive power strong in the human
mind, and probably this has had an influence with some of
you in urging you upon the course you are now taking. If so,
it is deserving of all encouragement and there is no path in
lift which gives greater hope of gratifying it than that you
have chosen. So much has been discovered in the past, that
some fear there is nothing more to be found out, and that con¬
sequently there is no opportunity of acquiring fame ; but
though much has been done by our predecessors, there is still
plenty remaining to be accomplished. In every branch of
medicine and surgery new fields are being opened up daily,
by earnestly labouring in which, he who has the capacity and
tne will, cannot fail to attain eminence. But even if you do
not possess the requisite talent for discovery, there is still
quite sufficient in tne mere honourable practice of your pro¬
fession to enable you to create names for yourselves that shall
remain long after you have passed away.
It sometimes happens that the mere love of, or inclination
for, the medical profession, or some of the sciences connected
with it, is the cause of its being selected. Where such an
inclination exists, I believe it is to a certain extent an earnest
of future success; and therefore, I trust, gentlemen, that you
all possess it to some degree at all events, for you will then be
more likely to make progress than if you had no sympathy
with or had a decided antipathy to it; indeed, when there is
such an antipathy, I doubt whether success can ever be
gained.
The motives I have hitherto alluded to arc all more or less
of a selfish nature ; but it would be folly to expect that any
of us have yet attained to such a degree of self-abnegation as
wholly to lose sight of them ; still, we must not forget that
there are other and higher motives, in which we look away
from ourselves, and fix our attention upon those to whom we
shall hereafter be called to minister. Undoubtedly the oppor¬
tunities of doing good to others form, in the case of some, the
diief attraction to our profession, and if we rightly apprehend
our work, this ought to have no small influence upon every
one of ns. It has been said that “ the cause of the physician
is the general cause of humanity,** and this is a saying full sf
truth. Upon the medical man devolves the duty of caring for
others, no matter to what rank they belong, in almost every
circumstance of difficulty, trial, or distress. It is he who has
often to give advice in their daily wants, to minister to them
in their infirmities, and to sympathise in their trials and afflic¬
tions ; to his lot it falls to instruct them as to the proper regu¬
lations of their minds and bodies, as well as of surrounding
conditions, with the view of maintaining them in a state of
health and comfort; with him the power frequently lies of
driving away the pangs of pain, and he is the instrument
chosen to raise the sufferer from the bed of sickness, or per¬
haps snatch him from the very grasp of death. Surely the
remembrance of all this ought to take a firm hold upon each
one of us ; and while, gentlemen, according to your various
inclinations, you may be looking forward—one to wealth—
another to position—another to fame,—let none of you lose
sight of what ought to be the grand object of your existence
—an object to which every other should be subservient, seeing
that it will even reflect upon yourselves more real pleasure
than all the rest combined can give—the desire of doing good
to others, and shedding abroad incalculable blessings auiogg
those in whose midst you may be called upon to labour.
Whatever feeling may have prompted you to aim at becom¬
ing “ doctors,” I presume that most of you have made that
choice, and have come to this School of Medicine professedly
for the purpose of making yourselves competent to fulfil the
duties which lie before you in that capacity ; but let us now
candidly inquire whether such is really the case with you, and
if any of you have erroneous ideas on the subject, or wrong
intentions, try to set them right. It is a fact that some enrol
themselves as students for no other reason than that the regu¬
lations compel them to pass through a certain curriculum;
were it not for this, they have plenty of conceit to imagine
themselves quite fit at once to pntctioe their profession, or at
all events to prepare themselves for it without any assist a nce
No less is it a reality that some enter upon this repontiUe
work with the deliberate intention of wasting their thus, and
spending it in the gratification of their own huts and plea¬
sures. This is a sad truth, but it is not the less a truth,
though I am thankful to be able to add, not one of frequent
occurrence—and I will take this opportunity of emphatically
declaring, that the degraded character so commonly attributed
to medical students in general, constitutes a gross libel upon
them ; for I venture to assert, that as a class the students of
medicine of the present day are as well-behaved, high-prin¬
cipled, and noble-minded a body of [men as is to be met with
in any other walk of life. Still, I have seen cas es a nd pro¬
bably such bad been the experience of others present in
which men, and, what makes the matter worse, often pouen-
ing talents of a high order, have set about preparing for a
profession, demanding above all others the roll exerase of
every mental faculty and the application of all the knowledge
they can possibly acquire, by deliberately and intentionally, snd
not merely as the result of temptation, deliberately plunging
into all kinds of folly and vice, utterly regardless of every ngbt
principle, throwing away their valuable time and opportu¬
nities, and rushing madly to their own physical and mental
ruin. Removed from the restraint of home and friends, day
give the reins to their vicious inclinations, and as if send
with a species of insanity, hurry recklessly on in their down¬
ward course. This is no exaggerated picture; but I sincerely
trust there is not one among you but thinks it to be so, fix
then it will prove that at all events the description does not
apply to you. Let me impre ss upon yon that it is for no mere
routine you come here; there is work before you, and tint d
a grave nature, and until you go through it, yon are by no
means qualified to practice your profession, however much yon
may think you are. And have a care that yon do not enter
upon your task—a task so full of vital importance to your
selves as well as others—with the intention of wasting your
precious moments in idleness or vice, else the issue cannot fail
to be your utter downfall in every respect
Probably the great object which the majority of students
have in view when beginning their career, is to pan tbrir
examinations successfully. Now it is quite proper that fins
should be regarded as an important end, and I befieve if H is
steadily kept in view from the first, and a final “ cram f * not
relied on, a very fair amount of professional knowledge win
be gained ; but it is a serious mistake to look upon the nwe
obtaining of degrees or diplomas as the grand end of a student's
life, and to concentrate all efforts upon that. There is a future
beyond the period of the examinations, and that future is
full of importance, and demands for itself the most earn**
preparation. It is then that the real struggle begins, whes
you will have to enter into daffy competition with your fd*
lows, and reveal to the world how yon have used your oj^x*
tunities as a student. Therefore he will have proved hifltfdf
to have employed his time to the best advantage who, looking
forward not only to the examinations which shall end bis
career as a student here, bat also to the period that Iks
beyond these, determines to avail himself of everything tW
can contribute to his success then. To this end it should be
your aim to lay up a store of knowledge of every kind tbs*
can in any way prove of value to you as practitioners, as ™
as to learn how to turn that knowledge to account. Bsman-
ber that, though of course the print of greatest moment to p*
is to become thoroughly acquainted with the subjects ns* 9
immediately connected with medicine and surgery, yet tkert
are other branches of knowledge in which you are expected to
he more or less v erse d , and which you will find of use in msaT
ways. Thus an acquaintance with general literature, and
other subjects which go to constitute a " liberal education* a
for several reasons very valuable; while it is i n cumb ent opes
you to learn something at all e visits of the various sasso*
not only becaus e you will be looked up to for informati on os
many points connected with thews out turn — m so**
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The Radical Praia end Circular.
INTRODUCTORY ADDRESSES.
October 14 ( 1M8. 841
branches a certain amount of knowledge is absolutely neces¬
sary before you can conscientiously engage in practice.
Learn also to exercise those intellectual powers which have
proved to others, and will prove to you, of such eminent ser¬
vice in after life; cultivate the faculty of observation ; be
ready to take in all that is going on around you, and also
exercise yourselves in collecting and arranging the facts
which you observe, so that you may be the more able to learn
the lessons which they teach ; and bearing in mind the cir¬
cumstances in which you will frequently be called upon to
minister, do not neglect those genial qualities which are of so
much value on such occasions ; strive to cultivate kindness of
disposition, gentleness of manner, and the power to sympa¬
thise with others, combined with a proper degree of firmness
—qualities which go so far in making a medical man accept¬
able to his patients.
*••••«
It is a fact, with bat few exceptions, that the position which
any one ultimately gains, falls short of that which he has set
before himself as the aim of his life; therefore, in order to
attain to anything great von must always keep in view some
objects that shall be worthy of your efforts. Ambition, if it
is of the proper kind, and makes use only of legitimate means,
is deserving of all praise, and I Would urge upon you all to be
ambitious. Place some high model before you, and strive
after that. Ton may not be able to reach it, but at all events
you will rise to a better position than if you had no desire to
elevate yourselves. And the earlier yon begin to do this, the
more likely will yon be to succeed in gaining your end. As I
have already remarked, there is no lack of opportunity for
each and every one of yon to distinguish himself in our pro¬
fession. and I trust the day may come when the names of
many I see before me now shall be known far and wide, as
belonging to men renowned in science or some department of
medicine or surgery. Bo not imagine this to be impossible.
You know not what you can do until you try. Those who
have advanced to the foremost ranks were once students like
yourselves, and probably had as modest an opinion of their
abilities as, 1 hope, you have ; but they kept a grand object
in view—they strove after it—they gained it, and you may
follow in their footsteps.
In order, however, to achieve anything noble, you must set
out with a determination to be patient and persevering, to
overcome all difficulties, and strenuously to resist every tempt¬
ation by which you may be assailed. It is the law in every
path of life that difficulties and trials have to be met with.
Life is familiarly illustrated by a voyage, during which ad¬
verse winds or tempest and Btorm must sometimes be encoun¬
tered ; or by a journey, which is not always along smooth
and pleasant paths, hut often across very steep and rugged
mountains; or by a battle, with its reverses as well as its
successes; and our course is no more exempt from such
vicissitudes than is that of others. Difficulties will meet you
in your way—obstructions will rise up against you—barriers
will intervene to check {your footsteps ; but resolve to over¬
come difficulties, to break down obstructions, to surmount
barriers, and it can be done. Do not, however, start with the
idea that this will be an easy task ; it will often require you
to call forth all your efforts, and will demand patient and
persevering labour. Yon must not be dispirited if the goal
which you have set before yourselves is not speedily reached,
for remember that we must be content for a time with
the lower stages, if we intend ultimately to gain a
high station. It is astonishing what can be accom-
S lished by perseverance in the use of faculties, limited
bough they may be ; it frequently leaves so-called “ talent ”
far m the snade. Our greatest men are often not those pos¬
sessed of what are termed “ brilliant capacities,” but those
who by quiet, earnest, continuous labour, have removed obsta¬
cle after obstacle, until, while benefiting mankind, they have
raised themselves to the highest pinnacle of fame. Bear in
mind that whatever may be your abilities or opportunities,
Without your own co-operation they can avail you nothing.
Not that tiie possession of talents is a thing to be despised—
nay, rather it adds immensely to the responsibility of the
possessor. If one of you, having abilities of a high order,
which, with proper use, are capable of doing great things for
y o ursel f and the world, yet by their neglect, allow one who is
much Inferior in intellect to surpass you—it will only redound
the more to your disgrace and shame. You are wasting God's
richest gifts, and a poor account will you one day be able to
re tt ter of the manner in which you have employed them. To
those who are not favoured with unusual mental powers, it is
a comfort to remember what can be accomplished by work, a
evidenced by every stage and grade of existence from th
school to the throne. If any of yon are feeling disappoints
to-day at a want of success in the competitive examinations,
let that feeling only prompt you to more strenuous efforts, and
a far higher prize must be your reward. To every one of you
—from the most profound genius to the least talented—I
would say, start now at the outset with a determination to
conquer, and to raise yourselves to positions of dignity and
honour ; let that resolve lead to perseverance, not short-lived,
but continuous; and for this end, it is well not to be too
vigorous at the first. It is not an infreouent thing in a race,
to see one competitor rush off far in advance of the others,
seeming to have everything his own way ; but after a time, his
efforts nag, the interval between him and those behind gra¬
dually lessens, until he finally drops away altogether ; while,
perhaps, one, who has for some time been far in the rear, and
apparently out of the contest, appears to ga n power as he
goes on, and his speed increasing, he rapidly gains upoii his
adversaries, and reaches the goal the winne- of the prize.
This is not unlike what takes place with some students—they
make a most energetic start, bat as the session advances, their
exertions gradually diminish, until at last they ceaso entirely,
and some quiet plodder wins the day. Begin then not too
rashly, but steadily, and you will find that as you go on,
your powers will increase, your efforts gain strength, and
continuing stedfast to the end, you Will at last reap a
rich reward. I have told you to aim at a high position, bus be
not satisfied with merely seeking for this, bat strive after it.
There are few who do not seek in a certain Way to achieve
something at all events, i.e. t they desire to do so, if they could
only succeed without labour ; but to strive is another matter
—it is to strain every nerve to gain the end in view, and to
make every opportunity contribute to its attainment; and it
is in that spirit that you must set about your task, if you intend
to succeed. Do not lose sight of the fact that in your future
life, you will be compelled to practice patience and perseve¬
rance, if yon wish to exercise your calling with any prospect
of success. You may not think so now, but daily experience
will hereafter convince yon of it, and if you do not begin to
cultivate those qualities now, yon may find it then a task more
difficult than you imagine, causing yon to look back npoh your
past neglect with the deepest regret.
(To be concluded in our next.)
THE PHARMACEUTICAL SOCIETY OP GREAT
BRITAIN.
The opening of the session of this society was celebrated on
October 6, when the prizes were distributed by Mr. G. W.
Sandford, President An Introductory Address Was also de¬
livered en the occasion by Mr. Henry B. Brady, F.L.S., P•0.8.
The Chairman observed that, in the interval since the last
meeting, another great advance had been made towards en¬
lightened legislation in respect to pharmacy, the greatest step
probably since the first recognition by the state in 1841 of the
claims of special education as set forth in the charter of incor¬
poration. They were now something more than a mere volun¬
tary association, and stood in the same relation to the govern¬
ment as other professional bodies who held compulsory exa¬
mining powers. The latest Pharmacy Act was but the
consummation of twenty years* steady effort in a. fixed
direction, and embodied the acceptance of principles which the
Pharmaceutical Society was founded to support. The legis¬
lature had given them, as a body, a certain monopoly on an
educational basis, and Parliament had done all that lay in its
power to make pharmacy a profession. It rested with them,
and especially with their younger members, to qualify them¬
selves for the enlarged sphere opened to them, and they must
look to those who, m the course of nature, might expect to see
the new order of things that time must bring to qualify them¬
selves by closer mental training for that higher social position
which it would be their own fault if they did not occupy.
Am ongst the most gratifying features in their recent Parlia¬
mentary experience was the absence of opposition °u the part
of the public, and the general approval with the set had been
received by the medical profession. There still existed some
remnant of an old jealousy, which sometimes showed ltselfm
the correspondence columns of the medical periodical s, wm en
might be traced to recent parliamentary debates, and even i*
the proceedings of the Medical Council. The relations be¬
tween medicine proper and pharmacy had till now boon so 111
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342 The Medical Frees and Circular.
MEDICAL NEWS.
October 14,18*
defined that much forbearance was needed on all sides whilst
things were settling* in to their proper order. Medical practi¬
tioners, from time immemorial, had been accustomed to dis¬
pense ; indeed time was when they only were properly qualified
for the purpose, and for the state of things which was desired
they must relv on the change that was gradually taking place
in medical education, which tended more and more towards
physiology and therapeutics, and concerned itself less and less
with pharmacy anumateria medica. On the other hand, they
might fairly <daim from the medical profession due considera¬
tion, since they were both servants of the public, whose ideas
of right and wrong in respect of medical advice could only be
reformed by a sort of educational process. Most of all it was
for them to show that practice in those branches of medical
science to which they were specially devoted might safely be
left in their hands, and in the mutual confidence thus estab¬
lished the ground for jealousy would soon disappear. The
lecturer then delivered a warm welcome to the new students,
and laid down the precept which he considered best calculated
to direct and aid them in their studies, advising them to strive
earnestly for proficiency in their profession, and to adopt as
their watchword “ Thorough,” or, if they would, take home
to themselves that olden injunction of King Solomon, “ What¬
ever thy hand findeth to do, do it with all thy might/'
- ♦ -
THE SALT-CURE OF REICHENHALL.
Reichenhall owes its existence as a watering-place to its
salt-springs, one of which, the Edelquelle, is the strongest in
Europe. It contains more than 23.] per cent, of salt, and has
a temperature of 57° F. The baths are of various kindB—
ordinary warm or tepid baths, douche and vapour baths, and
so-called “ Wellen sprudel bader,” in which last form the
water is forced upwards under pressure into the bath, so as to
imitate the effect produced in sea-bathing by the striking of
the waves against the body. A "cure'’ lasts four or six
weeks, and comprises from twenty to forty baths, in which
the salt-water is sometimes used pure, sometimes mixed either
with mother-liquor (which resembles the mother-liquor of
Kreuznach), or with the extract of the dwarf Alpine pine, the
latter mixture being specially recommended in cases of rheu¬
matic gout. The temper, ture, concentration, duration, and
number of the baths are under strict medical supervision.
Another mode in which the salt-water is used is that of inha¬
lation, of which two forms are employed. One plan consists
in allowing the patient to sit or walk up and down in the
immediate neighbourhood of the so-called Gradirhduser.
These erections, which form striking objects in approaching
the town, may be described as enormous hedges, forty or fifty
feet high, composed of bundles of twigs arranged horizontally,
in such a manner, that the surface of the wall is formed by
the projecting ends. Their purpose is to afford a large evapo¬
rating surface far the concentration of the weaker kinds of
saline mater—those containing only a few percentages of salt
The water is conveyed by pipes from the springs to the top of
the graduation-hedges, whence it is allowed to trickle slowly
over the bundles of twigs into reservoirs. By this process the
liquid is brought up to a strength of about 20 per cent, and is
then ready to be conveyed into the vats, where the further
process of evaporation is accomplished with the aid of heat.
The degree in which the air on the lee-side of the graduation-
hedges is impregnated with salt is surprising. It has been
accurately determined by analysis, and has been found to vary
at ordinary temperatures from 0*023 grains to 0 052 grains in
a litre, or from 0.054 grains to 0*123 grains in a cubic foot, so
that the air is considerably richer in suspended saline particles
than ordinary sea-air. The second method consists in impreg¬
nating the air of a room in which the patient is allowed to
sit for a certain number of hours daily, by means of the pro¬
cess of pulverization. For this purpose the liquid is forced by
steam power through an iron pipe terminating in a number of
minute apertures, from which it issues under a pressure of
four atmospheres, in fine jets. Opposite each jet, at a distance
of four inohes, is a metal ball, by which the stream is con¬
verted into invisible spray. The tube stands upright in the
middle of the inhaling room, like a poet, with the jets and
pulverising balls arranged round the top. The air of the room
becomes impregnated with moisture and salt, in a degree pro¬
portionate to the distance from the pulverizers. Near the
post it contains from twenty to forty milligrammes of salt in a
litre of air; in the corners of the room not more than four to
five. The humidity of the air is far below saturation : it does
i*ot exceed 83 per cent .—The Practitioner .
ggftint 1 |gfefo.
University of London.— 1868.—First M.B. Ex¬
amination.— (Entire .)—Pass Examination.
First Division .—Alfred Ashby, Gay's ; Ashley William Barrett, Lon¬
don; John Mitchell Brace (Af A. Abtrd. t ) Aberdeen; Alfred Cotterill,
K ing’s College; John Cumow, King’s College; Frederic Dorliam, Gey 1 !;
Richard Clement Lucas, Guy’s; Rol>ert Wishart Lyell, King's College ;
Henry Newell Martin, University College ; Rushton Parker, University
College : Edward Cox Seaton, Si Thomas's; Alfred Shewen, University
College; Herbert Alder Smith, St. Bartholomew's; Richard Thom*
Smith, University College; Hugh Ecclcs Walker, Gijy's. Seooul
Division. —William Henry Allchin, University College; Edgar Gangs
B.imes, St George’s ; Charles Henry Carter, (B.A.% University Colkre;
Aij.honso Elkin Cumberbatch, St. Bartholomew’s; John De Utfde,
Guy’s; James Alfred Harris, University of Edinburgh ; Robert Hank,
Guy’s; Richmond Leigh, Liverpool Infirmary School of Medicine;
Walter George Lowe, St Bartholomew’s ; William Smith Paget, Liver¬
pool School of Medic ne; Alfred John Wall, 8t Mary's ; William Beach
Whitmore, King's College. Physiology only.— First Division.— Janes
Reginald 8tocker, Gnyg. Second Division. —Thomas Bridge Bott,
University College ; Howard Hepburn Seccombe, King's College; Charles
Tanfield Vachell, King’s College. Excluding Physiology.— Fird
Division. —William Frederick Richardson Burgess, Guy’s; Alfred Thom*
Gibbing*, King’s College. Second Division. —Fletoher Beach, King 1 *
College; John Thomas Djrby, University College; Arthur WQhaa
Smith, Guy's ; John Taylor, (B.% Gay’s.
Examination fob Honours.—Anatomy.— First Class .—John Cnreov.
(Exhibition and Gold Medal), King’s College; John Mitchell Brace,
(Gold Medal, worthy of Exhibition). Aberdeen. Second Clou.— Alfred
Cotterill, King's College ; Rushton Parker, University College. Third
C7o«.—Herbert Alder Smith, St Bartholomew’s; Frederic Durham,
Guy's; Hugh Eccles Walker, Guy’s. Oboanic Chemistry, and Matkbu
Mzdica and Pharmaceutical Chemistry. —First Class —John Cnr-
now (Exhibition and Gold Medal), King’s College ; Herbert Alder Smith
(Gold Medal), St. Bartholomew’s; Richard Thomas Smith, University
College; Alfred Shewen, University College: John Mitchell Brace,
Aberdeen; Henry Newell Martin, University College.
Abortion as a Cause of Insanity.— The Super¬
intendent of the Michigan Insane Asylum, in his report jut
published, says:—“ Mental derangement has generally oc¬
curred as a result of local injury, and the serious impairmeat
of general health, directly traceable to the criminal act In t
few cases it has operated as a moral cause ; as, for instance,
when the unfortunate sufferer has borne a child which ha*
been permitted to remain with her only long enough to show
the unhappy mother the priceless value of the gift she had
previously refused to accept In these oases the immediate
cause of the insanity is remorse. Unless this most disastrous
practice be speedily arrested by the efforts now being used
to suppress it, and by more stringent laws, severely punishing
all parties implicated, it will materially increase the number ri
female patients annually presented for treatment"— N. Y.
Medical Journal.
Prolapsus Ani.—D r. Scharfcz, in “Hufeland’s
Journal,” recommends for this affliction a solution of the ext
of nux vomica of the strength of one or two grains to the
ounce of distilled water. Of this solution he gives six to ten
drops every four hours. This is the dose for very small chil¬
dren ; to larger children fifteen drops at the same intervals.
Children at the breast two or three drops.— Nashville Journal
of Medicine and Surgery.
An Aged Primipara.—W ith respect to child¬
bearing in advanced life, Dr. Cachot, of St Mary's Hospital,
informs us that ho delivered in that institution a female of
her first child, at the ago of 53 years, and again in sixteen
months. The labour in Doth confinements was tedious, from
inertia of the uterus, and required the forceps. The mammary
glands enlarged, but produced no milk. The children lived
in both cases.— Pacific Med . and Surg. Journal.
Minute Investigation of the Kidney — M. Ren-
donsky ( Virchmc's Archiv , bd. 41, 1867) gives the following
results of his investigations of the minute structure of the
kidney:—1st. The unniferous tubules are continued into the
capsules of the malpighian bodies, or terminate in blind ex¬
tremities. 2nd. The malpighian capsules are placed on con¬
voluted tubules, lined by nucleated epithelium; other and
smaller canals, supplied with transparent epithelium, com¬
municate fiually with these tubuli. 3rd. Straight tnboli are
connected with some capsules, which, at a short distance from
these capsules, show the characters of the convoluted tnboli.
41 h. The convoluted and the straight tubes are connected by
tubuli, which are lined by transparent (non-nucleated) epi¬
thelium ; the convoluted tubes are in communication with the
capsules, and the straight tubes open into the pelvis of the
kianey. 5th. Henle has described canals with transparent
epithelium, as continuations of the tubuli uriuiferi, which are
really blood-vessels,
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WH f§Udial %ttM &
tl 3ALUS POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 21, 1868.
CONTENTS.
LECTURE.
Lectures on Stricture: with Special Refe¬
rence to its Treatment By RawUon
Macnamara .
843
ORIGINAL COMMUNICATIONS.
Morbid Conditions of the Throat in their
Relation to Pulmonary Consumption:
their Diagnosis and Treatment. By S.
Scott Alison, M.D Bdin. S47
Experiences of a Regimental Surgeon in
India. By C. A. Gordon, M.D., C.B. . 348
The Radical Treatment of Hemorrhoids.. 850
HOSPITAL REPORTS.
Mjcecee’s Hospital—
Case of Ilins. Under the care of Dr.
351
PAOB
Edwbitroh Royal Infirmary—
Cases of Aneurism treated by Iodide of
Potassium. Under the eare of Dr.
George W. Balfour. 850
i
LEADING ARTICLES.
Local Sanitary Committees. 353
The Medical Club. 853
NOTES ON CURRENT TOPICS.
Over-Population. 358
Health of I >ublin.. .. 858
Queen's University in Ireland. 859
Sir Dominic Corrigan . 853
Repression of Syphilitic Disease. 854
Disease in Dublin during the last Quarter 355
Arrival of the "Mauritius" at Portsmouth 855
Scarlet Fever. 855
Health of Salford. 355
West Kent Medical Society. 355
The Elections ... 355
British Pharmacopeia, 1887. 855
PAGE
Alleged Pauper Ill-Treatment in Work¬
houses . 855
Medical Auctioneering. 855
Domestic Torpedos. 355
Holbom Union. 855
The Stage Doctor. 857
The Queen’s University in Ireland. 357
CORRESPONDENCE.
The Norwegian Self-Acting Cooking Appa¬
ratus . 358
Sanitary Museum at Brighton. 358
The New Nomenclature. 858
Note-Taking . 859
Medical Manners. 859
Medical 1 raining. 859
INTRODUCTORY ADDRESSE&
The Liverpool Royal Infirmary School
or Medicine . 880
Social Science Association—
Health Section.—Address by H. W. Rum-
sey, Esq., M.D. 881
Medical News, Notices to Correspondents,
Ac. 888
%tt iVLXL
LECTURES ON STRICTURE.
WITH SPECIAL REFERENCE TO ITS TREATMENT.
By Rawdon Macnamara,
Vice-President and Professor of Materia Medica in the Royal College
of Surgeons of Ireland, and Surgeon to the Meath Hospital.
Gentlemen, —In the fulfilment of a promise, now of
gome months standing, I am here to-day to commence a few
observations on the difficulties that you will experience in
the treatment of stricture, and of some of the diseases allied
thereto, and in limine , I may be permitted to observe
that, I by no means pretend these observations to be by
any means exhaustive of the subject. They are simply
intended to be clinical reoords of what I myself have ob¬
served, and are offered to your consideration as the result
of some years observation and experience in the treatment
of a class of affections, admittedly amongst the most difficult
which surgeons are called upon to treat; in a word, as the
exposition of the surgical faitn which is within me upon these
topics ; a faith which is based upon numerous cases of many
of which you yourselves have been the intelligent observers.
Now, I may divide the difficulties to which I alllude into
two distinct classes,—first, difficulties which are totally un¬
connected with the patient, and secondly, those which are
connected with the patient. The difficulties which are
totally unconnected with the patient are on your side.
They belong to the operator, and it is your duty to educate
yourselves in such a manner as to overcome these difficulties.
Let us consider what these difficulties are. They are,
first, difficulties connected with your knowledge of the
natural anatomical arrangement of the parts. It is per¬
fectly evident that you must be acquainted with the ana¬
tomical relations of the part which you are going to treat;
and premising that you nave made yourself master of all
these details, you have next to educate your hand in every
way possible to make yourself familiar with the use of the
instruments which you are to employ in the treatment of
disease. Now, as to the study of the anatomy of the part,
my advice to you is to make yourself familiar with good
pates. I dont't want to inculcate the idea that anatomy
■ to be learned from plates, but in this case you will
f a c ilit ate your practical anatonfical studies if you examine
good plates and good drawings of anatomical preparations.
Haring done this you are prepared to study the anatomical
relations of the parts on the dead subject. I would advise
you to lose no opportunity of studying these parts. Then,
having learned the whole of the anatomical relations, and
having fixed the leading landmarks in your own minds,
you should proceed to the further action of passing the
instruments on the dead subject. When you go into the
dissecting rooms you should always have a catheter, which
you should endeavour to pass on the dead subject. You
can do him no hurt, and you will thereby educate your¬
selves to recognise the difficulties that you will have in
passing the instrument through the living one. And I say
here, seize every opportunity of passing the catheter
through the living subject, as by so doing you will educate
yourselves for the treatment of disease. Of course you
may think that it is because I have devoted so much of
my time and study to this subject that I will say it is one
of the most important duties that will be required of you
hereafter. I can assure you that in the writings of every
surgeon of any experience, if you open his works, you will
see how thoroughly is recognised the difficulties which
attend a bad case of stricture. Every surgeon, whose name
is a household word, will tell you that the difficulties which
attend the treatment of strictures, are amongst the most
embarrassing that attend the every-day duties of a surgeon.
You will not be long in practice until you will be called
upon to treat some such case as you have witnessed here.
But it is not then that you should have educated your¬
selves. You should have done so long before you were
called upon to take charge of the case. It is a remarkable
fact that any gentleman who commences practice in town
will meet more cases of this sort than those who go to the
country. I believe also, that strictures are far more diffi¬
cult to deal with in town than in the country. Bat it is
possible that even should your lot be cast in the country, you
will meet with such cases, and then you will have to act
upon your own resources, for possibly you will not be able
to call in other surgical assistance. Therefore, I impress
upon you the necessity of studying these cases. I have
been told by gentlemen in the country that they rarely
have cases of stricture, and that they rarely have to pass
an instrument; but in the city we know how repeatedly
we meet with bad cases of stricture. The only way we
can account for this is, by taking into account the healthy
life a man leads in the country, contrasted with that
whidh he leads in town. Men are not so likely to contract
disease in the country as persons are who live ft city
life. In towns, unfortunately, and but too frequently,
they may lead a dissipated kind of life, but the
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344 The Medical Preee end Circular.
LECTURES ON STRICTURE.
October 21,1W8.
peasant leads a far more rational life than the in*
habitant of the city. He goes to bed early, and
rises early. He lives in country air, and he i3 employed in
toil of a healthy description ; whereas, in a town, a person
lives a life the very reverse of all this. The townspeople,
too, are exposed to temptations to which the country peo-
fc are not, and they are, therefore, more liable to disease.
s is the principal reason why it is that strictures are so
rarely met with in country, and so frequently in city prac¬
tice. But then you may meet a case even in country prac¬
tice. Although it may be your lot to go to the country, men
may go down to your district suffering under bad stricture,
and you may be called upon to treat the case. Don’t hug
yourself with the idea that because you live in the country
you won’t meet with such cases. Cases also may present
themselves to your notice in the country, in which it may
be that you will be called upon to relieve a patient of what I
I shall presently refer to—retention of urine uncon¬
nected with stricture. In the town districts we always
have numbers of persons to assist us, if we think it neces¬
sary ; a number of adjuvants also in the treatment of such
diseases, such as warm baths, drugs, &c., are at our com¬
mand in towns. These we may not have in the country.
The responsibility there will be all your own, and, therefore,
will it be all the more necessary for you to know how to
manage these cases.
So far, as to what is connected with yourself, now we
shall proceed to consider the difficulties that are connected
with the patient. I think the first of these are the diffi¬
culties which are connected with the healthiest state of the
human constitution. I have here before me a work which is
very valuable. I don’t know whether it is as great a
favourite now as it was in my student days; but it is
very valuable and I should recommend it to your notice.
It is entitled * Morton on the Perinseum.’ It contains
much important matter on this most important anato¬
mical region. The plates here are exceedingly accurate,
and they give you a very good idea of the parts you have
to treat. You have here also on this black board, diagrams
giving you some idea of the anatomy of the region of
these parts. Now, first as to the urethra. I don’t pre¬
tend to go into a minute anatomical description of the
urethra. I shall only endeavour to give you a few obser¬
vations on it, such as will enable you. to follow me in my
remarks. The urethra is generally described as being nine
inches long—be that more or less ; we will admit this
measurement as being correct in the description we are
about to give. This urethra is divided into three principal
regions ; begiiming from the bladder, you have the first
inch of it which is called the prostatic portion of the
urethra, which terminates an. inch from the opening into
the bladder. The next is called the membraneous portion
of the urethra also about an inch in length, and the re¬
maining seven inches are called the spongy portion of the
urethra. You see here the three portions :—theprostatic,
the membraneous, and the spongy portions. Where the
spongy portion of the urethra is about to terminate, there
is a large development of the spongy tissue on the inferior
surface, and this is called the bulbous portion of the
urethra. This has been occasionally described as a region,
so that then it would be divided, commencing from before
backwards into the spongy, bulbous, membraneous, and
prostatic portions. But the bulbous is nothing more than
a portion of the spongy ; so that if you divide it into
three regions it will do you very well. Here you have the
anterior termination, which is called the meatus urinarius.
This is always the narrowest portion of the urethra, and of
this you may be sure that any instrument which will pass
the meatus urinarius, ought to traverse the entire of a
healthy urethra into the bladder. You will have to take
that as a guage of the size of the instrument that you
employ. This is the narrowest portion of the healthy
urethra, and in many instances is the chief difficulty you
have to encounter in passing a large sized instrument. On
the mucous surface of the urethra you have seveial open¬
ings of mucous glands and follicles which are called
lacunae. These little black spots which you see on these
diagrams are what are the so-called lacunae of the urethra.
There is one larger than the rest situated about an inch
and a half from the external orifice upon the upper surfaceof
the urethra which is called the lacuna magna. It is evident
that the mouths of these lacunae are presenting towards the
orifice of the urethra and may possibly entangle onr in¬
struments. This is the second difficulty. In passing a
tmall instrument into the urethra you may entangle the
end of it in the mouths of one of these lacunae and
especially in that of the lacuna magna and so have its
course retarded, After a little practical education yoa
will be able to recognise that you are going into one of
these. If you forcibly push through them you may lacerate
the walls of the urethra, and so make a false passage. If,
in passing a small sized instrument, you experience any
resistance about this point, your duty is to withdraw it a
little, vary its direction, and then possibly you may over¬
ride this difficulty. This lacuna magna is mentioned in
every work on anatomy ; but there is another lacuna
which is not mentioned in any work on anatomy that I
know of, but which I have very frequently met with
myself. I think it necessary to draw your attention to it
It is a lacuna which is on the low§r surface of the urethra,
and about half an inch further back than the lacuna magna, 1
have got into it very frequently in passing an instrument
so as to avoid going into the lacuna magna. You may
ask me how did I do so, and I don’t know how to explain
it to you except that in trying to avoid the lacuna magna,
I have dropped from Scylla into Charybdis ; but I have
frequently got into it, and I now warn you of its existence.
The majority of these lacunas are on the under surface of
the urethra, hence you are properly advised to keep the
instrument rather towards tne upper wall of the urethra in
passing it in, for there are fewer of these lacun®, once
the lacuna magna is passed, on the upper surface. The
majority of them are all on the under surface, and
to avoid them you are to keep close to the upper
surface. Avoiding thus these lacunas we may go down
from six to seven inches fully through the healthy urethra
without experiencing much difficulty, and then we come
to the sinus of the bulb. When you come to that point,
you will experience another difficulty, and that is situated
in the triangular ligament. In this diagram you see the
triangular ligament and an opening in it; this opening
is abont an inch below the symphisis pubis, and is for
the purpose of allowing the urethra to pass through. On
arriving at this point, you can readily perceive how by
either unduly elevating or depressing the beak of year
instrument you may hitch it against the fold of ligament
and so impede its further progress. If at this point you find
any difficulty, withdraw the instrument a little, change its
direction, and its onward progress into the bladder in a
healthy urethra will no longer De impeded. That difficulty
having been got over, the next thing you come against is
the prostate gland, which, in an aged person especially, is
a difficulty to the passing of the instrument, and, finally, at
the entrance into the bladder, we meet with a ridge or
elevation that occasionally impedes the entrance of die
instrument, a difficulty, however, which can readily he
overcome by depressing to a corresponding degree the
handle of the instrument. In addition to these natural
impediments to the passage of an instrument through the
urethra, may also be mentioned the openings of the ducts
of the prostate gland, which, in rare instances, are found
so pretematurafiy dilated as to admit the entrance of a
small sized catheter; and also the Sims’ pocularis, a slight
depression upon the surface of the verumontarium, within
the margins of which may be observed the openings of the
commou ejaculatory ducts. In this latter position, how¬
ever, the difficulty which we shall experience is not so
much of a mechanical character, as due to the severe pain
which the passage of the instrument as it traverses this
region, even in the hands of the gentlest manipulator, occa¬
sionally gives rise; this pain occurs most frequently in
patients who haye been in the habit of inordinately in-
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The Ifodtaal Prat and Circular.
LECTURES ON STRICTURE.
October 21, 1868. 340
dulging in sexual excesses, or in the pernicious habit of
masturbation. So far for the natural anatomical compli¬
cations of the parts ; it is absolutely impossible, if you are
not acquainted with these, that you can with safety to
your patient introduce any instrument.
Presuming that a case has arisen for passing the
catheter, how are you to do it. Here one simple rule above
all others is to be observed. The patient comes to you
to have an instrument passed. Take a large sized instru¬
ment, and if he says, “ Oh, Sir, that instrument is too
large,” never mind him. Take a large sized instrument,
No. 9 or 10 of Weiss’ guage, and even if he has stricture you
will be able to take soundings. Some people will come to
you to be operated upon, fancying that they have stricture,
who really have no such disease, and presuming them to have
a normally healthy urethra, by using a large sized instrument
you escape all these dangers ; and in fact almost all those
difficulties are avoided by using a large sized instrument.
Having consulted with your patient, the next step to be
considered is, as to the position in which you will place
him while passing the instrument. Some people invariably
S lace the patient in a standing position, others lying down.
ly advice to you is not to adopt any invariable rule at
alL If any person weds himself to any particular line of
conduct he will get into a habit, outside of which he will
experience some difficulty. Put the patient into the recum¬
bent, or erect position as it suits his case. You cannot get
a patient in fever to stand up, you must operate upon him
lying down. A great deal depends upon the position in
which you have your patient. You should never dream of
passing the instrument in the erect position unless he is
propped up in some way. You can put your patient against
the wall if he is to be standing up, so that he may have a
point (Tappui . You will let him lean up against the wall
with his feet about a foot asunder, and about eight inches
from the wall, so that you place him in a kind of slanting
position, the buttocks leaning against the wall, and in that
way you get him at nearly as possible in the best and most
favourable position for the passing of the instrument. If
it be the first time that the patient is having the instru
ment passed, I am supposing even that there is no dis¬
ease at all,—be sure to nave a chair convenient, for over
and over again, at the sight of the instrument in the sur¬
geon’s hands, the very idea of having an instrument passed
has produced such an impression as to make him faint; j
you will know that he is going to faint by the tottering of
his knees, and you must then put him seated on a chair,
or better still, lying on a sofa. You must remember the
danger of his fainting, and see that no harm happens him.
Your own observation will justify this statement, that the
mental impression in anticipation of the operation has been
sufficient to produce this effect. Some practitioners have
rests fixed in the walls of their studies for the purpose of
facilitating the introduction of the instrument into the
urethra. They have padded pieces of wood coming out
from the wall, in order that they may be placed under the
armpits of the patients ; some of them have others lower
down, also to be grasped by the patient’s hands, but these
are refinements we are scarcely called upon to have. So
much for the erect posture, now for your own position. Sit
down before the patient ; avoid also that stage trick, the
trying to introduce the instrument with one hand ; use
both hands, and remember it is a nice trick to pass the in¬
strument, and you have a right to give every fair play to
your patient. I think it is taking a great liberty with a
man not to do otherwise ; to take the catheter, pass it
under the penis, toss it up, and try to catch it in the meatus,
is a juggler’s trick unworthy of a surgeon seriously intent
upon discharging his duty by his patient. What you are
to do is this : take (he penis in your left hand, hold it
gently and put the instrument in, having first seen that
the instrument is of the same temperature as that portion
of the body, and properly oiled. If it be below the right
temperature, you can bring the instrument up to the re-
qnind temperature by rubbing it in some wolien cloth, or
dipping it m hot water. You are next to see that it is
properly oiled. You cannot oil it too much. Have it
thoroughly lubricated, and of the same temperature as the
part, and you have done a great deal towards effecting an
entrance for the instrument. You should always pass it in
most gently—upon this point I shall have occasion in a
future lecture to speak more forcibly. You introduce it
into the meatus urinarius, and in passing it will place your
hand below, in this way. You have remarked that I intro¬
duce it by placing the handle towards the left groin, inas¬
much as you get more room in this way. According as
you slip it in, you bring the handle round towards the
mesial line, keeping it still close to the abdominal wall,
until the beak approaches the opening in the triangular
ligament, and then depress gently, and so continuing, at last
the instrument will gently glide into the bladder. You
are not to imagine that this procedure is intended for the
tour de maitre. This consisted in keeping the hand
down at the commencement of the operation between the
patient’s legs. Then you introduce the catheter so, until
you get to the triangular ligament, when you give it a
sweep around to the mesial line, and the idea was that in
the turn round you slipped it into the bladder. This was
nothing but a stage tnck, and I think that in trying to
effect the tour de maitre many a false passage has been
made. Well, I will presume that you have gotten the in¬
strument down towards the opening in the triangular liga¬
ment, and the handle goes down between the patient’s
thighs, and as you depress it, the instrument does not go
in. We are here now at the triangular ligament, and this
diagram represents the opening in it. It is evident that
the beak of the instrument may be hitched against its
lower margin, the most frequent source of the impediment
to its ingress, or against its upper margin ; in either case
withdraw the instrument slightly and alternately depress, or
elevate the handle, and its passage through this portion
of the urethra will be securea. ft is evident that if you
bring the handle of the catheter down in this way, you
turn up its beak, and so change its axis, that you bring the
beak of the instrument up by the very act of depressing
its handle, and vice versa , and so it slips on into the
bladder. You thus avoid all that natural difficulty of the
triangular ligament; and the prostatic difficulty, which
you will subsequently meet with, will also be overcome by
depressing the handle of the instrument; this, however,
is a subject to which I shall yet have more particularly to
allude. As a general rule, it is always better at this point
to depress the handle of the instrument, and so avoid the
inferior margin of the triangular ligament, and by the same
manoeuvre you avoid the prostate gland. So much now
for passing the instrument m the erect position, remember¬
ing always, on the first occasion of passing the instrument,
the danger of the patient’s fainting. The next position is in
the recumbent posture. Here you take great care to have the
patient lying evenly on his back. It is evident that if you
have him placed more on one side than another you en¬
danger the chance of passing the instrument. You put
him lying evenly on his back. These trifling details may
appear to you to be unimportant. An old writer has said,
“ these things may be trifles, but trifles make perfection,
and that is no trifle.” Put the patient lying evenly on his
back ; then, with the left hand, lay hold of the penis and
introduce the catheter in the way I have described to you
in the last posture. There is one great advantage in the
recumbent posture—that even if he faint you can take ad¬
vantage of his faint; von can introduce the instrument,
and leave it in until he recovers. Another advantage
accrues from the habit of practising catheterization upon
the patient in the recumbent posture, and it is this : tnat
it is the posture in which, in many cases of disease—
fever, for instance—the instrument perforce must be
passed, and so you become familiar with that which you
nereafter must practise. So that it becomes all-important
for you to familiarize yourselves with it, before being called
upon to discharge this duty. In either of these ways, all
cases where the urethra is healthy may be easily treated.
There is a third way, which is a mixture of the recum-
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346 The Medical Press and Circular.
LECTURES ON STRICTURE.
October II, 1M
bent and erect positions, and which is most useful, and
that is to seat the patient in a large arm chair. You
put him in the arm chair, and he has the arms of it
to bold on to for support, and you can place your¬
selves between his legs to operate; you have the advan¬
tage, that if he faints you may let him lie there, and
the arms of the chair keep him from falling over. That is
the way in which I frequently operate. I have an arm
chair in my study for the purpose, and in that position 1
pass more instruments, perhaps, than in any other. When
operating in any one of these positions, it is a very good plan
to hold the penis between the second and third fingers, as by
so doing you leave the other fingers free. You leave the
forefinger and thumb free to assist in any way that may
be required. And it will be as well to have the forefinger
well oiled, so that, in the event of any difficulty occurring,
you can slip your finger into the rectum to free the instru¬
ment from the obstruction, and then in it goes.
The question now arises—Under what circumstances, other
than stricture, may you be sent for to pass the catheter
into the urethra to relieve an over-distended bladder?
Retention of urine may happen to a person who is per¬
fectly free from stricture, but who may have been drinking
heavily at a party. He may have a perfectly healthy
urethra, and yet not be able to pass one drop of water.
This is generally called paralysis of the bladder. I cannot
understand why it is called paralysis, for even were the
bladder paralysed, the abdominal muscles pressing upon
the bladder should of themselves be able to expel the
water. It is something other than paralysis of the bladder.
If you can imagine the bladder distended, and that it
rises up out of the pelvis, and into the abdominal cavity;
as it rises it elongates the neck of the bladder, compress¬
ing it against the under surface of the symphisis pubis,
and thus mechanically prevents the passage of the water.
When a man experiences any difficulty in the passage of
his water, he gets into a fuss; but the worst that can
happen him is a short-lived inconvenience and fit of ner¬
vous apprehension. For in such a case do you introduce
your instrument, draw off the water, and the probability
is that he never troubles you again. In some instances,
however, this temporary inability may be of longer dura¬
tion ; but eventually, under proper treatment, the patient
will recover complete control over his bladder. A some¬
what similar condition may arise also after the operation for
the cure of haemorrhoids by the ligature; here, also, a fa¬
vourable prognosis may be given your patient, and the
treatment will be the same.
In the course of continued fever, also, it frequently be¬
comes our duty to relieve an over-distended bladder; and
hence it is that you will experience the vast advantage of
having accustomed yourselves to practise catheterization
upon your patient placed in the recumbent position : for
evidently, it would be highly culpable of you, even were
he able to assume it, to place him in the erect position.
Every practising physician knows how much a case of
fever is complicated by inability on the part of the pa¬
tient to empty his bladder—how the bad symptoms are
intensified—and how frequently a successful catheterization
improves the aspect of an otherwise unpromising case.
And here I must caution you of an easy source of error.
The nurse may assure you that not only is he passing his
water, but that it is absolutely running away from him—
in fact, that it is what we term incontinence of urine ;
and yet all the time the bladder is distended with urine
to its utmost capacity, and this is but its overflow. When
the bladder is distended to such an extent, it can readily j
be recognised by the dull sound elicited upon percussion I
over the lower portion of the abdomen. Should, how¬
ever, any doubt exist in your mind upon the subject,
solve it by the introduction of the catheter, when, if this
condition exists, you will confer material benefit upon
your patient, but if, on the contrary, it does not exist,
you will have done him no harm, provided always that
the operation has been skilfully performed.
Independent of retention of urine from enlarged pros¬
tate—a fertile source, by the way, of such a condition in
the aged—there is rather a rare condition which occurs
just in this situation, and of which I have seen some
examples. One you yourselves may have recently ob¬
served, under the care of Mr. Stronge ; it is abscess in
the cellular tissue surrounding the prostate, or in rarer
cases still, in the prostate gland itself. The earliest case
of the kind that came under my notice occurred in a
gentleman suffering under the worst attack of typhoid
fever from which I ever saw a patient recover. Early in
the progress of his fever he got retention, and the catheter
had to be used two or three times daily for four or five
days. This condition after a time passed off, and we had
no more trouble from the urinary complication until con¬
valescence was far advanced, when I was called early one
morning to his assistance ; I found him perfectly unable
to empty the bladder. I proceeded to introduce the ca¬
theter, and experiencing an unwonted difficulty in the
prostatic region, I examined him per anum , and found a
tense tumour in the region of tne prostate, which sub¬
sequently suppurating, was tapped through the rectum
with a long curved trocar, a large quantity of pus given
exit to, and from that time all difficulty in micturition
ceased. A remarkable feature in this case was the ap¬
pearance all over the patient’s body of a copious crop of
ecthymatous pustules, a condition of system that may
throw some light on the development of the abscess in
the prostatic region.
In very bad attacks of acute gonorrhoea, also, consider¬
able difficulty may be experienced on the part of the pa¬
tient in emptying his bladder. It has never been my lot
to meet with a case of the kind so bad as that, unable to
relieve it by appropriate treatment, I have been com¬
pelled to use tne catheter. Still, I can readily imagine
that such a case might occur, and then the catheter will
be our only resource.
A not unusual source of inability to empty the bladder,
especially so in young boys, is the impaction of a small
calculus in the urethra. The very first operation I ever
was called upon to perform in this Hospital after my ap¬
pointment to it as surgeon, was for the relief of a case of
this kind. Every other means having failed in dislodging
it, I cut down upon the calculus, extracted it, introduced
a large-sized catheter into the bladder, which I fastened
there, and allowed the wound to heal over it After some
days the patient left the Hosital, having made a good re¬
covery. In concluding this lecture, permit me, gentle¬
men, to give you these practical hints, which hereafter
may save you some trouble :—If sent hurriedly to see a
case of retention of urine, inquire always the age of your
patient ; in the majority of cases, if it be a young boy*
you will find the difficulty to consist in a calculus im¬
pacted somewhere in his urethra ; if an adult, it is more
than probably a case of stricture of some kind or other;
and if an aged man, the enlarged prostate will be the
source of the evil. With a knowledge of these proba¬
bilities, you can prepare yourselves beforehand with the
instruments most likely to prove of use in the treatment
of the case.
(To be continued.)
Subcutaneous Injections in the Radical Cube or
Varicose Veins. —Dr. Stephen Smith, in the Medical
recommends the subcutaneous injection of the persulphate of
iron in this troublesome affection. The patient being in the
erect position, from 5 to 15 drops of Squibb’a preparation of
the persulphate may be forced into the cavity of the vein by
the use of the common subcutaneous syringe, the vein hieng
pressed by the finger. In a few minutes the clot may be de¬
tected by the finger, and the needle may be withdrawn. Tw
patient should remain in bed several days, and cold nppbfj*
tions be made to the puncture. To prevent the possible
escape of a clot into the general circulation, a compress snfl
roller should be applied to the trunk of the vein on the cardiac
side. The larger trunks are usually injected, and at several
points at the same sitting. The clot at once perfectly oo*
eludes the vessel. J
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Th« Medical ¥rm and Circular.
ORIGINAL COMMUNICATIONS.
Ootober SI, 1868. 347
CtfMWttiriraiixriJs.
MORBID CONDITIONS OF
THE THROAT IN THEIR RELATION
TO PULMONARY CONSUMPTION: THEIR
DIAGNOSIS AND TREATMENT.
Bv S. SCOTT ALISON, M.D. Edik.,
rU-LOtr OF TUI BOTH. COLLEOE OF FHTSICIAMS, LOXDOX, AMD
FUTSICIAM TO TUB HOSPITAL FOB COMSL'XPTIOM ABO DISEASES OF THI
CUBST, BBOXPTON, AMD TUB SCOTTISH HOSPITAL.
No. IX.
TREATMENT OF ASSOCIATED CACHEXIAS.
In a previous paper the morbid conditions of the system
which have been found to complicate disorders of the trachea
and other parts of the upper air-tube apparatus, simulating
pulmonary consumption, were enumerated. It was pointed
out that cases so associated were remarkable for obstinacy,
more particularly when the associated general morbid con¬
ditions were not early recognised, and were not duly sub¬
jected to that general treatment applicable to the consti¬
tutional evil.
The remarkable obstinacy observed in such cases has,
happily, in a large proportion of cases, been speedily
brought to an end by the adoption of suitable general
means, and so much depends in this class of cases on such
management, that I have deemed it right to dwell at some
length on the chief morbid cachexia} or taints which we
find most frequently associated with the disorders under
consideration.
The Scrofulous Cachexia .—When the associated cachexia
has been the scrofulous one, the best results have been ob¬
tained by residence at the sea-coast, bv regular and ample
exercise, the strength of the patient being duly regarded,
by the administration of medicines calculated to give tone
and increased vitality to the solids, and to the thorough
production of a healthy, well organised, and well propor¬
tioned blood. The temperature of the body has demanded
nice management; the avoidance of excessive and long
continued cold in winter, and of long continued over¬
exciting dry heat, or of relaxing, hot, moist air in summer,
and a suitable adaptation of clothing to the various
seasons, and even the transitory alternations of the tem¬
perature of the surrounding atmosphere.
When debility has been a marked feature without febrile
action, the preparations of iron have been most serviceable;
the iodide, the ammonio-chloride, the ammonio-citrate, and
the phosphate have afforded the best results. When there
have been associated great relaxation and languid, oozing,
cold sweatings, the tincture of the perchloride has quickly
imparted tone to the system.
Iron, in the form of mineral waters taken at their
source, has done much good; and of these waters the Tun¬
bridge and the Chalybeate of Buxton found, as they are,
in bracing localities, are eminently calculated to correct
the scrofulous taint or cachexia. Cod-liver oil and vege¬
table tonics have contributed much good. Salt water
baths, warm in winter and cold in summer, have greatly
contributed to the invigoration of the general health in
the scrofulous cachexia.
The syphilitic taint demands general treatment. Mer¬
cury in moderation, given so as to act as an alterative,
ana to invisibly promote the secretions of the skin and the
various emunctories of the body, has been found very ne¬
cessary But I have found great caution to be required
in its administration. With the irritable mucous mem¬
brane of the alimentary canal, it is incompatible except in
very minute doses, and guarded by combination with
Jiyoscyamus or a very small portion of opium. When a
febrile state prevails, with a furred tongue, thirst, and
active inflammatory action of the tonsils and velum, the
exhibition of mercury may induce destructive ulceration
or gangrene. A young man with the syphilitic taint con¬
sulted me very lately; he was extremely emaciated, had a
phthisical aspect, and had much cough and great hoarse¬
ness. The pulse was very active, the tongue was covered
with yellow fur, and the velum palati was perforated and
presented ragged edges. To endeavour to heal the parts
while the system was so disturbed seemed visionary, and
to give mercury was likely to aggravate the ulcerative and
destructive action; he was therefore put upon a course of
saline treatment, and tranquillity of the body was enjoined
by confinement to bed at first. In the course of ten days
he returned, with a quiet pulse and clean tongue, and all
the wounds smaller and disposed to heal up. Small doses
of mercury were now ordered, but in combination with the
saline treatment, and after some days the hoarseness and
cough had entirely disappeared. The patient had lately
contracted syphilis, and was at the time suffering from
virulent gonorrhoea.
In chronic syphilitic. taint, to which disorders of the
trachea and other parts of the air-tube apparatus simulat¬
ing pulmonary consumption is superadded, it has been
found better to administer iodide of potassium or the bro¬
mide of potassium in small doses, long continued and given
in combmation with sarsaparilla. It is necessary, when
there is much irritability of the mucous membrane of the
fauces, to watch the effect of iodide of potassium, for it
sometimes leads to sudden and great effusion of that part.
Warm bathing has been found a great corrective or this
taint, and to aid the removal of the local mischief.
The gouty cachexia presents, for the most part, the si¬
mulative disorders of the upper air-tube apparatus, if not
in a very formidable form yet manifesting very great obsti¬
nacy; and it is therefore necessary to deal at once with
this general morbid condition. The gouty condition is,
indeed, very frequently found in combination with the
disorders of the trachea and fauces simulating pulmonary
consumption.
Treatment directed solely to the local disease— i.e. } con¬
sisting of merely local appliances—will very generally fail
to afford much relief, or to impart anything like perman¬
ency to what benefit they may chance at the time to im¬
part. The persistent employment of the alkalies will be
round very necessary. My experience in treatment of the
local disorders under consideration, when associated with
the gouty condition of the system, has proved the superior
efficacy of bicarbonate of potash. When, owing to irrita¬
bility of the stomach, this remedy is ill borne, much ad¬
vantage will result from the employment of bicarbonate
of soda, and this may be reinforced by the carbonate of
bismuth, whose valuable property of subduing irritation and
combining with noxious and acrid secretions, is now so
much required.
The action of the skin is to be promoted by the internal
use of sulphur, and the greatest advantage is perceivable
by the long-continued employment of hot, sulphureous, and
saline baths, such as those of Bath, Buxton, and Harro¬
gate in this country, and those of Baden-Baden and other
well-known health resorts in France and Germany.
The internal administration of the mineral waters of the
Eaux Bonnes, Bath, Cheltenham, Leamington, Harrogate,
and Buxton, is pre-eminently useful, and in obstinate
cases, and when the circumstances of the patient will per¬
mit, should on no account be omitted. Seltzer soda and
Lithia water form excellent beverages, and when spirits
are ordered may be made the receptacle for their adminis¬
tration. The value of a treatment of this nature now
recommended was duly pointed out years ago by Dr.
Gueneau de Mussy, of London, in his valuable work on
“ Angine Glanduleuse,” a copious notice of which, by the
writer of these papers, will be found in the Medico-Chirur-
gical Review.
Treatment of the Anaemic Condition .—The means of
dealing with this condition are so generally known, and
as I have no particular remedies to recommend, I shall
content myself with doing little more than enforcing the
necessity of this condition being recognised and duly and
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348 The Medical Press and Circular.
ORIGINAL COMMUNICATIONS.
October *1, 1668.
efficiently treated, even when the symptoms give a very
great prominence to the local disorder. The employment
of vegetable tonics, cold bathing, and the arrest of ex¬
hausting discharges are very necessary. Exhausting leu-
corrhoea and excessive catamenial discharge must be duly
dealt with. I have found tannic acid locally employed
very useful, and in some examples of excessive catamenial
discharge the internal exhibition of the tincture of ergot
of rye has produced good results.
The internal employment of iodine by amende subjects
suffering from disorders of the throat simulating phthisis,
though affected with bronchocele, is to be deprecated.
The bronchocele, at all events in such cases, is a condition
of atony not to be obviated by the internal use of iodine.
Pure country air, free from damp, serves greatly to in¬
vigorate the system and to obviate the associated local
disorders of the upper air-tube apparatus.
The hysterical condition is one which demands careful
and persistent treatment when associated with throat dis¬
orders simulating pulmonarv consumption. The singular
conditions, both of mind ana body, which manifest them¬
selves in this condition must be dealt with, would we
prove at all successful in our treatment of the throat dis¬
order.
The mind must be strengthened anthregulated by sober,
firm, yet affectionate instruction. The partly voluntary
absurdities in word and action which the hysterical often
commit must be deprecated in a kindly and firm manner.
The mind is to be subjected to moral control as the brain ;
its physical medium must be invigorated by means adapted
to the physical organisation, by pure air, suitable diet, and
the avoidance of excessive spirituous stimulation when
that has been in operation, which is not unfrequently
found to be the case.
The shower bath, friction along the course of the spine,
exercise regularly taken, with a healthy object in view,
have been very useful. With respect to medicines, the
best I have found have been ammonia, camphor, galbanum,
assafoetida, and valerian. The latter, combined with zinc
and iron in the preparations of valerianate, of these metals
is very useful. Mr. Morson, of Southampton row, took
great pains, some fifteen years ago, to prepare for me a
tincture of the valerianate of iron, which I have found
useful in such cases. The removal of irritation, either in
the uterine region or in the bowels of course, is essential
to success in treatment, and of local disease so far removed
as that even of the trachea.
The treatment of the scorbutic state is so well known to
the 'profession that it is unnecessary for me to say more
than that I have found cases of disease of the upper air-
tube apparatus, simulating pulmonary consumption, to be
hastened in their cure by the full employment of fresh fruit,
including grapes, and fresh vegetables, lime juice and the
securing ot pure air and cleanliness.
Besides the conditions which I have noted above as
complicating cases of disease of the upper air-tube appa¬
ratus, simulating pulmonary consumption, I have seen such
cases of local disease occasionally associated with another
general state, viz., one of psoriasis, freely manifested on
the integument of the arms and legs, and also displayed
in oval and round, white, and sometimes polished patches
on the tongue. In most cases the administration of Fow¬
lers solution of arseniate of potash has been found very
serviceable both as regards the general state of the skin
and the local affection of the throat.
The treatment of cases of throat diseases simulating
pulmonary consumption, has hitherto occupied the chief
place in these communications, but it seems proper to say
a few words respecting the treatment of throat affections
complicating or super-added to pulmonary consumption.
From the full details of the treatment in simulating
disease which have been given, the necessary treatment of
the same local disorders when associated with the more
graver affection of the lung in its early stages, the reader
may infer what I conceive to be the proper and necessary
course of management to be adopted. It is therefore unne¬
cessary to do more now than to refer to the preceding ob¬
servations. It is otherwise, however, with the grave con¬
dition of the fauces, larynx, &c-, which we find associated
with pulmonary consumption when about to end in death.
The morbid state of the larynx gives rise, in the sinking
patient afflicted with phthisis, to such cruel sufferings that
a little time may be usefully and perhaps humanely em¬
ployed in reciting the means which I have found most
useful under such melancholy circumstances.
The red, the aphthous, and even the ulcerated conditions
of some or all the parts seen on opening the mouth of the
patient dying of pulmonary consumption, demands the
kindly and careful consideration of the physician. Borax,
citric acid, and mineral acid gargles are scarcely ever
tolerated under such circumstances, being too irritant.
Tinct. of honey and olive oil, glycerine and oil, or glycerine
and tannic acid, cakes of chocolate, and lozenges of bis¬
muth and acacia afford much temporary relief, and are
greatly prized by the poor sufferer in his lamentable state.
The chocolate is found very serviceable ; it readily passes
down the oesophagus and goes to supply, in some degree, the
place of the usual food which the patient too frequently
finds himself utterly unable to swallow. The lozenge of
extract of beef, sold by Coleman and Co., of St. Mary-at-
Hill, and manufactured by Tooth, of Sydney, in Australia,
is an admirable form of nutritious, agreeable, and demul¬
cent food, extremely notable in such cases. I have some¬
times found advantage from pencilling the aphthous parts
with a very weak solution of nitrate of silver, two grains
to the ounce of nitre.
The fearful difficulty of respiration which is sometimes
observed in cases of pulmonary consumption about to ter¬
minate in death, and which proceeds from obstruction of
glottis, associated with destructive ulceration of the larynx,
occasionally gives rise to a question respecting the pro¬
priety of performing tracheotomy. This question has fre¬
quently come before me, and not without some embarrass¬
ment on my part, for the actual good to be obtained by
the operation is only a respite from death for a few days;
and to purchase this the patient has to pay, in pain, alarm,
and is in some degree in danger of immediate death.
I have, under such circumstances, sought the aid of sur¬
gical skill; but the result has always been, that we have
rested satisfied with mild temporary expedients, such as
those referred to above, and with the use of the gentle ex¬
ertion of the neck, with chloroform and camphor liniments,
and with the employment of light fomentations, such as
those of chamois leather soaked in hot water and covered
with impermeable material, or of spongio-piline, moistened
with hot water, nicely fitted to the throat.
EXPERIENCES OF A REGIMENTAL SURGEON
IN INDIA.
By C. A GORDON, M. D., C.B.,
Deputy Inspector-General of Hospitals.
The reader need hardly be informed that in 1857 the
Sepoy mutiny occurred. The regiment to which these
notes specially refer had the misfortune, in July of that
year, to sustain a heavy loss in officers and men, by a part
of it falling into an amouscade at Arrah, on which occasion,
of six officers one was killed on the field, and two wounded,
of whom one shortly afterwards died ; of 152 men, there
were killed on the spot 47, and wounded, more or less se¬
verely, 32. Thus there occurred on this single occasion a
far greater loss of life than the corps had sustained duriug
some of the hard fought battles in which it had taken a
part previous to the subjugation of the Punjaub being com¬
pleted.
Throughout the other affairs in which the regiment was
engaged during that year, 2 officers were wounded, 7 men
killed, and 43 wounded more or less severely. Thus we
learn that, in an average of 705 men, the ratio for the whole
period was of killed before the enemy 7*65 of strength. Of
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October 21,1068. 349
the 75 wounded, there died 7, or 2*42 more ; that is, 10*07
men out of every 100 were killed or died of their wounds
during the year. The deaths from all other causes at, and
absent from, head-quarters were 59, or at the rate of 8*36 per
cent, strength in addition ; or a grand total of 18*43 per
100 . But great as is the list of casualties here given, it
by no means represents the entire loss sustained by the
regiment during this eventful year ; 44 men were, by the
nature of their wounds, or other circumstances incidental
to service, incapacitated for continuing at their duty, and
as a result had to be invalided and sent to England.
To render this fearful state of causalties still more evi¬
dent, I remark that, in an average strength for the year of
705, there were—
Killed in an ambuscade . . .47
Killed at head-quarters during the Lucknow cam-
^ paiga.7
Of 75 wounded, there died . . .17
Died of disease at, and absent from, head-quarters
during the year . . . .59
Invalided and sent to England . . 44
Total casualties . .174
Showing a rate of decrease, from all these causes, of 24*68
per 100 strength per annum !
The following table shows the nature of the wounds and
injuries from which our soldiers suffered ; those injuries
that did not prove fatal on the spot being alone enumer-*
ated namely:—
Injury.
Occurred.
Died.
Invalided.
1
Vulnus Sclopitorium...
60
10*
11
2
„ Incisum.
8
0
0
3
„ Punctatum.
1
0
0
4
Amputatio.
5
1
0
5
Fractura.
1
0
0
G
Subluxatio.
7
0
0
7
Contusio.
13
0
0
8
Ambustio.
6
6
0
9
Concxusio Cerebri.... ..
1
0
1
Totals...
102
17
12
1 Two of these died of Tetanus.
The military surgeon will have no difficulty in gathering
from the above figures the nature of the service in which
the subjects of the injuries were engaged, thus the incon¬
siderable proportion of sword cuts as compared to gun¬
shot wounds indicate as clearly as need be, that our troops
were seldom enabled to come to hand-to-hand combat with
the rebels ; the almost entire absence of bayonet wounds,
there being only one enumerated, and it of very trifling
nature, clearly showing that it was no part of the Sepoy’s
tactics to stand a charge by our indomitable Infantry.
Bums from explosions constitute some of the charac¬
teristic injuries that attend a siege ; mines, tumbrels, and
expense magazines on such occasions, often explode either
by intention or by accident, inflicting the most terrific
injuries upon the unfortunate men in the vicinity, that it
is the lot of the regimental medical officer to witness,
among all the terrible sights to which on a campaign he
must become accustomed.
What do we learn from the rate of occurrence and mor¬
tality of gun-shot wounds. Let us first compare what has
taken place during the first year of the Indian mutiny,
with what happened during two previous campains in that
country in which the 10 th regiment took a distinguished
part. _
Number.
occurred
Number
died.
Bate of death
per 100 treated
1 st. year of Sepoy
Mutiny
1 st Seikh War
60
10
16*66
55
6
10*81
2 nd. Seikh War
149
14
9*46
We see from these simple figures that on the presen
occasion the wounds inflicted upon our men have been
much more severe in their nature than on either of the two
former. How is this ? It clearly shows that whereas on these
two occasions, the career of the regiment against the
enemy was one continued glorious success, the latter being
pressed so closely and effectually as to prevent them from
taking steady aim, a party of our men on the present
occasion were led into a trap where the enemy had it in
their power to take deadly aim at their victims, themselves
being the while secure from danger. Can anything,
therefore, more clearly prove than they do that not
only saving of life on the field, but great saving in the
severity of wounds that do not prove immediately fatal, are
best secured by pressing on rapidly to close quarters with
the foe.
The meaning conveyed to the mind by the word “gun¬
shot wound ” is, to most people, sufficiently plain, yet if we
are asked to define what an injury of this nature really
consists of we have some difficulty in clearly expressing
ourselves regarding it. Let me see then what some of our
standard authorities say on the subject. Hennen (p. 32)
says “ that a gun-shot injury is a violent contusion with
or without solution of continuity, suddenly and rapidly
effected by a solid body projected from fire-arms.” Druit *
is less correct. He states that “ they consist of severe
contusions with or without solution of continuity,” a defi-
* nition equally applicable to injuries inflicted by a bludgeon
in an Irish faction fight as to a wound inflicted by fire¬
arms. Guthrie f seems to be satisfied with stating gene¬
rally “ that a wound made by a musket-ball is strictly a
contused wound.” Ballingall does not stop to ask the ques¬
tion what is a gunshot wound.
The ordinary kinds of what is called gun-shot wounds
met with on active service are 1 st., from cannon-balls, 2 nd.
from fragments of shells, 3rd., from grape canister or
shrapnell, 4th., from musket bullets, and 5th., from pistol
bullets. An injury from a cannon ball must always be
severe in its uaturul, and dangerous in its results. In the
early part of its progress a missile of this description
ploughs a lane through an advancing column, mangling
the unhappy men whom it happens to strike in a manner
terrible to look at. After it has expended its force, how¬
ever, it will often impinge against a person so slightly as
not to break the continuity of the skin, perhaps merely in¬
flicting a bruise, but more generally breaking the bones,
or if it strike the chest or stomach producing instantaneous
death. Cases of this description used to be referred to
the wind of the shot. Hennen in his work on “ Military
Surgery,” expresses his belief in such a cause, and at page
94, thus expresses himself, “ I should be very far from
denying altogether the influence of the shock, whether that
is electrical or not, because we frequently meet with cases
where no local injury can be detected after death. That
the compressed air alone or the friction of the ball, has no
such effect appears to me satisfactorily proved by the usual
arguments drawn from instances of near comrades being
killed, or parts of the body being torn off without the
individual being destroyed ; and it is rendered if possible
still stronger by instances of escape owing to a sudden
contortion of the body in the attempt of evading the sum¬
mary military punishment inflicted in some foreign
countries by blowing men off from the mouth of a gun.
Among the remarkable cases of injury of this nature,
we have that where death has been occasioned by a cannon
ball striking a load carried upon the head, post-mortem
examination failing to detect any lesion of tissue. Sir
George Ballingall mentions the case of an officer whose
knee-pan was dislocated, as he firmly believes, “ by the
wind of shot during an action on shipboard,” and quotes
from Sir Gilbert Blane the instances of two men who
were killed in Lord Rodney’s action in the West Indies,
by balls passing across the pit of the stomach. There is
no doubt, however, that in all these cases, actual mechani-
* Surgeon's Vade tftcum,
\ On Chm-ihot Wound*.
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HOSPITAL REPORTS*
October SI, IMS.
cal contact took place ; and two similar cases came under
my own observation, in one of which instantaneous death
was the result, in the other, fracture of the clavicle.
A man of the 20th Regiment, during the advance upon
the guns of the Oude rebels at Sooltanpore, February 23rd,
1858, dropped dead in the ranks at the instant that two
others beside him fell wounded by a round shot. Not an
injury could for some time be detected ; and the placid
expression of the face strikingly illustrated what has so
often been remarked in death from bullet wounds. The
only unnatural appearance was a considerable degree of
lividity of the lips and face generally.
This man’s chest was afterwards found to have been
completely flattened, the sternum absolutely ground to
small fragments, yet not a scratch was evident on the skin.
The other instance was that of private John Byrne, who
was wounded at Huineerpore on tne 19th February, 1858 ;
a six-pound shot in its ricochet struck the left side of the
chest, over the upper border of the pectoral is major, just
grazing the skin. Considerable swelling occurred at once,
there was much tenderness, but apparently no fracture.
The patient, a very powerful man, was brought to
the rear in a state of great mental agitation, but the pulse
remained natural. Cold water was applied, a little stimu¬
lant given, and by the 21st he suffered only from stiffness
and inability to use the left arm. Several days after re¬
ceiving the injury, on turning himself suddenly in bed he
felt a sharp snap, and a transverse fracture of the clavicle
was found to have occured at its middle. The ordinary
apparatus for the treatment of that accident was applied.
He was sent to the field hospital, when favourable recovery
took place. He subsequently rejoined the regiment, and
was killed while charging the rebel Sepoys.
Guthrie in his work on “ Gun-shot Wounds,” states that
injuries of this description were formerly attributed to the
wind of ball, but the opinion was abandoned from a total
want of any positive evidence in support of it, whilst much
positive evidence could be brought against it. The Baron
Larrey explains that a cannon ball is propelled at first with
a rectilinear movement, and if, during this part of its course,
it strikes against any part of the human body it carries it
away, but the ball after having traversed a certain distance,
undergoes some change of motion in consequence of the
resistance of the atmosphere and the attraction of the
earth, and turns on its own axis in addition to the direct
impulse received from the explosion of powder. If it
should strike any part of the body when the velocity with
which the ball is passing is greatly diminished, it does not
carry away as in the preceding case, but in consequence
of its curvilinear or rolling motion it turns round the part
in the same manner as a wheel passes over a limb instead
of forcing a passage through it. The soft elastic’parts, such
as the skin and cellular membrane yield, whilst the bones,
muscles, tendons, arteries, &c., offering a greater degree of
resistance are either bruised or fractured. If the ball
should strike one of the cavities of the body the viscera
suffer in like manner. So far as my experience enables me
to form an opinion, I am inclined to believe that this ex¬
planation is the correct one. Most extensive swelling and
ecchymosis follow injuries of this nature, and the liability
of the part injured to suppuration or sphacelus is well
known to military surgeons.
Shells are even more destructive to life than cannon
balls, for while the latter when they strike only carry death
in one direct line, a shell, by virtue of its very nature, sends
death and destruction equally on all sides. Besides this,
a cannon ball* if discharged a distance of 800 to 1,000
yards leaves sufficient time, before it travels over that dis¬
tance, to enable men against whom it is directed to take
advantage of any means of shelter that may be available.
This I have personally witnessed at Lucknow, and there are
still officers m the 10th Foot who were present when two
companies of that regiment had for several hours a continued
duel with one of the rebels’ batteries, the fire from which
they “ kept down,” so as to be comparatively harmless.
* We now allude to round Mof.
THE RADICAL TREATMENT OF
HEMORRHOIDS.
One or two points in Mr. Henry Smith’s operation for
the radical treatment of htermorrhoids may be worthy of
note.
The first point is the facility with which the clamp
grips the part; the second point is the extremely minute
amount of local pain experienced by the patient on and
after the application of the actual cautery.
On a late occasion, where Mr. Smith operated, the pain
experienced by the patient appeared to be more acute
during the time the haemorrhoids were being drawn down,
in order to be clamped, and during the application of the
iEtlier spray, than at any other time during or after the
operation.
The clamp used by Mr. Smith is not of the nut-cracker
or cork-presser pattern, with joint at extreme end. It is
more the pattern of that very domestic piece of cutlery,
the scissors, with fulcrum near the centre, and with
blades which close uniformly from points to heel—the
blades run parallel (to be again domestic in illustration),
like the blades of a curling-tongs. Where secondary
haemorrhage is expected, the clamp has a screw arrange¬
ment which allows gradual dilatation, in order to free the
art, so that the presence or absence of haemorrhage may
e ascertained.
With regard to the trifling amount of pain experienced
by the patient during, and after, cauterization, Mr.
Smith is of opinion that it is attributable to the non-con¬
ducting guards attached to the inner sides of the clamp
blades, and which check the transfer of heat from
the irons employed (through the blades) to the healthy
surface behind them. Be this as it may, the pain ex¬
perienced by the patient (a medical gentleman) was, as
we have said, less, during and after the operation than
prior to it.
The clamp was very easily applied, removed, and re¬
applied (as more than one haemorrhoid required extrac¬
tion) with facility; the simplicity of the instrument may
in part account for the facility of its application—a point
of importance to patient and to operator.
-» --
Hospital Hearts.
EDINBURGH ROYAL INFIRMARY.
Cases op Aneurism treated by Iodide of Potassium-
Under the care of Dr. George W. Balfour.
Case III.—James Wilson, aged 44, a mason from New¬
castle, admitted into Ward VII., on the 31st of August,
1867. About nine months before admission, this patient
began to have occasional attacks of lightness in the head,
accompanied with a flashing of light before the eyes. These
attacks came on usually while he was at work, and
obliged him to sit down for a little to recover himself
At first they occurred once or twice a-day, but they soon
became more frequent, and he always felt much weaker
after them. During these attacks he suffered from pro¬
fuse perspirations. About the same time the patient
began to suffer from “ beatings ” in his abdomen^ in the
left side of the chest, and on the right side of his neck.
At the last-mentioned place a swelling appeared, which
gave him great uneasiness, and produced a choking sensa¬
tion. He consulted various medical men without relief,
and at last came to Edinburgh, as already stated, on the
31st of August last. On admission it was found that he
had no radial pulse in the left arm, but there was nothing
to account for this, the “ beatings * on the left side being
apparently merely cardiac palpitation; on the other hwj
those in the abdomen and on tne right side of the neck bad
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HOSPITAL REPORTS.
October 21, 1868. 851
each an abnormal and evident cause. About the lower
part of the epigastric region, towards the left side, and
lying close above the aorta, whose course could be dis¬
tinctly traced, a small pulsating tumour, the size of a small
orange, could be distinctly felt, pulsating itself, and not
merely moved by the artery beneath it; over this tumour
a loud bruit could be heard. On the right side of the
neck there was also an evident pulsating tumour, extend¬
ing up into the neck from the sterno-ciavicular articula¬
tion, and towards the mcsian line. This tumour was
somewhat larger and longer than that in the abdomen,
resembling in shape and appearance a large kidney
potato. Upon any excitement, and especially when the
man was up and walking about, its size increased con¬
siderably. No distinct bruit was heard over it; never¬
theless it was evidently an aneurism implicating the
innominate, subclavian, and carotid arteries. He was at
once placed upon thirty-grain doses of the iodide of
potassium twice a-day, which he has continued to take
steadily, with occasional intermissions, up to the present
time, and a diet and regimen similar to that already de¬
scribed, were prescribed for him ; but as his symptoms
were not so severe, strict recumbency was not insisted
upon, and he was allowed to go to chapel every night.
The intermissions in the use of the iodide were necessi¬
tated from the circumstance that it was not so well borne
by him as by the other two patients; every now and
then pain in the stomach or severe headache giving warn¬
ing that it was time to stop it, These symptoms, how¬
ever, always abated after leaving off the medicine for a
day or two. His appetite was always good, but his
bowels required to be regulated by medicine. No imme¬
diate effects were observed from the remedy, but after the
lapse of some months the abdominal aneurism was found
to be quite firm and solid to the feel, while the bruit had
disappeared, and could only be reproduced by pressing
somewhat strongly with the stethoscope ; the tumour is
now gradually disappearing. After a time, and only
within the last two months, the aneurism in the neck
ceased to swell out when he walked about; it also gradu¬
ally became firmer, aud though still quite evident, he no
longer suffers any inconvenience from it. The coats of
the arteries in this position seem to have undergone fusi¬
form dilatation, and it is doubtful whether further
treatment will be of any avail. His health has, however,
much improved ; he has no longer any disturbing pulsa¬
tions ; and though he occasionally suffers from lightness
in the head and dazzling flashes of light, his condition is
unquestionably better than it was, and considering his
inveterate aneurismal diathesis, he has probably reaped
as much benefit from the treatment as is possbile under
the circumstances.
MERCER’S HOSPITAL.
Case or WM. BYRNE:—ILEUS,
Under the care op Dr. EAMES.
Seen at dispensary Sept. 28rd, 1868 . Complained of
constipation. Bowels haa not been moved since 31st of
last month (four days). Had taken purgative medicine
without effect. He was aged fifty-four. Previous health
pretty good ; married, and of temperate habits; a ware¬
house porter by trade. He was ordered to remain in the
house for a few hours, and to have a turpentine enema.
Saw him again the same day at four o’clock p.m.; the
enema had not affected the bowels. Had him stripped
and put to bed. Nothing remarkable about the face.
Heart’s sounds and position natural. The abdomen
was swollen and tympanitic. No local pain on pres¬
sure ; passed water freely; distressed only by sense of
fulness in the abdomen, and slight dyspnoea. Ordered
R. Pil. col co. t gr. viij.; ext. hyoyc., gr. ij. ; two pills to
be taken immediately. Warm turpentine stupe to ab¬
domen. Wine, Jiv.
Sept. 4th. —Bowels had not been acted on by the pills.
Abdomen more tense. Dull pain on deep pressure over
the caecum. Abdomen generally tympanitic. Pulse 100,
small and compressible. Ordered the stupes to be con¬
tinued, and a turpentine enema with O’Beine’s long tube.
Four o’clock, p.m.—Bow r els still unmoved. Ordered him
to be placed in a warm bath, and an injection to be thrown
up whilst in the bath: the abdomen to be gently kneaded.
Wine, Jvj.
Sept. bth. —Bowels still unmoved. Tympanitis in¬
creased. Pain in various parts of the abdomen on pres¬
sure ; especially over the caecum. Had passed no water
since previous evening. Pulse, 120, small and thready.
Frequent vomiting. Countenance anxious. Three ounces
of urine drawn off. To have ice in the mouth, and
draughts of acid, hydrocy. dil., TJ\jj.; aquae dist., ^j.; to
allay the vomiting. A drop of croton oil in Jss. of castor
oil, with lT\xx. of Battley’s sedative liquor of opium, to
be given in an hour. The abdomen to be covered with a
light poultice of linseed meal sprinkled with tr. opii., 3ij.
Wine as he might require it. Four o’clock, p.m.—The oil
was rejected about live minutes after being swallowed.
Ordered elaterium, gr. ss., in mucilage.
Sept. 6 th. —In every respect worse. Tried electricity,
passing a strong current from the caecum and various
parts of the abdomen to a pole introduced into the rec¬
tum : without effect. The long tube passed eight inches
without meeting obstruction. Subcutaneous injection of
morphia. A consultation of the entire staff at 2 o’clock,
p.m. The patient was evidently sinking ; resolved to
try calomel, gr. iij., opii., gr. ss., in pills every four hours ;
mercury to be rubbed into the axillae and groins. Ten
o’clock, p.m., met again, no hope; died at one o’clock the
following morning.
Autopsy nine hours after death. —The abdomen im¬
mensely distended. On being opened, this was found to
be due to the enormous distension of the small intestine.
About six feet of the lower end of the ilium intensely
congested, and in some parts gangrenous. The colon
was found lying behind empty and collapsed. The caecum
contained part of the last enema. About two inches from
the ileo-caecal valve the ilium had twisted on itself, and
presented an appearance like that produced by drawing
out a glove, and then twisting it round. The walls at this
spot were glued together by an annulus of recently effused
lymph, and there was local peritonitis around it.
The patient was examined for every form of hernia.
The vomiting was at no time stercoraceous. It is evi¬
dent from the lesion that purgatives, whether by the
mouth or rectum, could afford no relief. Electricity
might, perhaps, if tried at the very outset, have caused
the gut to untwist itself. The fumes of tobacco, I do
not think, could have been of use, as the twist was
impermeable.
The question of opening the abdomen arose during
consultation. Tho opinion of the majority was against
this course. Even after death, with every facility of a
very large opening, it required some time and much
handling of the parts to discover the seat of the lesion,
and when found the walls of the intestine were glued
together, and six feet of it semi-gangrenous—the vital
powers at the same time so low that part of the last in¬
jection remained in the colon. The only time that
operative interference could have afforded hopes of relief
would have been wheu he was first seen, and when the
tympanitis was comparatively little. But one could
scarcely find anyone sufficiently hardy to propose opeuing
the peritoneal cavity to relieve a constipation of four
days’ standing.
Sulphate of Zinc in Dyspepsia. — Dr. Gillespie recom¬
mends the use of the sulphate of zinc in dyspepsia, in doses of
half-a-grain gradually increased to two grains, three times a
day, combined with opium or hyoscyamus, at the same time
regulating the diet. He thinks this drug “ as safe and sure
as quinine in intermittents .”—Boston Med . ond Surg . Journ.
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LOCAL SANITARY COMMITTEES.
October 11,18(8.
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"SALUS POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 21, 1868.
-♦-
LOCAL SANITARY COMMITTEES.
Turn we to the 20th Section of the “Army Hospital
Regulations,” and there we read that “the medical depart¬
ment of the army and its officers are charged, not only
with the medical care of the sick, but with the duty of
recommending to commanding officers, verbally or in
writing, whatever precautionary measures, as to barracks,
encampments, garrisons, stations, hospitald, transports,
diet, dress, drills, and duties may, in the opinion of the
department and its officers, conduce to the preservation
of the health of the troops, and to the preservation or
mitigation of disease whether, at home and abroad.
But in the event of any verbal representation not being
complied with, the medical officer shall make a represen¬
tation in writing on the subject to his commanding
officer.” The paragraph here quoted at full length was,
when the code of which it forms a part first appeared,
rightly considered to authoritatively give medical officers
a power which, when previously put in operation by an in¬
dividual here and there, had been so at the.peril of his own
personal comfort, if in a regiment, and at all times of his
professional advancement. During the Crimean War the
fact had over and over again been demonstrated that the
functions of medical officers were considered to have no
more extended sphere than the treatment^ of sick and
wounded soldiers in hospital; that so long as a soldier
was not in hospital, all that concerned him was altogether
beyond the surgeon’s province ; and the w orks of medical
officers down to that time teemed with illustrations of
evils that arose to the soldier from such restrictions. The
palpable anomaly thus presented formed the theme of
letters, private and public. It was taken up by a Royal
Commission, and, finally, a new book of Regulations
, appeared, having apparently been prepared with the
special object of making medical officers directly respon¬
sible, as they should be, and as in reality they are, in
regard to all matters that bear upon the health and
physical efficiency of soldiers, whether in hospital, bar¬
racks, camp, or on board ship. To ensure the performance
of the duties thus for the first time authoritatively re¬
quired of medical officers, a sanitary department was
created, the head of which was to give the Director-
General advice and assistance on all subjects connected
with the hygiene of the army. Inspectors and deputy*
inspectors-general had specific instructions given them
for periodically ascertaining that all regulations for pro¬
tecting the health of the troops, and for securing the sani¬
tary condition of garrisons, camps, and hospitals were fully
carried out; and, as if still further to facilitate the per¬
formance of the duty and keep the Director-General fully
informed in regard to it, a special form of report was in¬
troduced, w r hich, under the designation of War Office
Form, 463, has to be furnished monthly by all executive,
and those of districts and divisions summarised by ad¬
ministrative medical officers.
The Director-General is, at page 27 of the Code of
Regulations already named, declared to be the sole admi¬
nistrative head of the Medical Department of the British
Army.
So far, good. All that is plain enough, and as it should
be. But 1 what says the last edition of the Queen’s Regula¬
tions and Orders for the Army ? At pages 205 and 206
we read that “ A permanent sanitary committee is to be
appointed at all camps and garrisons, consisting, if pos¬
sible of a field-officer, a captain, and an engineer-officer
if possible, or an officer of any corps in camp or garrison.
A medical officer will be detailed to attend the board
when required, for the purpose of giving a medical opi¬
nion.” Various rules are then laid down with regard to
the duties to be performed by this board, to which it is not
now necessary further to refer; the last paragraph on the
subject,however, deserves to be extracted:—“The sanitary
committees are to make special reports to the general
officers commanding districts upon any subject that may
require immediate attention, and are also to keep journals
of their proceedings, which are to be forwarded monthly
for the perusal of general officers, who will transmit a
summary of the committee’s proceedings from time to
time, as occasion may require, to the Quartermaster-
General for the Commander-in-Chief.”
We naturally ask, what does such an arrangement
mean 1 Are the medical officers of the army still charged
with the care of the health of the troops 1 If so, what
is the use of such a committee as this, composed entirely
of military officers, but with a surgeon to act as dry
nurse whenever they choose to confess themselves un¬
able to deal unsupported with scientific matters ? If, on
the other hand, committees so composed aTe held to he
sufficient for their purpose, surely there is an opportunity
afforded to economists to cut down the estimates, by
sweeping away at least nine-tenths of the present medical
officers of the army !
But in the eyes of the public, and also of the military
authorities themselves, the proceedings of sanitary com¬
mittees thus instituted would in no way relieve the
medical officers of responsibility, were an epidemic un¬
fortunately to occur, and they not have adopted the ne¬
cessary measures in regard to it Who, for example, in
the event of scarlet or typhus fever, or any other epi¬
demic disease occurring among the troops would seek
information as to the preventive measures taken in re¬
gard to it from a committee “ consisting of a field-officer,
a captain, an engineer-officer, or an officer of any coips ?
The very idea is monstrous; the system that give6 rise
to it calculated to complicate duty, interfere with the
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•Hie Medical Ptmr and Circular.
NOTES ON CURRENT TOPICS.
October SI, 1668. 353
functions of the department specially charged with the
care of the health of the array, and directly injurious to
the interests of the soldier, who may be permitted to re¬
main exposed to causes of disease apparent to and re¬
presented by the Medical Department, while information
on the subject is being sought from those to whose
province such matters are entirely foreign—quite as
much so as the command of a regiment, wing, or com*
pany would be to the province of a medical officer.
THE MEDICAL CLUB.
Shall the Profession stand by this institution ? That
is a question worthy of attentive consideration. At the
General Meeting on the 14th, after a protracted debate,
the proposition was carried that 11 the questions of the
future government of the club and the responsibility of
its members, be referred to the committee for considera¬
tion ; and their report to an adjourned General Meeting
of the members to be held a month hence.’ 1
From what transpired it was clear that many members
were reluctant to increase the amount of their subscrip¬
tions *, but we trust that all would be found ready to
listen to any reasonable proposal for maintaining the
efficiency of their club.
Now at the commencement it was feared that the sub¬
scriptions were fixed at too low a rate, and if we under¬
stand the matter correctly, such has been found to be the
case. Increasing entrance fees is fair enough to a certain
extent, but it should be remembered that the process is
apt to prevent the accession of new members.
But for the unwearied energy and true English spirit
of Dr. Lory Marsh there would have been no such thing
as a Medical Club in existence.
It is, we believe, no secret, that this gentleman’s hono¬
rary secretaryship is not only an exceedingly arduous
post—that might pass, for to him it has been a labour of
love—but it includes the more honourable position of
actual treasurer, and unfortunately the club owes a con¬
siderable balance to this treasurer. Now we are sure the
profession would wish to see this remedied. The club is
strong enough to run alone, and the members ought to
make an effort to put it out of debt, and give it au im¬
petus worthy of the new premises. Country members
who joined at the low rate of 1L Is. per annum would,
we should think, if fairly appealed to, consent to increase
their subscriptions to 2 1. 2s.: nothing less than that can
possibly pay. The town subscription might then be
41, 4s.
But then there is need of capital, and how should this
be raised ? It the members at the next meeting will only
be prepared lor some practical move, and if those who
speak will be but brief and precise, some scheme may
be hit upon. It seems to us that every member should
be willing to bear a certaiu just proportion of the ex¬
penses that have been incurred for his benefit. At the
original meeting to take steps to establish the club, we
well remember a number of suggestions, some of which
might even yet very easily be adopted.
Failing some plan, the only resource will be for the
club either to be abandoned, or else for it to amalgamate
with some other club; the chief objection to which would
be that in doing so, some of the distinctive characteristics
would be lost to actual members, and the profession
would have once more exhibited its inability to set up
any centre and bond of union.
- ♦
Juries on fcmtt topics.
Over-Population.
The production of large families without the means of
maintaining them is one of the stock reproaches to Irish¬
men with which the Times and its following feed the pre¬
judices of country against country, from which its columns
derive much of their filling. That the Times should state
the fact is, no doubt, sufficient for the class which imbibes
its three pennyworth of intellect from its columns with
their breakfast; but, like many of its other statements with
regard to Ireland, the reproach turns out to be totally un¬
founded.
The last Quarterly Return of Births in the City of
Dublin shows that the proportion of births to the popu¬
lation is greatly less than in large English towns. We
don’t think any great merit attaches to that fact; but if
the Auiberley platform will have it so, the statistics are
all in favour of Ireland. The ratio of births in London
for the quarter was 35 per 1000; in Glasgow, 40 per 1000;
in Edinburgh, 36 per 1000; and in Dublin, only 29 per
1000.
Health of Dublin.
It appears from the Monthly Report of Dr. Mapother,
that the mortality in Dublin by diarrhoea has at last de¬
creased. That disease, which is usually regarded as pre-
ventible, has destroyed during the past quarter 244 per¬
sons, four-fifths of whom were infants. The unprecedented
heat and drought, which in America has promoted cholera
infantum to an alarming extent this year, seem to be the
only ascertainable existing causes. The new Vartry water,
it seems, must be acquitted, for although it contains much
organic matter, this is of vegetable origin, and water supply
is not a very influential cause for the production of infan¬
tile diarrhoea.
Fever cases have been very few, and the Medical Officer
of Health interprets the fact as a favourable indication of
the results of recent sanitary improvements.
Queen’s University in Ireland.
The examinations of this body have been held during
the past week, the new feature of demonstrative examina¬
tion on the dead subject being added. This practical test
was conducted in the School of the Royal College of Sur¬
geons. The public conferring of degrees and the Convo¬
cation of Graduates will be held on Thursday. At the
latter meeting some ad eundem Graduates ore to be pro¬
posed as Members of Convocation, and the Annual Com¬
mittee is to be elected.
Sir Dominic Corrigan.
Ws understand that the candidature of Sir Dominic
Corrigan for the City of Dublin, which we announced some
weeks since, may probably be pursued to a contest. The
claims of the learned baronet are very favourably received
by the Liberal electors, and the promoters of his election
are sanguine that Sir Dominic Corrigan would obtain
considerable support from the section of voters known as
Liberal-Conservatives. The expenses incident to a contest
would be very heavy. Mr. Pirn’s last contest, in which
he succeeded in unseating Mr. Vance, cost, we believe,
£7,600; and even deducting the cost of conveyance of
voters and other expenses, which, under the New Reform
Act, cannot in future be incurred, the lowest estimate can¬
not bring the expense of a contest for the City of Dublin
below ,£3,000. The Liberal party, in the face of the long-
tried Conservatism of the Dublin voters, can hardly ex¬
pect so large a sum to be paid for the chance of a seat by
any candidate, however promising his probabilities of
success may be, and should be prepared to sustain an
Digitized by vjiOOQlC
354 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
October 31, 1866. .
eligible representative of their political opinions, as Sir
Dominic Corrigan is acknowledged to be, by a “ material
guarantee.”
It would be a great pity if the services of Sir Dominic
Corrigan to the profession, already so well attested at the
Medical Council and elsewhere, should be lost to our
brethren; and we earnestly trust that the learned baronet
will not be discouraged from laying his very just preten¬
sions, political, medical, and intellectual, before some con¬
stituency, if even now he should decide not to urge them
upon the Dublin electors. Studiously abstaining from
suggesting to our readers any political course, we earnestly
ask them to consider well the great gain which should
necessarily accrue to our profession in the advocacy of an
independent representative in Parliament, and to give this
homely consideration its full weight in the rival claims of
their politics and their profession. Every elector may, at
least, without compromising his personal views, indulge
the hope, to which we give our most hearty concurrence,
that Sir Dominic Corrigan may, before long, replace some
one of the host of jobbing lawyers which at present com¬
pletely overwhelms all other professional representation in
the House of Commons, and whose members generally
embody no greater interest than their own hopes of a
judgeship, to be achieved by the clap-trap political com¬
monplaces which constitute the inevitable creed of such
persons.
Repression of Syphilitic Disease.
The Health Section of the late Social Science Congress,
with several clergymen as its exponents, has declared de¬
cidedly, as all reasoning and practical men must, strongly
in favour of the extension to the civil population of the
legal provisions for keeping venereal diseases in check,
which have proved so valuable as applied to the Army and
Navy. At the meeting of the Section—
“ Papers were read by Dr. Robert Pringle on 1 Stamping
Out of Contagious Diseases f and by Mr. Furneaux Jordan
‘ On the Desirability of Extending the Contagious Diseases
Act/
“ Dr. Holland expressed himself strongly in favour of
the Act, the operation of which might be beneficially ex¬
tended.
“The Rev. Dr. Wilkinson, Rector of Birmingham, re¬
minded the section that many of his clerical brethren were
opposed to the act, because they thought the carrying out
of its provisions would have t the effect of removing one of
the natural safeguards against young men indulging in
vice. For his own part, however, he was unable to concur
in that- argument, which, if good for anything, might be
urged with equal force against the curing of disease after
it was contracted (hear, hear).
“ The Rev. Dr. Bell, of Goole, remarked that he had
belonged to the medical profession for twenty-seven years,
and for twenty years had been a clergyman of the Church
of England. From his experience, both as medical man
and clergyman, he was led to believe that the Act, if made
general instead of local, would be a great preventive mea¬
sure, physically, morally, and religiously.
“ The Rev. Charles Brittain, of Birmingham, also ap¬
proved the extension of the act, though he confessed that
some of the details presented difficulties to his mind. It
would be interesting to know whether the continental
system of inspection had had the result of diminishing
prostitution or the evil effects of the venereal disorders.
He had reason to believe that the regulations in force at
Paris had not caused a diminution of those evils.
“ Mr. Hastings thought the act had been most wisely
framed and prudently administered*
“ Mr. Sanders was of opinion that the evils resulting
from indulgence in vice had in many instances a deterrent
influence.
“The Rev. C. Marson, of Birmingham, believed that the
act would be productive of the most beneficial results.
“ Mr. Councillor Davis pointed out that, with regard to
prostitution, Ireland presented a most favourable contrast
to this country. It was a remarkable fact that, in the
course of his travels, which had extended to most parts of
England and Ireland, he had not seen any Jewesses who
were prostitutes—at least only one.
“ Mr. Jordan admitted that prostitution was less general
in Ireland than in England. That was, doubtless, owing
to the people usually marrying at an early age in the
former country. In reply to what had fallen from Mr.
Councillor Davis, he might mention that among the pros¬
titutes in all the countries of Europe the Jewish feature*
were occasionally, though not perhaps very frequently, dis¬
cernible.
“ Dr. Rumsey, President of the Section, remarked that
the discussion showed it was the general opinion that legis¬
lation was necessary, founded on the principle, if not on
the provisions, of the Contagious Diseases Act He wa*
extremely gratified to see the leading clergy of the town
coming forward in support of such legislation. Their con¬
duct, in this respect, partook of that grand benevolence
and love of mankind which was shown by the Divine
founder of Christianity (cheers). For his own part, be
doubted the advisability of adopting repressive systems in
regard to prostitution, believing that they would only tend
to increase immorality in that numerous class of women
who had not the means to render themselves independent of
temptation, and who were, nevertheless, being perpetually
put in the way of it, as, for instance, the servants in hotels,
and domestic servants generally.
“ On the motion of the Rev. Dr. Bell, seconded by Mr.
Jordan, the following resolution was unanimously adopted:
—* That this Section recommend the Council of the Asso¬
ciation to take the necessary steps to continue to bring
before the Government the necessity of extending the
operation of the Contagious Diseases Act, as far as it may
be deemed applicable to the general population of the
kingdom/ n
In the face of the convincing statistics of improved
health and rapid decrease of the prevalence of syphilis
which are before the public, we can hardly imagine any
principle which should justify inaction in respect of the
spread of the pestilence amongst the public at large. We
know positively that it is possible, by legal supervision,
almost to stamp out one of the most repulsive and hurtful
of human diseases. Are we to listen to a theory that the
ravages of the disease, and its extension from culpable
fathers to innocent children, should be fostered, because
the moral and physical penalty, which we well know seldom
acts as a deterrent to crime, is removed? What would be
said of a theorist who refused to apply a remedy for typhus
fever on the ground, that to save people from disease*
caused by sanitary neglect would offer an inducement to
people to be dirty and careless?
Surely, practical and sensible men will prefer to combat
a real and absolutely unavoidable evil, instead of fostering
a musty theory, however morally perfect it may be. If
the public recognize the immensity of the evil to be dealt
with, and the efficacy of the powers in their hands to treat
it, they will never be deterred from purchasing a substan¬
tial gain on the score of the expense. The principle has been
publicly accepted; and no Government can long continue
to plead that it cannot afford the cost of rescuing wives
and children, and the people at large, from a pestilence
which is even more dangerous morally than it is physically
Digitized by C jooole
The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
October 91,1868. 355
Disease in Dublin during the last Quarter.
The number of deaths registered in the Dublin Regis¬
tration District during the quarter amounted to 1,869,
affording an annual ratio of 1 in 42, or 24 in every 1,000
of the population. Of these 686, or 1 in 40 of the popu¬
lation, occurred in that portion of the city north of the
Liffey; and the number in that portion south of the river
was 903, affording an annual ratio of 1 in 40 of the popu¬
lation. In the suburbs of Rathmines, Donnybrook, Black-
rock, and Kingstown, the number of deaths registered was
281, being equal to an annual ratio of 1 in 53 of the popu¬
lation.
The ratio of deaths registered in London during the
same period was 1 in 41, or 24 in every 1,000; in Glasgow
the number was 1 in 34, or 29 in every 1,000; and in
Edinburgh 1 in 38, or 26 in every 1,000.
The most fatal disease during the quarter was diarrhoea,
which caused 279 deaths, or 1 in every 67 of the total
deaths. During the corresponding period of last year, the
deaths from diarrhoea amounted to 132. Eighty-one
deaths resulted from heart disease, and 6 from aneurism;
60 deaths were caused by scarlatina; 59 deaths were re¬
ferred to fever—in the corresponding period of last year
the deaths from fever amounted to 65; 50 deaths from
tabes mesenterica were registered: measles, which during
the corresponding quarter of last year caused 109 deaths,
caused but 9 deaths during the last quarter; 25 deaths
were attributed to whooping-cough, 24 to croup, 7 to diph¬
theria, and 2 to quinsy; cancer caused 44 deaths; 11
deaths were returned from cholera, choleraic diarrhoea,
&c.; 6 persons died from nephria or Bright’s disease ; 42
deaths resulted from accidental causes ; 3 cases of homi¬
cide, and 1 of suicide, were registered.
Arrival of the “Mauritius” at Portsmouth.
The Hospital Ship u Mauritius ” arrived at Spithead
from the Mauritius on the 12th instant, having on board
Staff-Surgeon Woodward, Assistant-Surgeons Jessop (in
medical charge) and Faitland. The troops and their
families included 3 officers, 1 officer’s wife, 33 invalids, 29
time-expired men, 7 soldiers’ wives, 18 children, and 26 men
of the Army Hospital Corps from Abyssinia. The voyage
occupied sixty-seven days, and it is gratifying to learn that,
although a good many cases of ague occurred among the
men who had suffered from the prevailing epidemic at
Port Louis, no death happened during the voyage.
Scarlet Fever.
The Registrar-General’s returns show such a prevalence
of this disease that the public begins to feel uneasy. We
believe the type of the present epidemic is unusually
mild. It is right, however, to repeat that too much
caution cannot be used. Scarlet fever is not a disease of
the poor. It cuts off the children, and sometimes the
adults, of the richest household. That pestilent word,
scarlatina, too often misleads. People fancy it is a
different disease. It is no such thing. The mildest
attack may give off the contagium that results in the most
severe. Complete separation of every one attacked from
the commencement is of great importance, and carbolic
acid, chloride of lime, and Cond/s fluid should all be
employed. Every sore throat during the epidemic should
be regarded with suspicion, and submitted to the inspec¬
tion of the doctor. It is a disease which, if the public
would help, we might yet c< stamp out." The burning of
the sulphur pastilles, introduced by Dr. Pairman, is good
both as a preventive and a curative measure.
Health of Salford.
Some uneasiness has been caused by the high mortality
of Salford, so that Dr. Syson’s report has excited more
attention than usual. That vigilant Medical Officer of
Health has spoken very distinctly to the authorities on the
defects of the place, and the amelioration necessary ; and
we are glad to find that the Salford Weekly News has
given full publicity to the report, and drawn special atten¬
tion to it in its leading columns. Dr. Syson’s remarks
about the non-trapping of the sewers are specially impor¬
tant, and unless the authorities speedily get them trapped
they will be responsible for whatever increase of mortality
may occur.
Weat Kent Medical Society.
This unpretending society does much good work in the
course of the year, as our last year’s volume will prove.
At the late opening of the session, the new President, Dr.
Thorowgood, gave an eloquent address, touching on many
points of interest. The society has done well in selecting
this thoughtful and painstaking physician for the honour¬
able post of President for the year. We hope shortly to
publish the address or an abstract.
The Elections.
We are glad to report that our suggestions as to the
questioning of candidates has been acted upon. We are
aware of several instances in which candidates for par¬
liamentary honours have, through our influence, been
led to express themselves as favourably disposed towards
medical questions. It is certain very few medical men
will have seats in the new House of Commons, and it
therefore becomes doubly important to oppose candidates
who are hostile to the profession, and help the canvas of
those who are ready to promote fair dealing towards all
medical men—whether in private or public practice.
British Pharmacopoeia, 1867.
The following corrections have been inserted in the re¬
maining copies of the Pharmacopoeia. Those who have
the work may be glad to mark the Errata, for which pur¬
pose we are happy to print them.
At page 20, line 6 from bottom, for 10*14 read 11*14.
„ 130, „ 17 „ „ 57 „ 37
„ 150, „ 9 „ „ 8 „ 28
„ 193, „ 4 from top, for PbC a H 3 0 2 read Pb a C 4 Hc
0 5 .
„ 400, bottom line, for Tart. Dil. read Tart.
„ 27, between lines 8 and 9 from bottom, insert
Emplastrum Cantharidis.
„ 51, between lines 5 and 6 from bottom insert
Tinctura Cinchome composita.
„ „ between lines 6 and 7 from bottom insert
Spiritus Armoracise compositus.
„ 114, beneath bottom line insert Unguentum Bel-
ladonnse.
„ 171, after line 11 from top insert Oleum Lini.
Alleged Pauper Ill-Treatment in Work-
houses.
The investigation on which Dr. Markham has been en¬
gaged, as the representative of the Poor-law Board, re-
| specting the accusation of ill-treating a pauper, preferred
Digitized by vJiOO^lC
356 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
October Si, 1868.
against the taskmaster of the Lambeth Workhouse and his
assistant, presents us with many considerations worthy of
the most serious attention. Keeping in view the class
with whom workhouse officials have to deal, and the total
unreliability of the statements of the average refractory
pauper, it is right that their statements should receive a
more jealous investigation on the part of the public than
the position of the accusers would otherwise entitle them to,
and it would be far better that the public should be ready
to accept such accusations and closely enquire into their
accuracy, than that they should allow the character of the
accuser to render them callous or inactive. Between re¬
fractory paupers who have no character to lose by false
accusations, and workhouse servants who, without doubt,
may be tempted to abuse their authority, there is no such
distinction as should allow us to disregard the complaints
of the weaker party.
In this special case there appears to be many facts to
corroborate the charge of the pauper against the officers.
She alleges that she was ill-treated by the taskmaster
knocking her head against the wall. She was immediately
afterwards taken with convulsion, under which she nearly
died. The most suspicious circumstance, and it is one
calculated to discredit the officials, is the conflict of swear¬
ing between them and the inmates, which necessitates the
assumption of unequivocal perjury on either side. The
master, matron, and other officers swore that no violence
was used or was necessary, as the pauper made no resist¬
ance, while several inmates, and some of the nurses and
helpers, swore positively that they heard loud screams and
scuffling ; and a witness living outside the workhouse dis¬
tinctly corroborates the latter statement. The Medical
Officer, however, swore that when he applied for the key
to view the cell he was told the master refused to give it.
The most instructive lesson of the whole affair is the
readiness of the officials to M stick together ” in their evi¬
dence, and without in the remotest degree desiring to
imply that their coincidence of evidence may not be simply
because it is true. We cannot resist the natural suspicion
that it might be the result of a tacit compact to swear
through thick and thin for the system of which the accused
parties are a part.
Medical Auctioneering.
We felt it our duty last week to comment upon the
recent appointment of Dr. Anthony to the office of Con¬
sulting Physician to the Birmingham General Dispensary,
and to deprecate in the strongest manner the underselling
system in the ranks of the profession. We observe that
a further instance has occurred more disgraceful in all its
details to the inculpated, and through him, more dis¬
creditable to the code of honour which is supposed to
rule the profession. We give the story from a local
paper:—
“ A shoit time ago the doctors of Hales Owen gave
their various lodges notice of a rise of Balary from 2s. 6d.
to 4s. per head, and this demand the men determined to
resist. The doctors, therefore, closed their surgeries against
them, and Dr. Offman, at Harburne, hearing the report,
came over and offered to take all the lodges at the old
price. This brought the Hales Owen doctors to their
senses, and most of them wanted to resume work at the
old rates, but at a committee^ meeting, held at the Shen-
stone Hotel, it was unanimously decided that Mr. Offman
should receive the appointment, and he has taken a house
at Hales Owen, where he attends daily. It appears the
number of members exceeds 400, and as Mr. Offman has
also agreed to take their families at the old rate, he will
doubtless soon get a good practice.”
If this report of Dr. Offman’s proceedings be accurate,
and we have not observed any disclaimer from that
gentleman, we unhesitatingly declare that the profession
should not allow it to be supposed that it countenances
such a transaction by holding further intercourse, social
or professional, with Dr. Offman. We unhesitatingly
declare that there is no remedy for such proceedings but
thnt which, when applied to the medical profession, is
called “ trades unionism,” but is euphonised, as regaids
other professions, under the name of w esprit de corps”
Does the theory of demand and supply oblige lawyen
to accord full license to all comers to undercut their legi¬
timate remuneration ? Certainly not. Barristers would
at once, under similar circumstances, sustain their dignity
and their proper remuneration by refusing contact with a
person guilty of such a transaction.
Shall we not do likewise, or shall we see some pushing
doctor, anxious for consultation practice, band in hand
with Mr. Offman ? More probably the latter.
Domestic Torpedos.
Now that the British consumer is at length thoroughly
satisfied, by the exponents of the adulteration of food,
that every morsel he puts into his mouth conveys in a
greater or less degree destruction to his internal economy,
he is assured on the most convincing authority that his
external culicle is no safer from sophisticated manufac¬
tures than his internal mucous membranes. Ulcerated
legs are to be the least penalty of those who yield to the
w eakness of red stockings; and we are now informed that
we are carrying about with us a domestic powder maga¬
zine, and may at any time find ourselves “ blown up” in
other sense than we have yet experienced.
Mr. William Crooks, F.R.S., makes the following
contribution to the discussion now going on relative to
deleterious dyes« Within the last few years manu¬
facturers have adopted the plan of saturating picnc acid
with an alkali before using it; and it is not improbable
that wool so dyed, and then imperfectly washed, mar
have produced some of the effects complained of. It tni»
turns out to be the true explanation, manufacturers niay
feel interested in knowing that by the use of this alkaline
compound of picric acid they run the risk of not only
poisoning their customers, but also of blowing themselves
up, as it is almost as explosive as uitro-glycerine, and has
already destroyed one factory, wdth loss of Several livea
Should the dye retain this character in the fabric, the
we are re of these socks would he able to vary the excite¬
ment they are now indulging in in a highly sensational
manner.”
Henceforth, provident fathers must take out a fire in¬
surance for themselves as well as for their dwellings; and
if another mysterious disappearance, d la Speke, occurs,
we must be prepared to search for the infinite atoms into
which the incautious may at any moment be converted.
Holborn Union.
Why must the Poor-law Guardian in the aggregate, be
more obstructive and impracticable than the Poor-law
Guardian as an individual ? If he is called upon to dis¬
charge a public duty, surely it is not necessary for him
be more mulish and obstinate than he would be in hw
own private affairs. And yet the public are beginning
Digitized by
Google
The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
October 21, 166$. 357
evince their impatience with such a policy, and with very
little consideration of politeness, to take what they require
by main force, without asking for it. We believe that
the Poor-law Board have practically abandoned the prac¬
tice of asking leave or co-operation from Local Boards
when they desire information, and they now send an in¬
spector to make the enquiries on the spot, which it would
take weeks to screw out of unwilling or careless local
officials. We observe that the same course has been
adopted towards the Holborn Board of Guardians, who
meet the action by a characteristic proposal. The Guardians
and the Poor-law Board differ as to the site of the new
District Lock Asylum. The Board consented to let the
Guardians have their own way on certain conditions, and
gave them a fortnight to consider and reply. Of course
they did not do so, and the Poor-law Board have taken
the law into their own hands, and fixed the district ac¬
cording to their own views. Did the Guardians profer
their assistance to make the best provision for the sick
poor ? Not at all. They threatened to resign in a body,
but in the view that probably that event might not be
considered very calamitous to the public service they
thought better of it, and decided to hold a special meeting
on the subject. Is it to be regretted that they changed
their mind ?
The Stage Doctor.
Shall we be considered sentimentally tender in our
professional feelings if we protest against the pictures of
medical men which are habitually presented in theatrical
representations of real life ? Many of these representa¬
tions are as innocent of any similitude to the routine of
the common world as of any resemblance between the
conventional Stage Doctor, and his living prototype. As
far as the minor theatres are concerned, detectives and
the guardians of peace and order are invested with all
sorts of demoniacal characteristics, because the character
of a persecuted innocent is assured to the virtuous
convict who does the admirable Crichton of the piece,
and we suppose, on the same principle, doctors are ad¬
visedly pourtrayed as monsters of inhumanity, in order
that the audience of such theatres may be satisfied that
they are little else than inoffensive lambs led to butchery
to gorge the cruelty of bloated aristocrats. How close is
the resemblance between the cold-bloded medical villain
of the play, who consigns the heroine to a living death in
a mad-liouse, and the mild, polite, white-tied, unassuming
practitioner, who actually does the pliysicing for the
artisan classes.
We expect the medical demon at the low theatres—
without him the villain would be unable to effect his
essential atrocities, but we look for better things from
Lord Lytton and the Lyceum Theatre; and yet we find
Mr. Hermann Vezin, in the “ Rightful Heir/* in his
summary of the penalties of poverty, declaring that if the
poor man is sick he is " mangled. If this is poetical
licence, we fear the hearers will not recognise it as such,
and we think Lord Lytton ought to rise superior to so
small a policy as that ot “stroking the fur” of his
audience by cultivating the prejudices of the upper
gallery.
The Queen’s University in Ireland.
A kreting to confer the degrees of the Queen’s
University of Ireland, in St. Patrick’s Hall, Dublin Castle,
on Wednesday afternoon, was attended by the Lord Lieu¬
tenant, the Chief Secretary (Colonel Wilson Patten), the
Right Hon. Maziere Brady, and the presidents and pro¬
fessors of the Queen’s Colleges. It trauspired that the
number of students at present in the colleges includes 210
of the Established Church, 181 Roman Catholics, 274
Presbyterians, and 97 of other denominations. The degree
of LL.D. was conferred upon Sir Robert Kane.
At the Convocation of Graduates, the prospects of ob¬
taining parliamentary representative for the University was
discussed, and it was regarded as certain that under the
scheme of Redistribution of Irish Seats, the University
would obtain a voice in the Legislature.
Professor Moffet mentioned that the constituency of the
Queen’s University is now 777, increasing by nearly 100
every year. Gratification was expressed that one of the
professors of the colleges had been nominated to the Senate
by the Government.
The new Convalescent Hospital at Dunoon is to cost
about .£10,000. The progress of such institutions is satis¬
factory.
The Clinical Society met on the 9th, when Mr. Paget
delivered an address. The next meeting is on Friday next.
The Medical Society of London met on the 19th, for
the first time, to hear the President's paper on “ Blood¬
letting.”
The Medico-Psychological Association’s next quarterly
meeting is on the 29th prox., at the Library of the Royal
Medico-Chirurgical Society.
Mr. Busk was elected an Examiner to the Royal Col¬
lege of Surgeons of England at their special meeting last
Thursday. Mr. Hilton was elected Examiner in Dental
Surgery.
The Royal College of Surgeons of Ireland has received
at the hands of Surgeon-Major Clarke, of the 84th Regi¬
ment, a Fellow of the College, a valuable and interesting
addition to its Museum. It is the complete skeleton of
Jowallah Persand, a Brahmin banker, who is distinguished
as one of the most sanguinary promoters of the Cawnpore
massacre. The man subsequently suffered death by hang¬
ing for his crime. The cranium is remarkable for possess¬
ing all the evidences of talent, and certainly presents no
phrenological indication, whatever, of deficient or peculiar
cerebral development.
There seems a prospect of larger classes at the Dublin
Schools and Hospitals than have attended for many
years—a fact with which the general prosperity of the
country may have much to do.
Mr. C. E. Adams has been elected to a Scholarship for
Natural Science in Sidney College. An examination for
one or two of these Scholarships, of the value of ^£40 per
annum, takes place, annually, early in October; it is open
to all students who have not begun to reside in the Uni¬
versity. Information respecting it may be obtained from
the Tutor of the College.
Our prediction has been verified. The number of fresh¬
men entered at the Metropolitan Schools if above the
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358 Ths Medical ftrea and Circular.
CORRESPONDENCE.
October 21, IMS,
average. This is the more satisfactory since it proves
that the preliminary examinations have not deterred young
men from selecting medic ine as their profession; while it
is certain that such a test of their fitness is highly desirable
both for themselves and the public. A good general edu¬
cation is the best preparation for a successful medical
career.
We are sorry to have to record the decease of Dr. Hera-
path, of Bristol, at the early age of 48. Our readers will
remember that a little time since his father’s death was
announced in these columns, to which both gentlemen
have contributed on questions of toxicology. Dr. W.
Bird Herapath died of jaundice.
- 4 -
®Qxxt$$an'btxttt.
THE NORWEGIAN SELF-ACTING COOKING
APPARATUS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —The above-named apparatus is truly worthy of notice in
your columns. My acquaintance with the above was at Messrs.
Silver’s establishment in Bishopsgate street, Within, where I
was permitted to examine the same, and every information
afforded me for proving the statements as set forth in their
circulars—that boiled food or liquid may be (many hours after
being shut up in the self-cooking box) put on the table in as
well-cooked or hot a condition as a Soyer could do with all
the appliances of a culinary department.
Now, to give a short description of the affair may be ac¬
ceptable. Various sized tin boxes, or vessels with lids are con¬
tained in a wooden box, which is lined thickly with a noncon¬
ducting heat medium in the way of horse-hair felt, or something
very like it. You may have one to hold a quart vessel up to
several of gallons. Supposing you were on the travel for half-
a-dozen hours, and anxious to satisfy the cravings of nature in
the shape of a hot dinner. Previous to your start, take one
vessel, put into it a certain quantity of boiling water, also add
your piece of meat, or fowl, or fish ; just let the water boil for
five or ten minutes on a fire ; shut down the lid of the vessel
and put it into the box. Do the same with the other tins,
containing vegetables, or a pudding, or baked cold pie. A
dozen hours after , or less if you are hungry, open the box, take
out the tins, and behold ! you have everything as hot, nice,
and cooked to a turn , no more , as any gourmand or alderman
could desire.
This is simply a specimen, and the extent of the value of
the self-acting cooking apparatus is to my mind unlimited. I
determined to test the time beat could be retained in one of
these boxes. Messrs. Silver immediately complied with my
desire. In an underground room of their establishment, where
the temperature was likely to be lowest, the experiment was
made. A box apparatus, holding two tins, was opened, half-a-
gallon of water at boiling point poured into each tin, the lids
of them and the box shut down, then locked. The results are
as follows:—Sept. 24, water 212° put into tins at 11*15 ajn.;
box opened in my presence Sept. 25, 1868, at 12*5 p.m.; large
tin, heat by thermometer, 108° ; smaller one, 106°; mean
temperature of room, 68°. Here we have, full twenty-four
hours after, heat retained in a small bulk of water suitable for
a great many purposes. I really must commend this to my
profession as a boon to them. How many of us never get
meals at regular hours, particularly country medical men, in
wintry weather. The lawyer and parson are not so fixed, as
they are seldom disturbed at feeding-time, perhaps may not
interest themselves in the invention, except on a railway
journey of hours, when a cup of hot tea, coffee, or brandy-and-
water may be acceptable.
I go further. From my own experience in large military
hospitals abroad, and the difficulty of keeping food or water
hot at night for the sick or wounded, a good doctor ought to
Understand the art and facility of cooking. Besides, in large
military, or naval, or public hospital establishments, the cooks,
assistants, and nurses are human nature, as Mrs. Brown says,
and want their rest. Night relays cannot be depended on,
and many an invalid would thank the inventor for proper
nourishment ordered by the doctor, if it could be so obtained.
Of such value do I estimate the affair that I am sure I shall
be pardoned the liberty of calling the attention of military
and naval directors-general to the important fact of the value
of this apparatus for their hospital establishments at home
and abroad. It is also economy, saving of labour and firing-
considerable advantage in these days of expenditure of public
money. One other remark and I am done. Troops on active
service in an enemy’s country can have food, ready to use in
comfort, twenty-four hours after it is prepared. Consider this,
in these days of light infantry movements, flying dragoons,and
galloping artillery. John Bull fights well at all times, but
give him his dinner first, says our French neighbours, it is
then dangerous work to come to close quarters with him, good-
humoured though he be. A bugle sounds on a forced march
halt ; in ten minutes every man is eating good food, instead,
as I have seen, a draw of the pipe to kill hunger while the pot
boils. Such, is invaluable. I should like to hear that my
Lords of the Admiralty, and His Highness the Duke of Cam¬
bridge, ever the soldier’s friend, commanded that experienced
medical officers be sent to Messrs. Silver’s establishment to
examine facts, and report on the same, for the benefit of our
gallant soldiers and sailors. I have finished, Mr. Editor, and
trust you will not consider I have taken up valuable space is
your honest journal in vain.—Yours truly,
J. MoGrsoor Croft, M.D.,
M.R.C. Physicians of Lon¬
don, formerly Staff-Surgeon
to Her Majesty’s Boyal
Army and Hospitals.
SANITARY MUSEUM AT BRIGHTON.
TO THE EDITOR OF THE MEDICAL PRE88 AND CIRCULU.
Sir, —A collection of objects illustrating economic and sani¬
tary science and art, is being formed by the Brighton Sanitary
Association, and is intended for the Town Museum in the
Pavilion. Samples or models, or, failing them, diagrams of
ventilators, economic and sanitary building materials; of
draining, lighting, and filtering, contrivances; of improved
costume or material; of new food ingredients, and of all the
things belonging to such a collection, will be thankfully re¬
ceived, and may be sent to the under-written address. The
space is limited, and before sending anything, enquiry by call
or letter is advisable. Models of cottages are much wanted.
The object of the collection is to aid in removing the preva¬
lent ignorance on sanitary matters, to show the best inven¬
tions for the prevention of illness or accident, and to demon¬
strate how new things can be turned to acoount for human
food, clothing, building, or other uses; thus adding to the
wealth of the community. The plan is copied from that of
the Economic Museum at Twickenham, founded by Hr.
Twining ; and it is to the liberal assistance and judicious en¬
couragement of that gentleman that we owe the origin of our
collection. Besides the articles contributed by him, the Com¬
mittee of the Labourer’s Friend Society have sent us pleas
and elevations of cottages. A gentleman in Brighton is pre¬
paring a valuable food collection; and sundry other donations
have come in. I have not time to write singly to the different
inventors whom I daily read of, and therefore take this method
of soliciting their assistance and co operation in the good work
of helping to inform and educated the people by exhibiting
their useful and valuable inventions.—I am, Sir, your obedkat
servant,
W. E. C. Noursb, F.R.CB.
September. 11 Marlborough place, Brighton.
- 4 -
THE NEW NOMENCLATURE.
The history of this nomenclature is both curious and im¬
portant. At the end of the sixteenth .century “Bills of
Mortality ” were commenced in the metropolis. They w«*
prepared by the parish clerks, apparently to relieve the dtkena
from unfounded panics as to the extent of the Plague. The
clerks seemed to have returned the causes of death of which
they were cognisant in whatever form they thought fit Thar
statistical tables are not less remarkable than might have been
expected. Taking, for example, the year of the Great Plague,
a.d. 1665, we find, comprised under sixty-three headings, sll
causes of death. Among these are 1,258 chrisomesand infants;
3 calentures ; 2,036 convulsion and mother ; frighted, 23 »*
head mould shot and mould fallen, 14 ; rising of the lights,
397 ; plannet, 6 ; surfeit, 1,251; impoethumes, 227. It
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The Medical Press and Circular.
GLEANINGS.
October 81 , 186 *. 359
interest you to know that the returns of the Plague itself
gave 68,596. This wild kind of nosological record not only
existed long after the foundation of the College of Physicians
and the life of Harvey, but continued in truth imperfectly
modified until thirty years ago, notwithstanding all the pro¬
gress of medical knowledge and of the various institutions in
this country and on the Continent. In a letter to the
Registrar-General, printed in the first volume of the Returns
of his office, a.d. 1839, Mr. (now Dr.) Farr proposed a new
classification for the returns of the cause of death. This has
since been amplified, and finally, after discussion at various
European congresses, has been adopted by the principal
countries of Europe. I cannot say what amount of debt tnis
nation and the civilised world owes to Dr. Farr for his saga¬
city and industry in this department of social reform. Simul¬
taneously, the English College of Physicians has been engaged
for ten years in revising the nomenclature of disease. It is
due to Dr. Sibson to say that, to a great extent, this labour
fell on him *, and you must be glad to think that your own
Mr. Holmes and Dr. Barclay performed a full share of the
important work. The result is a provisional nomenclature in
four languages. In this catalogue of diseases, under the great
divisions of General Diseases, Local Diseases, Death Dependent
on Age, Poison, and injury, 1,146 abnormal states are named.
This number does not represent the number of diseases,
which are far more numerous, as the 1,141st heading will
show, where Ununited Fracture includes every bone capable
of fracture, and liable to that condition ; or the heading
Hernia, 480, which includes under that number many con¬
ditions of that affection ; and so of others. Nor are surgical
operations, parasites, and congenital malformations included,
they being all referred to an appendix. It is not easy for a
beginner to appreciate either the value or the labour of this
work. Indeed, I could imagine that when the student reflects
on all this he may be almost deterred from beginning his work.
In this case he must think of the advice of the old clock to
the young one, who, complaining on his birth that he should
never accomplish, as directed, 24 x 60 x 60=86,400 ticks of his
second’s pendulum daily during his life, was admonished to
try one at a time. The old clock ought to have added, “ Do
each one properly, otherwise the tick does not count, and you
■top.”
This new nomenclature will constitute a veritable epoch in
the history of the causes, the modes of prevention, and cure of
diseases of the human race; and will produce uniformity in
description of disease throughout the world.— Dr. A eland'*
Address at St, George's Hospital.
- * -
NOTE-TAKING.
Surveying the careers of some of my old companions, I
sec that some who took but few notes have become distin¬
guished men of robust intellect; and, on the other hand, I
see others whose note-books would form a library, who have
settled down into the most humdrum routine—very types of
mediocrity. I therefore conclude that a man of many notes
will not necessarily make a man of note. What is the great
end of education 1 It is not simply to heap up the greatest
amount of knowledge in the mind. The aim should rather
bo to discipline the intellect, to give precision and quickness
to the faculties of perception and observation, to strengthen
the power of reasoning and comparing, so as to form just and
rapia conclusions upon the cases and problems that arise in
daily practice. “J’aime mieux,” said Montaigne, “forger
mon fime, que la meubler.” Now this end is not attained, I
think, by trusting to note-books. The art of writing and
the invention of printing have even been thought by some to
have done doubtful service in strengthening the human intel¬
lect, however vast may be their influence in extending and
diffusing knowledge. Plato said that without this delusive
aid of alphabetical writing, “men would have been compelled
to exercise the understanding and the memory, and by deep
meditation to make truth thoroughly their own. Now, on
the contrary, much knowledge is traced on paper, but little is
engraved on the soul.” Quintilian too said, “ Memoriae
plerumque inhaeret fidelius, quod nulla sacribendi securitate
l&xatur. And I may enforce this argument by quoting the
opinion of one honoured alike amongst women and amongst
men, and deserving of special honour in this hospital. Flo¬
rence Nightingale says, “If you find it help you to take
note*, by all means do so ; I think it more often tames than
strengthens the memory and observation.” What I have
said of note-taking does not apply to recording facts and
observations. There is no better means of training the mind
to the habit of orderly observation and precision in judgment
thau the methodical practice of taking notes of case9 of sickness.
The power of taking a case correctly, seizing the important
S oints, and avoiding that prolixity and repetition which ren-
er subsequent study of the history tedious and repulsive, is
invaluable to the student and to the practical physician.
Each well-recorded case has its individual worth ns an exercise
and ns a record of facts; and cases acquire an interest and
impart instruction which cannot be limited when their num¬
ber affords the materials for comparison, and for drawing
general conclusions.— Dr. Barnes's Introductory Lecture at
St. Thomas's Hospital .
- «-
MEDICAL MANNERS.
I said just now that our manners should ever be but the
expression of the habitual frame of cur mind ; and the habit
and temper of mind which should animate us in our ministra¬
tions to the sick I can in no way so well describe as by reve¬
rently paraphrasing the words which so expressively tell us of
the Divine Physician's tender care aud true sympathy for us
in our soul’s sicknesses—namely, we must be touched with a
feeling of their infirmities. The refining and elevating influ¬
ence of such true sympathy will keep us from ever making
our noble office subservient to any ignoble end ; and though
it may interfere with our becoming rich, yet it will raise us
into a higher and purer atmosphere, above the petty vexa¬
tions aud disappointments of professional life. For what if
by our work we becomo neither rich in worldly wealth nor
great in the world s esteem ? Surely a good name is rather
to bo chosen than great riches, aud loving favour rather than
silver and gold. And though we may achieve no social distinc¬
tion, we may, by the Divine help, one day find, as many have
found who are now gone to their rest, that the conscientious
discharge of our duty in that profession which brought us
neither wealth nor rank has been to us none other than the
house of God—aye, and the very gate of Heaven.— Mr. Smith* s
Introductory Lecture at St. Bartholomew's Hospital.
-♦-
MEDICAL TRAINING.
Whatever special career you intend to follow in after-life,
your education remains the same. Whether you intend to
engage in general practice or in consulting, whether in town
or country—in surgery, or medicine, or obstetrics, your train¬
ing ought in nil important respects to be the same. Medical
training comprises all that fits you to be a doctor—all that fits
you, not to do credit to yourselves or even to your profession,
but to do good to your patients—to save their lives or ease
their sufferings. For these purposes two things are wanted—
knowledge and skill, —knowledge of the most satisfactory and
interesting kind, comprising acquaintance with medical ex¬
perience on the one hand, and medical science on the other ;
and skill in the exercise of the medical arts—therapeutics,
surgery, and obstetrics.
But most of you are, I doubt not, already aware that these
are not the only purposes of medical training. Besides pre¬
paration for practical work,which is by far the most important,
there is anotner preparation necessary for your examinations—
viz., the importance which each of you will assign to the two
preparations will depend on your estimate of your future re¬
sponsibilities and duties as practitioners. If it is your impros-
sion that medical practice is a business that any intelligent
person is able to carry on successfully who has acquired a little
S ractical experience and acquaintance with the use of a few
rug®, then of course you will regard passing the examina¬
tion as the principal, if not the only object that you have in
view. For when a man looks on his profession as a trade,
it is the fear of being rejected by the examiners, and of the
consequent inconveniences, which alone restrains him from
absolute idleness—the hope that he may succeed in persuad¬
ing them to sanction his ignorant drugging of his fellow-men,
is the highest incentive lor his exertions. But I take it for
granted that this is not the spirit in which you have entered
on the occupation ot your life, and that you have already made
up your minds to work at your studies here, not for the pur¬
pose of slipping through at Lincoln’s inn-fields or Blackfnars,
but in order that when tho time comes you may enter on your
professional duties with the bolduess of the man who is
thoroughly prepared for his work, and who feels each time he
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360 Tho Medical Press and Circular.
INTRODUCTORY ADDRESSES.
October 21,1888.
leaves the bedside of a patient, “ I lmve done, not my best (for
that might be a very poor best indeed), but the best. I have
done all that medical experience teaches was expedient in this
case, aud have left nothing undone that 1 ought to have done.”
I need no arguments to show that this is the only way in
which the daily work of life can be a pleasure. On occasions
like the present ouu is tempted to launch out into platitudes
about the divine art of healing, and the supreme happiness of
being occupied in doing good. There is truly inuen satisfac¬
tion in thinking that our future business will be to “ go about
doing good.” But, as human nature is constituted, it is only a
few who are capable of experiencing it. Medicine is truly a
God-like occupation ; but how few there are who, even while
pursuing a divine art, are animated by divine motives. The
pleasure to which I refer is less elevated, but more easy of
attainment. It is one which every earnest, upright man, who
has a sound mind in a sound body, may, and does, constantly
enjoy. It is the inexhaustible pleasure which the man who is
conscious that he is mentally and physically competent for his
work, and is determined to use the powers God has given him
for the purposes for which He has bestowed them, finds in the
very efforts which are necessary in order to carry that deter¬
mination into effect. Make up your minds then that, whatever
other sources of enjoyment you may find in life, there is an in¬
exhaustible source in fruitful work, and especially in profes¬
sional work. But bear in mind, also, that in order to work
fruitfully hereafter, you must work laboriously now in possess¬
ing yourself of all the knowledge and skill which your own
abilities, and the short time which is assigned you for prepara¬
tion, will admit of. If you do this, the work of seeing patients
will be a pleasure, not a vexation—a pleasure of which the de¬
gree and intensity will be found (in accordance with an in¬
evitable law) in exact proportion to the amount of labour spent
by you in purchasing it. In other words, if you would go
through what is called the routine of practice with satisfaction,
the first thing is to possess the requisite knowledge and skill ;
the second is, that when you go to the bedside of your patient
you should acquire the habit of concentrating all the energies
of your mind to the consideration of his case, so as to bring to
bear upon it all the knowledge you possess, whether acquired
by your own observation or experience, or communicated to
you by others ; and that until you have made up your mind
what is to be done for his relief, you should allow no other
subject to intrude itself on your thoughts or withdraw your
attention, even for a moment. It is by the habit of pains¬
taking attention to each individual case that all good prac¬
titioners have acquired that power over disease that makes
them trusted by the public. Such men rejoice in their work, are
bold in the selection of remedies, and skilful in their applica¬
tion. It is the glory of our profession in this country that it
contains a large proportion of men of this stamp—men who
really come up to this standard of practical excellence—men
who do not say that they value their patients’ lives more than
their own, but who act as if they did. While in the sick room
they are so entirely engrossed and absorbed in their work that
no thought of self crosses their minds. We are all personally
acquainted with such men. Let us follow their example and
try to be animated with their spirit; and to this end let us,
while we are students, use every effort to qualify ourselves for
our work, never forgetting that no amount even of painstaking
afterwards will make up for neglected opportunities now. For
you may depend upon it that life is much more frequently
destroyed by the omissions or blunders of the ignorant than
saved by the most judicious efforts of the most skilful and
experienced practitioner.— Dr. Burden-Sander son's Introduc¬
tory Lecture at the Middlesex Hospital.
-♦-
Introductory Address
DELIVERED AT
THE LIVERPOOL ROYAL INFIRMARY
SCHOOL OF MEDICINE,
THURSDAY, OCTOBER 1st, 1868,
By FREDERICK T. ROBERTS, M.B., B.Sc.,
Lecturer on Botany, and Demonstrator of Anatomy, PhysicUn to the
Northern Hospital, kc.
(Continued from page 841.)
I have told you that you must resist strenuously every
temptation by which you may be beset, and, without enlarging
upon this topic, let me warn you that these temptations are
often both numerous and powerful, requiring a severe effort to
battle successfully against them. Temptations coming from
within yourselves, from your surrounding circumstances, from
your companions, and tending to idleness, to neglect of duty,
to frivolous amusement, to vice, will assail you continually. I
refrain from urging upon you any of those higher motives for
striving to conquer them, but will merely appeal to yon on the
ground of your own temporal welfares. If you set out with s
firm resolve to master them, you can succeed, and they will
soon have lost all power to interfere with your progress; hut
if you yield to them and let them get the mastery over von,
most probably all hope will be for ever lost of your attaining
to anything but shame and remorse, for gaining a stronger
hold upon you every day, they will lead you a willing captive,
along that road which can only end in ruin and disappoint¬
ment.
Gentlemen, my task is ended. I have endeavoured, though
with many shortcomings, yet honestly and faithfully, to set
your duty before you. If anything has been said that esn
aid yon in your progress, I ask that it may be permitted to
sink deep into your memories, and bring forth fruit in your
future lives. Perhaps some of you are imagining that what
I have been uttering is mere meaningless talk, but I assure
you in all sincerity it is not so. In the name of my colleagues
and myself, I declare that we feel deeply our responsibility
towards you, and have a warm interest in your welfare ,* let
each of you feel his responsibility towards himself, aud have
an equal interest in his own welfare. Ere I close, let me im¬
press upon your minds two or three important truths. Be-
member first that not one of you can be standing still—if you
do not advance, you will most assuredly be going back—if
you do not improve, you must be getting worse. Perhaps
there is some one of you saying to himself, 11 1 will work at
some future day, at some more convenient season, and at all
events I shall be as well able to do so then as to-day.” If that
is your idea, you will sooner or later be undeceived. If that
future day, that convenient season, shall ever come, which
every passing hour renders less probable, you will find that
you are not under the some conditions then as now, but that,
while the amount and difficulties of your labours have been
increasing, you have been becoming daily less able to enter
upon, and cope with them. To work then without delay, and
be not satisfied with merely making resolutions for the future,
however good they may be, for so surely as you do so, the
hours will come with ever-increasing speed, aud wipe them
out, as easily as words traced on a sandy shore are obliterated
by the succeeding waves of an advancing tide, and your talk
will be left undone. Then, again, bear in mind that the con¬
duct of each one of you affects not only himself, but also in¬
fluences those with whom you are brought into contact
There is nothing stronger than the force of example. The
fact of a man having lived will never cease to be felt by his
friends and companions, either for good or evil. When yon
think that by your individual actions, your fellow-students
may be stimulated to rise higher, or be lured from some
worthy object, and assisted in a most disastrous descent, what
a grave responsibility should rest upon every one of yon!
And this force of example will react upon yourselves; if on
the one hand you encourage labour and lofty aspirations in
another, he will in turn do the same with regard to you;
while if you clog the efforts of others, you will just be putting
another difficulty in your own path. Therefore, never for¬
getting this mutual action and re-action upon each other, let
every one of you, by example, and if necessary by precept,
strive to aid the progress of his fellow-students, for by so
doing he will undoubtedly be also helping himself onward
With some of you, whom I am addressing to-day, the period
of studentship is drawing to a close. I know not what your
retrospect may be, but all I can say to you is—if your course
has hitherto been such as to give you true satisfaction in your
consciences, continue in it—if not, though late in the day, H
may not be too late to make some amends for the past, if you
begin at once ; others of you have still to look forward to a
part of your course, and some are merely starting upon it;
but time flies with wonderful and almost appalling swiftness,
and the day will speedily come, when for you all there will be
nothing but retrospect so far as your student life is concerned.
You may think that it will be possible to ignore the past, and
to blot oat from your consciousness the events of your by-gone
career; but this cannot be. Conscience will compel vou to
survey the life you have led, nor will memory fail to aeclare
what it reveals. With yourselves it rests whether this un¬
avoidable retrospect shall be one yielding more or less plea*
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October 21, 1868. 361
sure and satisfaction, or one full of sorrow and regret
Therefore, to those of yon who have hitherto trodden in the
path of duty, 1 would say, persevere in that path : you who
have not, I would with all earnestness urge to enter upon it
without delay. Those of you who are to-day taking their first
important Btep in life, let it be upon a road that shall lead to
happiness ana honour ; so that, when the time comes for each
one of you to quit these scenes of his early labours, and we
give him the parting grasp, he may be able to look back upon
the past, with the proud consciousness of having done his
duty towards his friends, his teachers, his school, himself:
and to glance forward into the future with every prospect of
filling with dignity his position as a member of one of the
highest professions to which it can be his privilege to belong;
of acquiring honour and respect for himself; and faithfully
carrying out those gracious purposes, which are the glory of
our vocation, of being a messenger of mercy, and a dispenser
of noblest and most welcome blessings in the midst of a suffer¬
ing humanity.
— ■ «»-
Atonal j&ckttte ^ssjxcMmt.
HEALTH SECTION.
^irirrt t%
BY
H. W. RUMSEY, ESQ., M.D.,
President of the Section.
Or all persons, perhaps, members of the medical profession
are the most liable to sudden and unexpected demands upon
their supposed fitness for rendeiing help in emergencies,
whether affecting tin individual or the body corporate.
Thus, even in the brief history of this prosperous Associa¬
tion, it has happened more than once that the chair of the
Health Department, in spite of its great attractions, has been
left by the force of circumstances without an eligible occupant-
elect until the executive committe in their extremity have
been driven to send for a doctor.
Yet in this Society, where each department has so many
complicated relations with other departments, it has been
wisely judged, and for the first five years it was happily
arranged, that some statesman, or legislator, or philanthropist,
should inaugurate and guide our proceedings, bringing to the
task all that public influence, that knowledge of social in¬
terests in general, which are necessary for the success of the
sanitary movement, himself in return receiving from the de¬
partment all that special and scientific information which may
be derived from the papers read, and the discussions herein
held, and which may thus be influentially applied to public
and parliamcntaiy action.
Thus, if we look back nt the great advantages which resulted
from the sectional presidency, first of Lord Stanley, and then
of Lord Shaftesbury, succeeded, as they were in turn by Mr.
Cowper, Lord Ebrington, and Lord Talbot de Malahide—we
may reasonably regret that we have on this occasion failed to
secure some one of those public men who are known to be
thoroughly conversant with matters of health, and who might
have brought us more closely cn rapport with the leaders of
public opinion. In our sixth year, we reaped the benefit of
the practical philosophy of Mr. Fairbairn. The intimate
relations which exist between sanitary improvements and the
skilful enterprise of civil engineers render it very desirablo
(if I may be excused for making the suggestion), that this de¬
partment should sometimes be headed by one of their
S rofession. During the last quinquennium, however, we have
ad an uninterrupted succession of medical presidents, men of
great achievements, acknowledged authorities in preventive
and legal medicine, and in the physical sciences.
No wonder that, on such a retrospect, I should have under¬
taken, very reluctantly, the responsibility which has been
committed to me—no wonder that I feel incompetent to sus¬
tain the rtlt of my predecessors in office, ana uufit for the
honour which has been, I fear unwisely, pressed upon me.
The science of health-preservation is an indispensable por¬
tion of the science of human society. Public health, that
branch of hygiene which concerns communities, involves the
enactment of laws, by which the safety of the whole is
protected against the errors and neglects of a part. Our
department, therefore, has inseparable relations with that for
the amendment of the law. Both departments are now con¬
cerned in the prospective task of reducing to order and con¬
sistency a chaos of conflicting sanitary statutes. Both have
called for the appoiutraent of public prosecutors, without
whom the most necessary enactments may prove inoperative.
Then, private or personal hygiene might almost come under
the charge of our educatioual section,—so entirely does a
hearty obedience to precepts of health—as regards personal
habits and conduct—depend on early instruction, good train¬
ing, and intelligent conviction. Such obedience cannot, in a
free country, be enforced by mere police regulations ; unless,
indeed, under some future Sanitary Act, any very unsavoury
man might be defined a “ nuisance, 1 ’ and so be brought under
the operation of the Nuisances Removal Acts.
Domestic hygiene, again, seems to be something between
public and private hygiene. Whilst the sacrcdness of the
family hearth roust be kept inviolate, the law may sometimes
rightly and reasonably interfere, not only for the protection
of neighbouring families, but also for the safety of dependent
and helpless inmates. Here we see, in many ways, the con¬
nection between this department and that of social economy,
especially in questions of labour and industry. How bene¬
ficial, for instance, have provisions for the prevention of
disease and accidents proved in the regulation of employments !
There can bo no true social economy where there is no respect
for the rights and the welfare of others, no real education
adapted to and accepted by all classes, nor any allegiance to
those physical laws which are ordained by God himself for the
maintenance of a long, a healthy, a useful, and a happy life.
These objects, ns I understand them, constitute the ele¬
ments of Social Science.
Now, in the Health Department, at all events on this oc¬
casion, it seems desirable to confiue our efforts, principally to
matters of public health —to thoir scientific foundations, and
to some of their practical aspects and present bearings.
On reviewing the progress of public measures during the
past year, I have ventured to select, as the subject of this
address, a group of allied questions of pressing importance,
involving, perhaps, more senouslv than others, the recognition
of some first principles of natural science.
No one here need be reminded that the physical surroundings
of man mainly determine his degree of health, vigour, and
longevity. Now, the philosophers of old recognised four
elements of nature, sources of all things and all changes of
things, whether beneficent or malignant.
These elements of the ancients-fire, air, water, and earth
—may therefore serve me as heads nnder which to group a
few thoughts and suggestions on the relations of man to the
facts of his natural and social life.
Fire, I take to include and express heat, of which it is a
visible emblem and result. As the burning, purifying, and
renovating principle of nature, I shall have to notice it in its
action upon the other three—air, water, and earth.
These, when wisely employed, are our best friends, the
prime means and necessaries of our existence. Nature re¬
verently handled, is really our great mother; and not, as a
learned physiologist has of late faoetiously called her, “a
step-mother," to whom he attributed paroxysms of malevolent
intention.
These, our grand surroundings—air, water, and earth—are
however liable to such original disorder, they may each and all
assume such forms of danger and destruction, and they may
be so abominably perverted by human ignorance and error as
to produce, convey, and circulate among us the deadliest
poisons. But man is endowed with capacities for observing
the facts, noting the conditions, discovering the aberrations and
mistakes, determining the right uses, inventing and applying
the necessary remedial measures,—so that the primaeval ele¬
ments may be preserved and renewed as our perpetual sources
of health and longevity.
I take for granted that action of this kind, on behalf of the
public health and safety, is that of the community, by means
of its legislative and executive authorities; and I shall en¬
deavour to show, by one or two striking examples, under each
head, how incorrectly and imperfectly the first principles of
science have been acknowledged and applied in sopae recent
enactments of sanitary intention.
I. Air. —How strange it seems that society, for which man
was formed, should be the original cause of his violating that
primary natural law which demands purity and abundance of
air for his healthy existence 1
No sooner, however, is a community formed, and its space
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SOCIAL SCIENCE ASSOCIATION.
Ootofctril,!*
of habitation limited by neighbouring populations than the air
which supports it inevitably becomes more or less vitiated.
In scattered populations, this continual vitiation of the atmo¬
sphere may be remedied partly by atmospheric motion, and
partly by the rapid diffusion of gasses. Even the insupportable
nastiness of the air of an Esquimaux cabin finds its compensa¬
tion, if not its cure, in the wide expanse of barren land, open
sea, and fields of ice, over which the exhalations of the dirty
- barbarians are driven and dispersed.
But, in warmer climates, as men congregate, when towns
become the centres of active commerce, and the seats of art
and manufacture—as the crowd thickens, as every square yard
is occupied, at increasing cost, and as the average space per
head continually diminishes—so does the purifying principle of
the air, Oxygen, lose its power, so does it become less efficient
in renewing the blood, “ which is the life of man/* so is it ren¬
dered less capable of burning the carbon and other effete and
noxious products of animal life.
Here then, unless sanitary science be boldly and skilfully
applied to social action, the masses deteriorate physically and
morally. By degrees they lose the acuteness of those senses
smell especially, with which their Creator has endowed them
for purposes of self-preservation. The human form divine
degenerates. The less favoured classes sink in the scale of
race, dwindle, alter in shape, colour, and feature—they grovel,
sicken, and die prematurely. By a fatal descent, the lords of
creation reaches after, and wallows in, the lowest gratifications,
the grossest habits—acquires the profoundest indifference to,
if not deepest hatred of, law—divine and human—social order,
purity of life and manners.
Even the wealthier classes, upper and middle, cannot escape
the physical injury consequent upon contact with preventive
di s eas e and mortality. Such a state of things leaves, too often,
a sad impress, moral and social, upon the leading members of
a community. The chasm between the classes tend to widen.
In the skilful employment of capital, the workman has been
too generally regarded as a mere instrument—which, as a
machine, can be procured and used at the market price ; yet
on this instrument, as a man, is thrown the sole responsibility
of maintaining himjurif in & state of efficiency, and of bearing
the consequences, whatever they may be, of this human
crush.
.Hence has grown up antagonisms of interests, a mutual
distrust, which—unless it be removed, by just and liberal
measures on the one part, of which there is now some hope,
and by a fuller knowledge of the causes and remedies of their
oondition on the other—will shake the very foundations of
society, and show its apparent prosperity to be but the thin¬
nest crust of glittering matter over an abyss of revolution and
ruin.l
May 1 be.permitted now to refer to the physical-science
aspect of this question of great towns. And if I venture to
allude to facts and phenomena, which are well known to you
*11» it will be understood that I do so, merely to complete and
strengthen my argument.
What, then, is the physical nature of the impurities of town
air ? I know of no one who has contributed fuller information
on this head than Dr. Angus Smith. Yet he, as well as others,
have left much undetermined. Excess of carbonic acid is the
most discernible injury inflicted by communities of men upon
open air, an injury revenged with fatal force upon the agres-
sors. In nature, as we are told, there are rarely found more
than 35 parts of this gas in 100,000 of air. But in the air of
great towns are found from 40 to 74, according to the degree
of population density, and also of fog or atmospheric moisture.
In confined air, among tall structures, the proportion appears
to be greater; in rooms said to be well-ventilated, i.e., supplied
freely with town-air, the average quantity is said to be about
80 in 100,000; in ill-ventilated rooms and workshops, there
have been found from 100 to 700 parts—twenty times nature's
allowance !
Now, as carbonic acid prevails, the circulation of the breathers
is generally observed to slacken, the frequency of respiration
to increase, and the nervous power to fail. Much of the
pht hi si s and scrofula of town-populations is doubtless due to an
atmosphere overcharged with carbonic add. Incaeased tem¬
perature, due to season or climate, renders an nTccss of thi s
jat still more injurious. [Thus, even 1 per cent, may be en-
aured at a temperature under 50° F., which would be absolutely
intolerable at 70° or 80°].
• t Xho social toners el aatasttag tie sanitary condition of the
poorer classes nave been forcibly shewn by Mr. Rendle.
But if the presence of this destructive gas be more esalj
ascertained and its quantity determined, and if it also tell u
something of other gases of decomposition, it by no
reveals the most serious cause of atmospheric vitiation. There
is much sulphurous add in the air of smoky towns; mock
sulphuretted hydrogen near open sewers; and, worst of sD,
there are emanations peculiar to decomposing organic matter,
especially animal dtbrie .
Thus, the air taken from high table-land in the country, ■
said to contain only about one min of organic matter in
200,000 cubic inches of air, ana this mostly of vegetable
origin ; but air from a cesspool has one grain in only 60 csbie
inches—or 3,833 times as much as in nature.!
The degrees of organic impurity in town air vary infinitelj
between these extremes, in proportion as the known causes i
such emanations are allowed, to putrefy, without prompt re¬
moval or disinfection, e.g. t by means of charcoal in sewertnp.
Dr. Angus Smith has observed—“ We have, in different sir
breathed by people in the same country, a substance, the
amount of which in one case is 22 times greater than in the
other, and in air breathed by people in the same teem, s
difference which is as 9 to 22." He adds, (l that in the district
in which the highest numbers were obtained, there wen, is
1855, 4*5 deaths in 100 population."
It is this organic matter in the air which is the most peni-
cious result of human crowding. It is this which, in the sir,
as well as in the water, conveys specific germs of disease, in¬
conceivably minute forms, capable of infinite multiplication ii
the living human body. In this, then, lies the fatal secntof
density of population.
These emanations arise, as we know, in great measure, from
foul water, and from saturated and undrained soil; but ia
large proportion, also, they are exhaled from living btiags-
from the lungs of the diseased, from scattered saliva, and from
the skins of the unwashed. It was generally supposed that
nitrogenous matter, which has been detected in the co a d fn ied
vapour expired even by healthy people, came from the fangs-
But a French physiologist, M. Lemaire, has lately shown! that
in healthy adults it proceeds from the uncleanaed month,
throat, and gums, and the air about them. And he has re¬
corded the very disagreeable fact, that skin-dirt (composed of
perspiration, oily matter, and dust), when allowed to accumu¬
late, is found, on examination, to contain myriads of micro¬
scopic beings, vegetable and animal (Bacteria and Vibrios ),
similar to those which he had before discovered in the air
collected from the barracks of the Fort de l’Est.
The French savant selected, of course, for his experiment*,
the uncleansed —“qui avaient,” says he, with the politeoms
characteristic of his nation, “ nSgligi pendant huit el pda
jours les sains de la toilette ."
In onr population, town and country, there are millions who
neglect such attentions for as many months or 'years as this
philosopher reckoned days!
You may erect baths and wash-houses, but no Act of Parlia¬
ment can oompel their general use. Much, however, maybe
done by training the young in cleanly habits.
These cutaneous emanations are dissipated in, and
infect, the air. The closer the aggregation of nnwsAod
human masses, the more horrible must be the resulting atmo¬
spheric impurity.
When, without reckoning the floating organic putida
which arise from muoous discharges (as epithelial owls, &-h
we add the pulmonary exhalations of phthisical and scrofulous
persons charged with elements of disease believed by many to
be contagious, we may obtain some due to a source of ata»
spheric vitiation in dense populations, of which there is ao*
the faintest popular notion. ,
Those most delicate physiological tests of bad air and ®
defective oxidation—the blood, bones, and skin of a Ibmg
child—prove to demonstration, when mere chemical asalym
fails to throw light on the case, that town air, even in iti bat
conditions, contains subtle poison, from which the soy
land and the breezy shore are free, and that it also wsn"
some elements of nutrition and purification which the latt*
TV Morgan's eloquent words, “ A murky mass hang*
like a shroud over the city—a dismal list of noxious gases »
so intimately diffused throughout the air, that
the earth's heat radiate into space, nor can the warm besms
1 Watt’s “ Dictionary of Chemistry.”
8 Comptee Beudus, Oct. 14,1867.
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MEDICAL NEWS.
October 21, 1868. 363
of the summer's sun thoroughly dissipate the suspended
canopy. *'i
Although much has been learned from the study of death-
rates, I have for some time past scrupled to quote them in
support of sanitary dicta. With all respect for the Registrar-
General and for my learned and distinguished friend Dr. Farr,
I find these statistics full of fallacies, especially in crowded
towns, where the figures give by far too favourable an estimate
of that mortality which is strictly due to town life. I need
hardly Bay that the death-roll does not reveal the actual loss
of health among town masses, nor does it record the multitudes
disabled by a host of diseases and casualties, which may not
at once destroy life, though they ravage the territory of labour
and duty, and levy a most heavy tribute upon produce and
property.
For this we need an official registration of sickness attended
at the public cost.
^ The Rev. Professor Haughton “has shown that, on very
simple mathematical principles, the density of a population
would be a factor determining the ascent of the curve of in¬
crease of an epidemic. "2 This would apply to the case of the
distribution of poison by a water company. “ 1 believe/' adds
Dr. Morris, in his very remarkable essay on Germinal Matter,
“ that bad sanitary state of any kind would be equivalent to
greater proximity."
All other sanitary appliances and reforms being equally
adopted, or equally neglected, it is certain that close proximity
of dwellings, over an extensive area, is per se a cause of un¬
healthiness and deterioration of race. It is not fair to compare
fc well-regulated town population, having, perhaps, only eight
square yards for each person to live upon, with an ill-condi¬
tioned dirty population in the open country.
For all this vitiation of air, caused by town life, there ap¬
pear to be three natural remedies of different values in diffe¬
rent cases : motion of air; diffusion of gases by natural law ;
the presence, or introduction of, active oxygen.
1. Now, the mere motion of air, if it be natural motion,
s.s., wind, is occasional and variable ; while the (generation of
morbific causes is constant. The remedy cannot be relied on,
for the air is often stagnant in circumstances of the greatest
danger. The motion of air in towns is impeded by the
proximity and height of buildings, probably as much as by
insufficient openings in rooms. Nor do we know that, with¬
out the admixture of pure air, foul air can purify itself by
simple motion. If the motion be artificial, it may be exces¬
sive or ill-timed, but of this again.
2. The diffusion of gases is necessarily limited by space,
and mainly by superficial space; for of their diffusion in a
vertical direction, *.e. t into the upper regions of the atmo¬
sphere, we know little, and that little (depending partly on
diminution of temperature according to height of aerial
column, and partly on the relative specific gravity of gases)
does not favour the hypothesis of an effectual change.
Gaseous diffusion is also impeded by the very circumstances
which impede aerial motion. And these circumstances are
most potential in towns.
8. But the presence of active oxygen in sufficient quantity
—and sufficiency here means abundance—were that possible
in dense populations, would be the real remedy.
Oxygen I take to be the burning and purifying principle of
nature, represented by the elemental fire of the ancients. For
flame is but luminous combustion. Professor Tyndall has
shown by his curious candle-burning experiments in the Vale
of Chamounix and on the s ummit of Mont Blanc, that the
quickness and intensity of combustion, such as takes place in
vigorous oxidation, is, in general, incompatible with that
brightness of flame which depends on the presence of carbon
or other inflammable matter. The purer the air the more in¬
visible is the fire, yet the more effectual the burning.
The proportion, chemically determined, of oxygen in air
may not be much altered in towns, though it is sometimes
found to be less : but recent discoveries tend to prove that its
energy depends on the conversion of a portion of itself into
another form, which, when obtained artificially, we call ozone.
When Cavallo found that his Aura Electrics (caused by
sparks passing from his machine through air) was a disinfec¬
tant if applied to foetid ulcers, he laid the foundation of a
discovery the future beneficial results of which are incalcu¬
lable.
The researches of Schonbein—now, alas ! no more—and
1 Morgan on Deterioration of Race, p. 29.
2 Morris on Germinal Matter, p. 10.
subsequent scientific experiments upon this agent have thrown
great light upon its nature. By an electric current, the
volume of oxygen through which it passed was found to be
diminished to the extent of 8 per cent. Then, Odling and
Soret have proved that this condensation is due to the substi¬
tution of sixteen atoms of ozone for twenty-four of oxygen.
We also now learn that, while ordinary oxidiz&ble substances
absorb only the odd eight atoms, restoring the ozonic oxygen
to its original condition (though not to its original volume), a
substance—oil of turpentine—has been found to absorb the
whole of the ozone, which thus destroys itself in attacking its
enemy. Finally, we know that ozone speedily removes clead
and decaying matter “ by resolving organisms into primitive
and innocuous forms." (Day.) Men of science have thus
arrived, I venture to think, at the entrance of a wide field of
practical work with this sanitary giant.
Since the most delicate tests fail to detect anything like
ozone in the air of our crowded towns, we infer that in these
places our great benefactor is “ used up ; " and that without
Lis presence and aid, oxygen itself fails to purify.
Richardson some time ago observed that when oxygen had
repeatedly passed over dead and decomposing animal matter it
lost its power of oxidation.
We may also infer that, in these conditions, deadly germs,
carrying specific diseases, or their essences, may float in
myriads about us, multiplying and safe from destruction,—
save when, happily for us, that unseen mysterious Being
rushes down in the track of the lightning-flash, or rides by on
the tempest, or gambols in the light spray of the sea-breeze.
There may be yet other substances besides oil of turpentine
(an antozonide, according to Schonbein’s ingenious theory)
which may as effectually annihilate ozone, and may thuB be
ever at work to cut short our natural Bupply of oxygen.
In the growing compression of human masses and animal
life (I speak metaphorically), may there not be evoked a
demon of uncleanneefe and corruption strong enough to quench
the spirit of burning and of purification ?
Practically, then, the most essential measure of sanitary
legislation and administration would be not merely to purify
as far as possible the air of towns, but also to provide better
air than towns supply to the people. These objects may be
accomplished by three methods:—1. Speedily removing all
the debris of animal life, and everything which by decomposi¬
tion can corrupt the air ; 2. Promoting the free circulation of
air into every quarter, through every court and alley, into
every house, every room, in the inhabited area,—in a word,
ventilation ; 8. Enabling every person to breathe a sufficient
quantity of pure and good air, t.&, air having the properties
of ozone.
Our sanitary laws, if properly carried into effect, which
they are not at present, may secure the first object.
(To be continued.)
jeMxal Ipfos.
The Public Health.— We take from the Registrar
General’s return our usual details. In the week that ended
October 10, 4368 births and 3115 deaths were registered in
London and in thirteen other large towns of the United
Kingdom. The annual rate of mortality was 25 per 1000 per¬
sons living. The annual rate of mortality was 24 per 1000 in
London, 25 in Edinburgh, and 20 in Dublin ; 22 in Bristol,
18 in Birmingham, 30 in Liverpool, 81 in Manchester, 41 in
Salford, 25 in Sheffield, 26 in Bradford, 31 in Leeds, 28 in
Hull, 20 in Newcastle-upon-Tyne, and 27 in Glasgow.
Scarlatina and different forms of typhus and typhoid fevers
are just now showing increased fatality in several of the large
English towns ; the former more particularly so in Manchester
and Leeds, as well as London, and the latter in Liverpool,
Manchester, and Leeds. Scarlatina last week in Manchester
was three times, and typhus in Liverpool five times, as fatal
in proportion to population, as the same diseases in the me¬
tropolis. During the last four weeks 383 deaths have occurred
in the metropolis from scarlatina. It Ls to be regretted that
no general measure has hitherto been deviled for stamping out
this destructive disease. The deaths registered in Loudon
during the week were 1438. It was the forty-first week of
the year, and the average number of deaths for that week is,
with a conection for increase of population, 1293. The deaths
in the present return exceed by 145 the estimated amount,
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364 The Medical Press and Circular.
APPOINTMENTS.
October 31, 1668.1
and exceed by 209 tlie number recorded in the preceding week.
The deaths from zymotic diseases were 359, the corrected
average number being 872. Six deaths from small-pox, 25
from measles, 109 from scarlatiua, 10 from fever, and 49 from
diarrhoea, were registered. The mortality from amall-pox,
measles, and whooping-cough is comparatively low, but the
death-rate from fever is high, and from scarlat na greatly in
excess. One hundred and sixty-nino denths occurred from
hthisis, 91 from bronchitis, 63 from pneumonia, 85 from
iseases Of the heart, and 162 from diseases of the brain and
nevous system.
Njevus Maternus. —N. W. Brennan, M.D., in the St Louis
Medical and Surgical Journal, describes an unusual case of
this affection occurring in a half-breed Indian woman, who
was suffering from phthisis and epilepsy. The naevus covered
the whole trunk posteriorly, extending from the occipital region
to the inferior nates, and from side to side. It covered the
right mamma, and reached midway on the right thigh, and to
the upper third of the left. It reached midway on the arms. The
parts so marked were uniformly black ; not so black as negro’s
akin, but resembling the rough skin of a Mexican dog. There
was an unusual though sparse capillary growth an inch or two
long on the entire discolored part. Qn the back, below the
waist, particularly, there was a thick growth of hair, quite
bear-like, two inches long. She stated that the milk from the
discoloured breast always sickened the child. She stated that
her mother, while pregnant, went blackberrying, and in a
thicket a large bear suddenly started up beside her and
frightened her. She attributed the discoloration to the in¬
fluence of the mental emotion excited by the fright.
Boiler Explosion at the United Hotel, St.
James’s. —We have been favoured by Mr. Turner, M.R.C.S.,
House-Surgeon to Charing-Cross Hospital, with the following
particulars of the wounds caused by this explosion. They are
as follows :—Ellen Leonard, vegetable maid, four severe scalp
wounds, face, shoulders, and legs scalded; is suffering severely
from the shock, and is in a comatose state. Ellen Luttnem,
fractured humerus; face, arms, and legs scalded; going on
well Robert Humm, three scalp wounds; contusion of both
thighs and shoulders; going on well. All under the care of
Mr. Canton, Surgeon to the Hospital.
Sir Benjamin Guinness has been elected Registrar
of the College of Physicians, Ireland, by a majority of seven
votes.
Just as we are going to press, we are credibly in¬
formed that an influential deputation of the citizens of Dublin
has waited upras Sir Dominic Corrigan, with the earnest re¬
quest that he will contest one of the seats for the representa¬
tion of the city in the coming election.
- 4 -
APPOINTMENTS.
Crawford, Robert, M.D., L.F.P. A 8., Glas.—Certifying Factory Sur¬
geon for the District of Peebles, reebleehire, a d Surgeon to the
Parochial Boards of Peebles and Manor, vice J. B. Junor, L.R.C.S.
Ed., deceased.
Henderson, W., M.D.—Examiner for Graduation in Medicine In the
University of Aberdeen for 1868-69.
Kerr, D , '».D.—Examiner for Graduation in Medicine in the Unive: aity
of Abeideen for 1868-9.
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Smith, Dr. Edward.— By the Lord-Lieutenant, Resident Superintendent
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Riding House of Correction at WskeBeld, vice Wi.lim R. Miiner,
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Circular.
filial gtm &
“ SALUS POPULI SUPREMA LEX.’*
WEDNESDAY, OCTOBER 28 , 1868 .
OONTENTS.
LECTURE.
L w ta rw on Stricture: with Special Refe¬
rence to its Treatment By Rawdon
MAcnamara, Vice-President and Profes¬
sor of Materia Medica In the Royal Col¬
lege of Surgeons of Ireland, and Surgeon
to the Meath Hospital .. 855
ORIGINAL COMMUNICATIONS.
The Forms of Pneumonia. By Octavius
8turges, M.D. Cantab., Asaiitant-Physi¬
cian to Westminster Hospital, and Phy¬
sician to the North Loudon Consumptive
Hospital.... 858
Fracture of the Pubes, Ac. By J. Waring
Curran, L.R.C.S.I., L.JLQ.P.C.I, Ac.,
Spalding, Lincolnshire. 87V
HOSPITAL REPORTS.
Mkkcke’s Hospital—
Popliteal Aneurism cured by DoubleCom-
pression. Under the care of Dr. Morgan.
r.RC.8.1., Professor of Surgical ana
Descriptive Anatomy. R.C.S.I., and Sur¬
geon to the Westmoreland Lock Hospital 870
PAOE
Kao's Oollxqs Hospitai/—
Oases under the care of Dr. Beale, F.R.S. 871
LITERATURE.
Heiberg's Researches on Syphilis. 672
Poor-law Medical Officers’ Association_ 873
LEADING ARTICLE.
Vmtxlation of Troopships. 874
NOTES ON CURRENT TOPICS.
Medical Society of London .. 874
Alleged Lunatics . 875
Hom<sopathy . 875
The late Dr. Sibbald . 875
University of Aberdeen. 875
Ttio Registrarship of the College of Phy¬
sicians of Ireland. 875
King and Queen’s College of Physicians .. 875
Composition of Welsh Lake Water . 876
The Golden-Bridge Cemetery, Dublin .... 876
The Corrigan Election Fond . 876
Storage of Petroleum. 876
The Varty Water 8upply for Dublin. 866
PA 09
Honour to Surgery... 87T
Arrival of the Ship “Clara** at Portsmouth 87T
The Dublin Quarterly Journal.. 877
Woolwich Dockyard Drainage............ 877
Bitter Beer.... 877
Pauperism. 877
Sir D. Corrigan's Candidature.. 878
CORRESPONDENCE.
Lying-in Hospitals and Extern Maternities 877
TRANSACTIONS OP SOCIETIEa
Medical Socioty of London . 878
Social Scixkcb Association—
Health Section.—Address by H. W. Bom*
sey, Esq., M. D. , President of the Section 880
Summary or Scirnor—
Norwich Association... 888
British Pharmaceutical Conference .... 989
Withdrawal of Dr. Richardson from the
Content of the Universities of Edinburgh
and St. Andrew's.... 8S8
Royal College of Surgeons In Ireland .... 888
Medical News, Notices to Correspondents,
Ac .. 883
getitm.
LECTURES ON STRICTURE.
WITH SPECIAL REFERENCE TO ITS TREATMENT.
By Rawdon Macnamara,
Vice-President and Professor of Materia Medica in the Royal College
of Surgeons of Ireland, and Surgeon to the Meath Hospital.
LECTURE IL
I concluded my first lecture, Gentlemen, by stating to
you how, when hastily called upon to see a case of sudden
retention of urine, you might with some degree of accuracy
predicate, according to the age of the patient, the sources
of that retention. I told you that in the case of a male
child the retention probably would depend upon the pre¬
sence of a small calculus impacted in his urethra; that in
the case of an adult the cause most probably would have
to be referred to the existence of a stricture situated in
some portion or other of his urethra; whilst in the aged
an enlarged prostate would most likely bo the “ Fons et
origo mali.” Of course I do not wish you to understand
me as asserting that these are invariably the causes, but in
cases of sudden retention of urine it is more than probable
that at these several ages you will find them to be the re¬
spective causes.
Before entering on the subject of stricture of the male
urethra, I should wish to say a few words upon what occa¬
sionally, both in the adult and in the child, proves an im¬
pediment to the free passage of their urine,—I allude to
phymosis. You are probably aware that this disease has
been properly divided into two classes, congenital and
acquired, the latter being the result of some inflammatory
action set up in the system, most frequently of venereal
origin. About a week ago you had an opportunity of
seeing an example of the first variety under the care of
Mr. Smyly. The case I allude to was that of a boy, who
was the subject of a congenital phymosis, and in whom the
opening of the prepuce was so very small that it was with
difficulty Mr. Smyly was able to introduce through it a
probe. Of course you can readily understand that this
condition would materially interfere with the expulsion of
his urine. How much it interfered with it was evidenced
to me as the operation for its relief proceeded. In conse¬
quence of the extreme tightness of the prepuce, the whole
of the glans was covered in, and in the effort to micturate,
the urine, instead of flowing freely out, was retained be¬
tween the prepuce and glans penis, and ultimately en*
crusted these parts with calcareous deposit. It is evident
that a prepuce so contracted over the meatus urinarius
must prove an extra impediment to the passage of the
water, and thus give rise to an unfounded suspicion of the
existence of a stricture. One of the symptoms in stricture
is the forked or scattered manner in which the urine i9
passed; when in such a case as this the urine is expelled
m this way, the appearance is caused by the prepuce being
contracted over the glans, and the urine is thus scattered
in its passage. It will also give rise to another of the
symptoms usual with stricture, inasmuch as the water must
be passed as slowly and with the same expulsive effort as
in stricture.
The office of the prepuce is to cover the glans penis
and to protect it, and in its normal state it should
be capable of being completely retracted. But where
this cannot be done, where you cannot uncover
the glans penis at all, and where it interferes with
the process of micturition, steps must bo taken for the re*
lief of what now amounts to a deformity. You have here
a beautiful example of this condition in the preparation?
which I now show you. Here is the prepuce of an adult,
and a more perfect example of phymosis never was seen.
If you examine it you will perceive a bristle passing
through its orifice, and that it would not admit of the
passage of anything larger than a bristle—in fact, it is an
absolute stricture. This preparation is, perhaps, unique;
and you can readily understand, in this case, the great ex¬
tent to which the process of micturition must have been
interfered with. The patient who was the subject of this
malformation was circumcised in this hospital by the late
Professor Porter, and you see how nicely the operation
must have been performed. What is the lme of treatment
suited to suoh a condition? The operation of circumcision.
And this operation of circumcision is performed in a variety
of ways. The most ancient way, I should say, is the
manner in which it is, even to the present day, done by
the children of the Hebrew race. The operation is per¬
formed by the High Priests, and admirably and beautifully
do they perform it The most exquisite operations of cir*
cumcision are performed by these men, who have no know¬
ledge of anatomy except what they, as it were, intuitively
arrive at The way in which I have seen them perform
the operation is very interesting. The High Priest has a
piece of silver plate somewhat heart-shaped, and about the
Digitized by v joogle
366 The Medical Press and Circular.
LECTURES ON STRICTURE.
October 28,1868.
size of a five-shilling piece, having a slit traversing the
greater part of its diameter, of width sufficient to admit of
its receiving the little patient’s prepuce ; seizing the fore¬
skin between the fingers of his left hand, he elongates it,
and slides down the sdver plate close in front of the glans
penis, so as to protect it from injury when cutting off the
prepuce; having got matters into that position, he sweep off
the fore-skin with a sharp stout knife, somewhat resembling
a razor, and then he gets hold of the mucous membrane,
tears it with the points of his fingers, and retracts it back ;
then he fills his mouth with a little brandy and water, gets
the little penis into his mouth, and washes it. He then
puts a dressing on the glans, and ties up the patient when
he has done. The operation must be done within nine
days after birth, and it is very rarely that any unpleasant
consequences follow it. I have seen the operation per¬
formed on more than one occasion, and although I had
opportunities of seeing the patient subsequently, I never
saw anything injurious follow from this mode of procedure.
It would be an admirable plan for the circumcision of the
adult, and I really don’t see why it should not be adopted.
The next operation in point of anticjuity is with a director
and sharp-pointed bistoury. You introduce the director
through the opening in the prepuce, and make it
prominent on the dorsum of the penis ; having done so,
you pas3 down on it the bistoury, transfix the skin, and
cut outwards until all is divided. The bistoury you use
must be sharp-pointed, but if you wish to be very parti¬
cular, and effectually to provide against its point catching
in the mucous membrane, you can put a piece of bees’-wax,
about the size of a pea, on its point; then introduce it
along the director, and when it reaches its destination
force it firmly out; it will transfix the wax and the prepuce,
when you can complete this stage of the operation. In
transfixing the prepuce you will find your operation at¬
tended with better results if you draw the upper integu¬
ment of the fore-skin back towards the symphisis pubis ;
in this way you will make the wound in the mucous mem¬
brane correspond better with that in the integument;
neglecting this precaution may necessitate a subsequent
division of the mucous membrane to adapt it to that in
the integument. You now have two flaps hanging down
at each side, composed of the skin and of the mucous
membrane of the prepuce; these, either with a scissors
or a knife, you pare on each side; then take a needle,
armed either with a silk ligature (which I prefer) or
with silver wire, and connect at three or four points
the skin and mucous membrane together, taking care
to have one of your stitches at the superior angle of
the wound; then use a cold lotion, and keep the patient
quietly at rest. There is only one danger that I know in
connection with this operation, and that is, that a careless
person might introduce the director through the prepuce
on into the meatus urinarius, and so pass it into the
urethra. Such an accident has occurred ; but a person
must be very careless who allows it to take place. In the
first place, you should have nothing but the skin and
mucous membrane between your finger and the point of
the director, a fact which the “ tactus eruditus ” will soon
enable you to determine ; but in cases of inflammatory
phymosis, when the tissues are very much infiltrated and
thickened, an inexperienced operator, or indeed, for that
matter, an experienced one either, may be excused for
entertaining some misgivings on the point. In such a case,
how are these misgivings to be set at rest ? In this way.
When you get the director in between the glans penis and
the foreskin, take it this way, bring it around so, making
its point traverse the space between the prepuce and the
glans, and if it goes freely round, you may depend upon it,
it is in the right situation ; for if it were in the narrow
passage of the urethra, you could not so rotate it. In the
great majority of cases, you can thus with accuracy deter¬
mine the position of the director, but in exceptional cases
a difficulty may arise in consequence of adhesions between
the prepuce and the glans. For instance, in the case of
phymosis in tho child operated upon here the other morn¬
ing by Mr. Smyly, we positively could not so rotate the
director, for the glans penis and the foreskin were, to a
great extent, absolutely glued together with the quantities
of calcareous matter deposited upon them, and thus was
prevented the rotation of the instrument. But his sense
of feeling enabled him to recognise that his director was
in the right position, and not in the urethra; and, as it
ultimately proved, he was correct in his diagnosis. Pre¬
suming, however, that a case presents itself to your notice
in which the tissues are greatly infiltrated and thickened,
and in which these adhesions between the glans penis and
the prepuce also exist, you may well ask me how you aie
to decide as to the position of your director under suah
difficult complications. Well, there is our crucial test,
which will, unless you are peculiarly unfortunate, clear up
all doubts upon the point. Continue to introduce your
director, when, if it be in the right position between the
prepuce and the glans penis, upon reaching the point
where the mucous membrane is reflected from the glans
upon the prepuce, r its further ingress will be arrested;
wnilst, on the contrary, if it be in the urethra, it can be
introduced its full length without any impediment. I said
“ unless you are peculiarly unfortunate,” because a case
might occur presenting these two complications, with, in
addition, the existence of a stricture in the urethra near
its orifice ; this would, of course, arrest your instrument,
and might lead you into a serious error. In so unfortu¬
nate a case nothing but the very greatest caution will as¬
sist you out of the difficulty.
A rather simple method of performing this operation has
been suggested by the illustrious Ricord, who has devised
also an instrument for still further facilitating the steps of
the operation. This instrument is known to us as Ricord’s
forceps, and I here present it to you, gentlemen, for your
careful examination, for it and this operation are by no
means unusual subjects to be asked of you at our several
Licensing Boards. I don’t know whether you experience
much difficulty in recognising an instrument from its
written description or not, but of this I am sure, that you
are far more likely to form a correct idea of any material ob-
i 'ect from careful inspection of it than if you were to devote
lours to the perusal of the best written description of it;
hence is it that I beg of your careful inspection of this
forceps. At first sight, it does not appear to differ much
from an ordinary dressing forceps; but on divaricating the
blades, you will perceive that they are deeply indented oa
their inner surface, and you will also remark that in each
blade there is a slit running nearly its full length. The
method in which they are to be used is as follows-The
repuce is first to be elongated by being drawn forwards
etween the forefinger ana thumb of the operator’s left
hand, and then grasped close to the glans penis by the for¬
ceps, and in so doing they are not to be applied directly in
a vertical position, but rather slantingly, so as to comprise
in their grasp more of the superior portion of the prepuce
than of the inferior; we then entrust the forceps into the
hands of an assistant, with directions to him to grasp the™
steadily; having previously armed two needles either with
a silk ligature or with fine silver wire, you are now to
take one of them and transfix with it the prepuce, passing
the needle between the slits in the blades of the forceps,
and as near as may be in the very centre of the prepuce.
You now take the second needle and transfix the prepuce
in a similar manner through the slits in the blades of the
forceps, introducing the needle a little lower down, but
close to the point at which you had introduced the first
needle. You now warn your assistant to grasp the handles
of the forceps firmly and tightly , and with one sweep of a
sharp knife you remove the foreskin, of course making
your incision on the side of the forceps farthest from the
glans penis, which is protected from injury by the in¬
terposition between your line of incision and the glans
penis of the blades of the forceps. Now you are in a posi¬
tion to see the value of the slits in the blades of the for¬
ceps ; were they solid, the needles should either be passed
at one side or other of the forceps ; if at the side next the
Digitized by
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The Medical Proa and Circular.
LECTURES ON STRICTURE.
October 23, 1869. 3 6 7
glans penis, to the risk of wounding it, if at the far side,
to the almost certain chance of their being cut away along
with the foreskin. By introducing the ligatures before
removing the foreskin, the subsequent steps of the opera¬
tion are expedited, and of course some pain spared the
patient. Why you should tell your assistant to grasp the
handles of the forceps tightly just as you proceed to am¬
putate the foreskin is with a two-fold object. First, that
by so doing, the pain of the incision is considerably
numbed, an object when chloroform is not used ; and in¬
deed in these minor operations its use is rather to be de¬
precated, the pain being so momentary that, in my opinion,
the patient should not be exposed to the slight amount of
risk that, even in the ablest hands, attends the administra¬
tion of chloroform ; but more important than this, if your
assistant keeps a slack hold of the forceps you very likely
will shove down the prepuce before your knife, and fail in
completing the operation by what it should always be
done—one sweeping cut. If the operation has been skil¬
fully carried out in all its details, you now see the glans
penis appearing through the opening you have made, and
lying across it will bo your two ligatures. You now seize
them in the centre with a forceps, draw them out some
little distance, and cut each of them in two, by which pro¬
cedure you now have four instead of two ligatures, and
upon' tying these you approximate the mucous and cu¬
taneous surfaces of your line of incision ; the penis is now
to be lightly dressed with a slip of either wet or dry lint,
the patient i3 to be removed to bed, and kept there for
some days, when, if no contretemps arises, the cure will have
been perfected. Mr. O’Grady has suggested an adaptation
of the principles of Ricord’sjforceps to the common dissect¬
ing forceps which we surgeons carry in our pocket cases.
It is capable of fulfilling not only all the duties required
of Ricord’s forceps, but also the hundred-and-one require¬
ments of an ordinary forceps, as you can readily perceive
by examining this instrument, which is manufactured by
Fannin and Co., of Grafton street, who have admirably
realised Mr. O’Grady’s idea.
In this description which I have given you of Ricord’s
operation it must appear to you a simple one, and of easy
application ; yet it is one which requires some nicety of
manipulation, and some little skill on the part of the
operator. For instance, it requires some care to ensure that
tne amount of mucous membrane removed will correspond
with that of the cutaneous tissue. I have seen the opera¬
tion so performed that the mucous membrane has remained
perfectly intact, covering the glans penis as if it were its
night-cap. This mishap can bo avoided by grasping the
lower margin of the prepuce just at the junction of the
mucous membrane and of the skin, and forcibly elongating
the prepuce, whilst, at the same time, you draw the skin on
the upper surface of the penis up towards the pubis, and
then placing the forceps in position as previously described.
Some practitioners transfix the margin of the prepuce at
this point with a needle armed with a stout hempen liga¬
ture, which enables them to make the requisite amount of
traction, but this, in my opinion, is unnecessary; if you
follow my directions you will secure a correspondence in
the cut surface of these two tissues. Again, by not at¬
tending to my advice to transfix with your needles the
prepuce as near as may be in its centre, as grasped within
the blades of the forceps, upon completing your section
you will have the mortification of seeing that your intended
sutures have not transfixed the mucous membrane at all,
but that they lie either above or below it, necessitating
their withdrawal and subsequent re-introduction.
Presuming, however, that every step of the operation
has been most successfully carried out, I have said that,
unless no contretemps arises, the cure will be perfect in a
few days. It now remains for us to consider what are the
casualties that may interfere with the happy termination
of the case. Well, then, in the first instance, the adhe¬
sive process is but too frequently accompanied with an
amount of inflammation that interferes with union by the
first intention, substituting for it a process of granulation.
Again, ervsipehis may supervene ; even tetanus, fortu¬
nately a most rare as it is a most untoward occurrence.
From haemorrhage I have never experienced any trouble ;
still in that condition of the system known to all surgeons,
as it is their dread—the hamiorrhagic diathesis—such a
complication might arise ; it should be met by placing the
patient in the recumbent posture, with the penis lying on
the abdomen, and, if necessary, by the application of ice ;
here, also, the application of Richardson’s styptic colloid
will prove of use.
Presuming, however, that none of these casualties arise,
there is one other circumstance which may occur, and
which will materially interfere with the success of the best
conceived and most skilfully executed operation ; this mis¬
chance lately occurred in my own practice. I was asked
to circumcise a young gentleman whose prepuce was pre-
ternaturally tight, and who never could have connection
with a female without the almost certainty of contracting
some venereal affection. This tight condition of prepuce
predisposes in a singular degree to the development of such
diseases. In consequence, I believe, of parties so afflicted
not being able to retract the foreskin, and so submit the
glans penis to perfect ablution, they present a nidus, as it
were, for the lodgment of diseased secretions, and they
become peculiarly open to the invasion of syphilitic affec¬
tions. To exemplify this statement, I can affirm, from my
own experience, that Jews are, to a great extent, exempt
from syphilis ; not that they are more virtuous than their
neighbours, for I have often had to treat members of this
persuasion for gonorrhoea, from the attacks of which latter
disease their religious rite of circumcision does not protect
them ; but rarely, very rarely, indeed, have I met with
one of them suffering from chancre or even from balanetis.
Well, then, this gentleman was in this condition, and to
relieve him from it I was asked to perform the operation
of circumcision, in fact, as our Continental neighbours
term it, “ un operation de complaisance.” After the
operation everything went “ merrily as a marriage bell,” and
for two days every appearance promised union by the first
intention ; when, unfortunately, on the third night he had
in his sleep a powerful erection. Every effort at union by
the first intention was broken up ; every suture I had in¬
troduced was burst through ; and, instead of a speedy con¬
valescence, we had to submit to the more tardy process of
union by granulation. Had we beforehand any reason to
anticipate a contingency such as this, perhaps it might be
met by the liberal exhibition internally of bromide of po¬
tassium in the infusion of hops ; this, with cold evaporating
lotions and low diet, might, perhaps, counteract this form of
erythism. In such cases, however, gentlemen, you should
remember that an extreme of cold is very likely to inter¬
fere with primary union by unduly depressing the vitality
of the parts ; in avoiding one extreme you should not rush
into the other.
I have thus fully considered those difficulties of mic¬
turition which may arise from natural or acquired phy-
mosis, and the best means of abating them. In con¬
clusion of this lecture, gentlemen, permit me to give
you this word of practical advice : in cases of acquired, in
other words, of inflammatory, phymosis, be in no veiy
great harry to operate. If, previous to the invasion of his
present attack, the patient were able to retract his foreskin ,
place him on his back in bed, put him on antiphlogistic
treatment, and if, next day, you see the appearance of a
few rug® (wrinkles) upon the surface of what had been
the day before a dark, shining, glistening skin, threatening
all but immediate gangrene, you may rest assured of it
that perseverance in your plan of treatment will be crowned
with success ; that the inflammatory symptoms will gra¬
dually subside ; and that in the end he will be in a better
condition for the operation of circumcision, should such for
any reason be called for, than had you unreasoningly rushed
upon its performance when first you saw him. Why this
should be so you can readily understand if you reflect that
in the majority of these cases, the unfortunate patient has
been walking about with his penis in the prone position,
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in virtue of which the blood gravitates into the dependant
organ, and so intensifies mechanically his diseased condi¬
tion ; in addition to which, perhaps, irregularity of living,
undue indulgence in alcoholic potations, exposure to atmo¬
spheric influences, &c., may all exercise an untoward in¬
fluence upon his already sufficiently unfortunate position.
By your line of treatment you correct all these, and facili¬
tate by position and appropriate medicine and diet the
unloading of the gorged vessels. That you have taken
some advance in so doing, you recognise by the appearance
of these rugae ; they are consequent upon the subsidence of
the inflammatory swelling, and never could appear so long
as the intensity of the disease continued unabated. To
proceed to operative interference at once, without recourse
to palliative treatment, is to give your operation the very
worst chance of ultimate success, to wait is sound surgery;
but to wait too long, to wait an hour after you might rea¬
sonably expect the appearance of these rugae, and that
they have not presented themselves, is but to permit
nature to assume the functions of the surgeon, as on your
next visit you will find the glans penis presenting it¬
self through, most probably, the dorsal aspect of the pre¬
puce, having secured for itself an exit by an ulcerative
process, the result of the inflammation present in the organ.
In the course of my practice in the wards of this hospital
I have frequently given you opportunities of verifying the
soundness of these observations ; repeatedly have patients
been sent in to me with the intention of having their pre¬
puces removed for inflammatory phymosis, and as frequently
have I treated them in the manner here inculcated ; over
and over again have I pointed out to you the appearance
of these rugm, and as certainly as they presented them¬
selves, so certainly have these patients left the hospital
with their prepuce intact. Such cases as these, gentlemen,
are the true triumphs of the experienced surgeon. Opera¬
tions should be the opprobria of our art, they are but
confessions of our weakness ; and to avoid the necessity
for their performance, by scientific treatment, should be
our greatest boast. In my next lecture, gentlemen, we
will enter upon the consideration of those questions which
are more immediately connected with difficult micturition,
dependant upon stricture situated in the urethra itself.
(To be continued.)
-♦-
drightd
THE FORMS OF PNEUMONIA.
Bt Octavius Sturges, M.D. Cantab.,
Assistant-Physician to Westminster Hospital, and Physician to the
North London Consumptive Hospital.
(Continued from page 201.)
II.
Hitherto, in the forms of pneumonia which have been
alluded to, we have been able to trace the modifying
influence of mechanical and physical agencies. It is clear
that all such explanation must be abandoned, now that
we come to speak of partial and defined hepatization—of
limb, for instance—which is found in connection with
certain blood diseases, and occupies often the upper and
anterior portions of the lung.
Pathologically, this pneumonia may be identical with
the idiopathic. In their relation, at least, to the phe¬
nomena of inflammation, the two may be considered to¬
gether ; and it may be here asked how far either of these
satisfies any received definition of that process ?
Pneumonia is spoken of as exemplifying the inflamma¬
tory history, because it exhibits in successive stages in-
orgement, red hepatization, and purulent infiltration,
n some instances, tvuly, it is sufficiently evident after
death, from the co-existence in the same lung of these
three appearances, and from the last corresponding in
situation with the spot where the disease was first de¬
tected, that the morbid changes have taken place in the
order mentioned. In others, not only is there no such
evidence in the organ itself, but often the history of the
patient forbids any such supposition. Thus, co solidation
may occur suddenly with none of the preliminary signs
of engorgement, and be as suddenly recovered from. Or,
again, purulent infiltration may be found affecting the
whole of one lung in cases which fulfil their history so
rapidly, that it is impossible to suppose that red hepati¬
zation has preceded it.t In these respects it may he said
that what takes place in each individual air-cell reminds
us of the effusions which occur in serous sacs, effusions
which may be serous or plastic, or purulent, from the
first—and not each of these in that order of successions
The fluid of emphysema, for example, is not necessarily
“ an exudation which has passed into pus it may have
been so poured out.
Now, if we attempt to follow out this analogy, if, for
instance, we compare the conduct of the lung with that
of the pleura, when the two are exposed to the same ora
similar influence, it will at once appear that, in liability
to inflammation at least, the difference between them is
conspicuous. There is, first, the well-known fact that
while true pneumonia will always give rise to pleurisy,
pleurisy has little or no tendency to provoke pneumonia.
How seldom, again, do the air-cells become affected iii
capillary bronchitis, or when exposed to the action of
direct irritants, or, in short, under any kind of rough
usage. Surgeons tell us, indeed, somwhat vaguely, that
in punctured wounds of the chest pneumonia is among
the probable consequences. It is even thought by some
that a mere blow will suffice to produce it. So far as I
can find, there is little evidence in support of these state¬
ments. CertainlyS the lung may suffer rupture; it may
be cut and burnt, without any such result accruing.
Equally, foreign bodies may traverse the lungs, sojourn¬
ing there lor months, and making their exit at last by
means of abscess at some part of the. chest-wall, yet give
rise to no pneumonia. And we are told of bullets* rolling
about for a length of time in the pleural cavity, and fail¬
ing to produce any effect whatever upon the lung itself.
Still further, in those exceptional cases where pneumonia
does happen as a sequel of severe injuries, it i9 not the
pneumonia which we are in the liabit of calling by that
name, but reparative adhesive inflammation, limited to
the seat of the hurts—“ an exudation of plastic material,
causing a partial hepatization, and then contraction and
cicatrisation.”
But, however it may appear that the lung is slow to
respond to influences which act so readily and so uni¬
formly on the serous membranes, it miy yet be convenient
and reasonable to regard as inflammatory that form of
pneumonia which, originating in an altered condition of
the blood, leads to certain local pneumonia, more or lew
uniform in character. It becomes the more necessary in
that case to observe the distinctions which separate the
intercurrent disease from the idiopathic.
Now, a selection of cases of pneumonia where that
affection is obviously ingrafted upon some other, will
bring together mainly the subjects of three diseases,
uraemia, typhus, and acute rheumatism (I am speaking of
adults and excluding tubercular cases). We shall find,
moreover, the ingrafted affection comporting itself vari-
1 Cases 1«, 18, and 19 of Class V.; 2 of Class II. It was held long*? 0
by Dr. Hodgkin that purulent infiltration might occur with no preced¬
ing red hepatization. Sec his Lectures on Pathology, p. 93.
2 Dr. Addison, it will be remembered, draws a comparison between
the lungs and the serous membranes, likening the effusion of serom
into the air-cells to serous dropsy. See his article on Pneumonia, Guf 1 *
Hos ital Reports, 1843.
3 See Poland on Wounded Lung in Holmes's Surgery, vol. ii.» P-
358-59.
4 Loc. cit., 367.
5 Holmes’s Surgery, vol. ii., p. 358.
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October 28,1868. 369
ously. At one time it is scarcely scan to alter the
characteristic features of the original disease—it is in the
truest sense “latent,”—at another it is so far mixed up
with these as to lose its own individuality ; at another,
again, it will display definite pneumonia, identical with
those of simple pueumonia. Can we investigate the con¬
ditions of these variations ?
To take them in order there is, first, a form of grey
hepatization, confined often to the upper portion of the
lung, which will destroy life, or help to destroy it, with
marvellous rapidity, yet with none ot the signs which are
regarded as proper to pneumonia. In such cases it is
only an assumption, and a very improbable assumption,
that this purulent infiltration has been preceded by red
hepatization.
I have elsewhere stated the case of a woman 1 admitted
with fever, whose chest, examined the day before her
death, presented none of the physical signs of pneumonia,
there being at the same time no sputa and only slight
cough. Yet the right lung of this patient was grey,
softened, and on the point of breaking down. Very
similar is the history of a man 2 who, having long suffered
from epigastric pain and dyspepsia, had three attacks of
haematemesis in one day, vomiting about half-a-pint of
blood on each occasion. On the day following the
haemorrhage he entered St. George’s Hospital, lie had
then slight cough, with some mucous spitting, and some
rhonchus was audible about the chest. His chief com¬
plaint was still of dyspepsia ; he was treated for that and
got better, well enough, after eleven days, to take, an air¬
ing. On the evening of the twelfth day he had a rigor,
with great dyspnoea, and from that time, although life
was prolonged for more than two days, he lay on his
right side, evidently dying. Here again the whole of the
right luug was hepatised and grey, excepting a very small
portion at the base.
There are other similar cases where we can say nothing
of the duration of the hepatization, since from first to last
no symptom has arisen directing attention to the chest.
Consolidation at the apex of one lung—in a great
majority of cases grey consolidation at the apex of the
right lung—is a condition which occurs often enough in
this association to deserve notice. Thu*, out of fifty-three
instances of hepatization from secondary pneumonia, the
right apex is affected twenty- one times, and the left three
times ; or, otherwise, choosing out of these fifty-three
case*, twenty whose history has been obscure and not
suggestive of pneumonia during life, the right apex suf¬
fered in twelve ca«es, and the left only in one. More¬
over, the hepatization i3 almost always grey, and this
where the history of the case furnishes direct evidence
that the implication of the lung has been of very short
duration.
It has been said that pneumonia at the apex, whether
simple or intercurrent, is characterised by markedly
typhoid symptoms. Now, I think it may be shown that
simple pneumonia is essentially the same in its clinical
features, whatever be the portion of lung attacked, and it
would seem to be more true to say that certain blood dis¬
eases, whose symptoms are of a markedly typhoid character,
are apt to exhibit grey hepatization at the apex ot the right
lung. Especially, as has been said, does this phenomenon
occur in connection with typhus, antemia, and, I think,
delirium tremens.
It is only by overlooking or disregarding all clinical
evidences that such cases can be at all compared with
true pneumonia. We are not justified in so ranking them,
even in those instances where a rigid scrutiny rails to
discover any other material cause of disease, so long as it
can be shown that the illness commenced at a period an¬
terior to the change in the luug, and underwent no marked
modification when that change ensued.
Pathology is not yet perfect. Not many years ago
granular degeneration of the kidney would have passed
unnoticed ; even now, no doubt, there are many struc¬
tural changes which escape recognition, many diseases
regarded as idiopathic, which advancing knowledge will
enable us to refer to their true source. Meanwhile, it
may be wise, whatever information pathology in its pre¬
sent state may be able to afford us, to avoid so far erring
against common sense as to ascribe to an organ which in
the course of a long illness has maintained its integrity
almost to the last struggle, not only death itself, but all
the phenomena which have preceded it.
Now just as we have seen that there are cases which
reach the stage of suppuration at once, or at all events
with exceptional rapidity, so there are others where red
hepatization having been once established, the deposit in
the air cells shows no disposition either to depart or
undergo change, so that the affected portion of lung,
though solid and granular, and to the pathologist typi¬
cally the lung of acute pneumonia, owns a history of long
inactivity, like that of the aneurism with which the con¬
dition is often associated. 1
The term chronic pneumonia, which has been some¬
what broadly used, might be applicable to such cases. A
sailor of drunken habits was admitted into St. Georges’s
hospital with renal anueurism. Five months before he
had walked a distance of thirty mile3 in the rain, and at
the end of the journey sat down in his wet clothes, and
drank immoderately. Dropsy appeared the next day, and
never left him. The man lingered long in the hospital—
three months and a half—and having become exceedingly
anasarcous, died at last, with no special symptoms to mark
his end, the signs of pneumonia having been noted on his
first admission. Yet here the upper lobe of the right
lung is described as “hepatized and condensed from infil¬
tration of lymph. ’
A boy 2 had suffered for nearly two years with palpita¬
tions and dyspnoea, the sequel of rheumatism, and was in
the hospital with these symptoms for more than three
weeks. In him, again, almost the whole of the right lung
was “ red, solid, and granular,” while, as evidence of a
succession of attacks, and of the nature of the exudation
in each, the heart was embraced by a number of distinct
layers of deposition clearly separable from one another,
and of which the inner were the more recent. It would
appear, indeed, from this and other similar causes, that
the rheumatic diathesis is that in which softening is least
prone to succeed hepatization. The deposit, wherever
occurring, whether filling up the air cells or covering the
valves of the heart, has essentially the same history, and
is wont to remain for a length of time unaltered, and
only tending to produce secondary changes in the organ¬
ism by the mere effect of its presence.
And so, as I have said, secondary pneumonia may have
its features so far blended and mixed up with those of
the disease which it attends, as to lose, so to speak, its
individuality. In such cases the practice of giving a
separate name to every local manifestation of a disease,
and regarding each in the light of a fresh “ complica¬
tion,” is especially useless and misleading. We have
not only the hepatized lung, but along with it and inter¬
cepting it, lymph is found upon the pericardium, covering
the valves of the heart, impacted often in the substance
of the spleen. It is evident, in short, that the blood ha9
yielded a part of the fibrine which it held in solution,
whether by a direct precipitation, “ as a stick in certain
streams coats itself with a calcareous envelope,” or other¬
wise, as in the lungs, by an exudation of that constituent
whose excess in the circulation gave rise to the original
disturbance. I have elsewhere related the particulars of
some cases which illustrate this form of pneumonia. They
sufficiently prove that hepatization is but the local mani¬
festation of a general disease, not a new affection “ com¬
plicating M the old one. Its occurrence under such cir-
1 15 of Class V.
2 18 of Class V.
1 See especially Cases 14 of Table III., and 5, 9,12, and 21 of Table II.
2 The two cases here alluded to are 6 and 16 of Table II.
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HOSPITAL REPORTS.
October 28,1818.
cumstances does not comnlicate, blit tends to confirm
and illustrate, and in so far to simplify, the view which
on independent grounds we liad been led to adopt.
Far otherwise is the history of that pneumonia where
the local affection, whether arising from climate, change,
or from direct mechanical irritation, or even from some
blood poison, mischievous in this place first, is the imme¬
diate cause of certain constitutional symptoms. On it
the anatomical changes in the lung occur in a well-ascer¬
tained order, and give rise in turn to a succession of
clinical phenomena sufficiently definite in their character
to admit of general description. To a consideration of
this true inflammation of tne lungs, of the statistics re¬
garding it, and especially of the manner in which drugs
have been said to influence its progress, I propose shortly
to devote a paper.
FRACTURE OF THE PUBES, ETC.
By J. Waring Curran, L.R.C.S.I., L.K.Q.P.C.I., Etc.,
Spalding, Lincolnshire.
On the 29th ult. I was summoned, as one of the medical
officers of the Great Northern Railway Company, to visit
one of the men who was injured near the Spalding junc¬
tion. I found him lying by the side of the metals, supported
by some of our officials. He was pale and shivering,
quite conscious, but suffering the most agonising pain,
which he particularly referred to the lower and right halt
of the abdomen ; the stocking covering the right leg and
foot was saturated with blood, which coagulated in its
texture, and from the amount of deformity presented by
the thigh of same 6ide, together with other unequivocal
symptoms, easily determined the existence of fracture of
right femur at junction of lower with middle third. After
the administration of a restorative, I had him carefully con¬
veyed on a stretcher to his lodgings, when I was enabled
to make a more exact examination. On the removal of
his trowsers, &c., I observed a large lacerated wound frac¬
turing the inner malleolus, and extending over the dorsum
of the foot, exposing the bones of the tarsus ; the poste¬
rior tibial was divided, but the crushing nature of the
injury, produced by a truck-wheel passing over the foot,
prevented much haemorrhage. The fracture of the femur
was at once apparent, the upper fragment being tilted
upwards and forwards, the inferior backwards and out¬
wards. The upper part of the thigh and lower ot abdo¬
men was ecchymosed and grazed. At this stage 1 was
met by Dr. Ancell Ball, the other medical officer of the
Company, with whose assistance I reduced the fracture
and dressed the foot. Our chief anxiety was concen¬
trated on the abdomen, over which the. wheel passed.
The bladder I relieved by catheter, the introduction of
which required some little ingenuity, as there seemed a
pouch in front of the prostate, giving the feeling that the
instrument was in the bladder. To find the passage at the
posterior part of this manoeuvring and patience were neces¬
sary. On the fourth day after the accident gangrene of the
foot set in ; and at a consultation held with Dr. Cammack,
J.P. (the eminent surgeon), and Dr. Ancell Ball, we came
to the conclusion that operation was out of the question,
owing to the extensive abdominal injuries. The poor
fellow died on Sunday morning last, and, in company
with the above gentlemen, I made a post-mortem examina¬
tion. The tissues over the pubes and right iliac region
were infiltrated with effused blood ; the pubes were frac¬
tured on both sides,—on the left side the horizontal ramus
three-quarters of an inch from, the symphisis, and on the
right side the descending ramus was broken half-an-inch
above its junction with the ascending ramus of the
ischium. This is the most interesting feature in the
case, and attracted the attention of all three, that in an
individual not quite twenty-one years of age the pubes
should not have yielded at the line of articulation, as the
cartilages were not ossified. Instead of fracturing in the
strongest part of the bone I removed and made a prepa¬
ration of the bones, which shows the cartilages uninjured.
The triangular ligament was torn, and the anterior sur¬
face of the walls of the sigmoid flexure of the colon and
upper-third of the rectum was infiltrated with blood, and
presented a bruised appearance, but no laceration existed.
We never were able to set up a satisfactory reaction, or
rally him from the shock which he sustainei
Oct. 8, 1868.
MERCER’S HOSPITAL.
POPLITEAL ANEURISM CURED BY DOUBLE COMPRESSION.
Under the care of Mr. MORGAN, F.R.C.S.I.,
Professor of Surgical and Descriptive Anatomy, R.C.S.I., and Surgeon
to the Westmoreland Lock Hospital.
The following is a good illustration of what can be done
by the pertinacious and, at the same time, judicious ap¬
plication of compression for the treatment of aneurism.
Various instances of cure have been produced by con¬
tinuous and by graduated pressure, but as it was effected
in this case by an intermediate course, the history is, I
think, instructive. The aneurism was probably, in the
first instance, of traumatic origin, from sudden exertion.
The patient was of irritable and excitable constitution,
and in an anaemic unhealthy condition, having been the
subject of syphilis within four years.
J. R—, a" young man, aged twenty-four, by trade a
book-binder, pale, and of small build, not exceeding eight
stone in weight, applied at the hospital, May 4th, 1868,
for admission, suffering from pain and uneasiness in the
left knee and ham, hut able to walk without the support of
a stick, though a little lame from the stiffness. He gives
the following history of the origin of the affection -About
one month previous to admission, hearing the cries of a
girl entangled in a steam machine where he was at work,
he sprang down two flights of stairs to stop the engine.
At the time he felt a sharp pain, but in a week or so began
to feel a constant duller pain in the knee, especially
when bending it, or when laying the affected knee over
the other as in crossing the legs. On the 1st May, he
found that he had a tumour in the ham, and on admission,
May 4th, a tumour is distinctly perceptible in the popli¬
teal space, about the size of a hen’s egg, pulsating cen-
trifugally, and having a “whiz” perceptible to the
fingers. Considering the unhealthy appearance of the pa¬
tient, the circulation in the vessels below was normal, and
pressure influenced the size of the tumour; and the
possibility of the artery having been injured by the ex¬
ertion referred to, I determined on treatment by compres¬
sion, carefully and cautiously applied.
May 1st. —The limb was put up, raised at an obtuse
angle with the body, as far as could be borne; this
position, without doubt, influenced the intensity of the
pulsation in the tumour. A flannel roller was applied
around the lower part of the limb and a pyriform shaped
bag of shot was put over the artery in the groin. Five
pounds of shot were used to moderate the current, as i
was found that this weight could be borne without un¬
easiness, and was sufficient to impede considerably,
not obliterate, the blood-current I intended thus to
enlarge the collateral vessels. The patient was ordered a
tonic mixture, with tincture of iron and small doses o
digitalis. At the expiration of four days, as the vesse
around the knee-joint had increased sensibly in calibre,
had digital pressure kept on, by relays of the students,woo
zealously undertook the duty, pressing with the thum j
on the artery at the groin, pulsation was thus arres ,
in the most perfect manner for twenty-four hours,
without success, and the shot-bag pressure was con¬
tinued without intermission.
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HOSFITAL REPORTS.
October 28, 1868. 371
May 9th.—A Reid's compressor was now applied, and
the pad neatly adjusted over the artery directly, as it
entered the thigh. The pulsation in the tumour was
controlled, and ice applied to it, the pain being thus
relieved. The compressor acted well, but the pressure
could hardly be borne, from the irritability of the patient’s
system.
May 15th.—The tumour having become a little denser,
and the collateral circulation more free, I again tried
digital compression for twenty-four hours. This com¬
pression I saw most perfectly carried out till the patient
could bear it no longer ; and I followed up its use by
putting the limb in the flexed position, which I hoped,
from the fact that thus the pulsation was greatly con¬
trolled, would have been tolerated and be successful.
Full doses of liq. morphia were administered. After
bearing the position for some hours, I had to relieve the
limb.
May 21st.—The compression has been continued since
last date, and also flexion has been again tried, and as I
found that the use of the clamp (Reid’s) is causing fray¬
ing of the skin, I applied a smaller Carte’s apparatus,
which answered well so far as controlling the pulsation,
but the patieut did not find it so bearable as Reid’s
compressor.
June 1st.—The patient being anxious to go home, and
abrasion of the skin preventing the application of pres¬
sure, it was thought desirable to let him get some time
out of doors, particularly as the weather was so fine. He
was enjoined quietness, and the continued use of the pres¬
sure as far as possible when at home.
June 11th.—The patient was now re-admitted consider¬
ably improved in general health, the tumour had in¬
creased in size, the pain and numbness down the leg
being more marked, but manifestly a slight amount of
consolidation had taken place. Pressure was now care¬
fully applied by Reid’s compressor, on the femoral
artery, as it entered the thigh, and every care taken to
prevent fraying or irritation of the skin. Full doses of
iron and digitalis, carefully administered, and opium, in
such regulated dose3 as kept the patient moderately
under its influence.
June 17th.—The compression has been steadily perse¬
vered in, with but little change in the tumour. 1 now
determined on endeavouring to include a still column of
blood in the artery, and thus also moderate the applica¬
tion of pressure at any one point. I applied, therefore, the
Reid’s compressor with a small shot-bag interposed be¬
tween its pad and the skin, at the artery near Poupart’s
ligament, but sufficiently loose to allow a very little blood
to enter tho main trunk, and below the origin of the pro¬
funda femoris, to allow of collateral circulation being
more easily carried on ; a Signorini’s clamp was placed
on the artery a3 it lay in Hunter’s canal, as near as
possible to the ham. This, by some attention to its
application, was found to be easily bearable and very mo¬
derate pressure indeed sufficed to arrest the blood current.
After four davs the tumour had become more solid and
the pulsation decidedly less, but still very perceptible. A
gradual occlusion, not only of the sac, but of tne artery
from the profunda, now took place till June 30th. Con¬
solidation having thoroughly taken place, not only in the
sac itself, but in the vessel along the thigh, up to within
two inches of Poupart’s ligament, the collateral vessels
around the knee-joint could easily be felt, and seen en¬
larged and pulsating. The numb sensation in the leg
ana foot was the chief inconvenience.
The patient was discharged cured on July 3rd, and was
able to go to work (half-time) at his trade in a week after¬
wards. Previous to his leaving hospital all the large
vessels and the heart were carefully examined and found
healthy. The temperature in both limbs was found ex¬
actly to correspond, though differing from the commence¬
ment of the disease till the collateral circulation became
enlarged ; the temperature of the diseased limb had been
from two to three degrees lower than the sound. The
patient was very intelligent, and seconded the means of
treatment adopted as far as possible.
I may mention that on several occasions I tried also
the manipulation treatment, but without avail. Thus
after using graduated compression, complete compression
by digital pressure, compression by the shot bag, the
flexion treatment, and manipulation, together with atten¬
tion to the general health ana condition of the patient, the
final obliteration of the sac and the artery leading to it was
effected by the inclusion of a column between the two
points of pressure, the artery being particularly suited to
a method like this, owing to the ample anastomosing
truck furnished by the profunda, and the subsequent
length the artery runs without giving off any very large
branches. The Signorini’s clamp I found most appli¬
cable and convenient. In this instance the patient found
the steady down pressure of the clamp preferable to the
elastic pressure of either Carter or Reid’s compressor.
Sept. 19th.—I have examined the patient at this date
and find the obliterated artery is to be felt in the thigh,
along the course of Hunter’s canal, and the lower part of
Scarpa’s angle. The tumour is hard and small. Thero
is a little stiffness still in walking, and the numbness is
gradually disappearing. The patient is otherwise well,
and has oeen since working at nis trade for ten hours per
day.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. Beale, F.R.S.
(From Notes by Dr. Tonoe.)
HEPATIC ASCITES.
Margaret C., ast. 26, married; admitted April 1, dis¬
charged April 20; in hospital 19 days. Relieved . Dys¬
peptic two years, swelling of abdomen twelve months.
Catamenia scanty and irregular same time; loss of flesh
and colour ; costive bowels, and occasional jaundice. Was
tapped fifteen days ago. On admission, pale and weak ;
abdomen much distended with fluid ; girth at umbilicus, 44
inches. Rhonchus sibilus and crepitation at bases of lungs;
red lithate3 in urine ; no albumen ; 340 ounces clear fluid
drawn off by tapping on fourth day after admission. Two
days later, lower border of liver felt a little above umbili¬
cus, its surface rough and granular.
Treatment. —Diuretics, tapping, acetate of ammonia, and
chloric ether.
Re-admitted April 28, discharged May 5; in hospital
seven days. Relieved. Abdomen again much distended ;
great depression and dyspnoea; pulse small and rapid.
Was tapped on evening of admission, 422 ounces of fluid
drawn off; some abdominal pain afterwards.
Treatment .—Tapping; morphia, brandy, 6 ounces; after¬
wards aromatic spirits of ammonia, chloric ether, and de¬
coction of bark.
CIRRHOSIS OF LIVER.
L. P., aet. 32, land surveyor’s clerk; admitted Feb. 10,
died on Feb. 10; in hospital six hours. Acute rheuma¬
tism ten years ago; always subject to epistaxis. Previous
illness five months, with loss of appetite,-flesh, and strength,
and gradual enlargement of abdomen; pain across hypo-
gastrium one month. On admission, slight jaundice; some
oedema of legs; considerable ascites; superficial abdominal
veins enlarged. Pulse 120; respiration 40; coarse cre¬
pitation at left base. Liver as high as fourth rib; no
albumen in urine, but abundant lithates; skin dry; appe¬
tite bad; tongue red and dry, with a brown streak; vomit¬
ing of blood and coffee-ground matters, containing sarcince,
soon after admission; death from syncope.
Post-mortem Examination .—Lungs gorged; much serous
fluid in abdomen. Liver 93 ounces, firm, pale yellow,
fatty, with commencing cirrhosis. Heart healthy.
Hydrocyanic acid and tincture of ginger; ice; brandy
6 ounces. Haust. effervescens.
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LITERATURE.
October 18,1868.
RENAL (?) DROPSY.
Will. M., set. 39, carpet planner; admitted July 12, dis¬
charged August 30 ; in hospital 49 days. Recovery. Al¬
ways temperate; subject to winter cough. Had “brain
fever” twelve years ago; dropsy one month afterwards,
and again twelve years ago; well till one year ago, when
pain in chest, cough, and swelling of legs and abdomen;
now slight oedema of legs; much ascites; pain in right
chest; cough, expectoration, and dyspnoea. Crepitation
below left scapular angle; dulness and fine crepitation
below right scapular angle ; sibilus over upper part of
left lung. Chest resonant and barrel-shaped. Heart’s
sounds normal but faint. Urine pale; contains one-fourth
albumen, and a few large waxy casts.
Scammony powder, sesquichloride of iron, chloric ether,
and dilute hydrochloric acid.
ACUTE RENAL DROPSY.
J. S., set. 29, lithographic printer; admitted February
13, discharged March 26 ; in hospital 42 days. Recovery.
Five months ago, pain in epigastrium, sour risings, cough,
oedema of legs, and high coloured urine. Dropsy nearly
disappeared after treatment; worse ten days ago. On ad¬
mission, anasarca and slight ascites; urine pale, one-half
albumen, 1022, with large and small waxy casts, some con¬
taining a little oil and renal epithelium. Chest slightly
emphysematous ; sibilus and rhonchus all over it; slight
dulness and crepitation at bases behind; scanty mucous
expectoration. Tongue furred.
Sesquichloride of iron and dilute muriatic acid; jalap
and scammony powders; hot-air baths.
H. R., aet. 49, smith; admitted March 23, discharged
April 13; in hospital 21 days. Much relieved. Tem¬
perate; cough two months; oedema of legs six weeks.
On admission, urine scanty, containing two-thirds albumen,
small waxy and granular casts, renal epithelium, and blood;
twenty days later only a trace of blood and albumen in
urine; no dropsy.
Sesquichloride of iron; compound scammony powders.
Maria K., set. 17, book folder; admitted April 16, died
on July 12; in hospital 87 days. Previous illness three
weeks; vomiting, headache, thirst, and cedema of legs.
On admission, face puffy; moderate dropsy of legs; tongue
furred; bowels confined. Urine contained one-half albu¬
men, blood globules and renal epithelium, and a very few
small waxy casts; twenty-four days later urine containing
albumen one-third, blood globules, renal epithelium and
waxy casts, containing oil globules. Frequent vomiting
after eight days later; ten days later much pain in chest;
no rub; urine containing more blood. Eight days later,
delirious and restless; pulse almost imperceptible. Fresh
pain two days later, ana to-and-fro sound over heart. Cre-
itation at base of left lung; diarrhoea and vomiting; ex-
austion; death.
Post-mortem Examination. —Fluid in peritoneum and
pleurae; sanious fluid in pericardium ; honey-combed re¬
cent lymph on heart. Lungs cedematous. Kidneys large,
nine and a-half ounces each, mottled, pale, and fatty.
Sesquichloride of iron and scammony powders (fourteen
days); gallic acid and inf. rosae co. (ten days); sulphate of
iron, quinine, and sulphate of magnesia (fourteen days);
hydrocyanic acid and bicarbonate of soda (twenty-one days).
Then iron, quinine, creosote, and henbane; podophyllin;
hot-air baths ; dry cupping; turpentine stupes to chest.
Alfred M., fet. 3£; admitted December 5, discharged
January 27 ; in hospital 53 days. Recovery. Weak since
measles six months ago; cliicken-pox one month ago ;
oedema of legs fourteen days ago, followed by slight ascites.
On admission, no ascites; slight pitting of legs ; urine
albuminous, containing (four days later) granular casts,
renal epithelium, blood globules, and pus cells. Twenty-
eight days later, no blood globules or renal epithelium.
Nineteen days later, no albumen.
Liq. ammon. acetatis and sp. etheris nitric, (five days) ;
then syrup of iodide of iron, warm bath, scammony and
jalap powders.
RENAL DROPST.
Mary A. D., ad. 28, married ; admitted July 14, dis¬
charged July 27; in hospital 13 days. Very much relieved.
Intemperate; had general dropsy a year ago, followed by
partial recovery; dropsy increased again about four months
ago. On admission, moderate ascites; slight cedema of
legs; thirst; indifferent appetite; urine one-third albu¬
men.
Liq. ammon. acetatis; tincture of squills and sp. jump,
co. (two days); compound scammony powder; sesquichlo-
ride of iron and quassia.
ACUTE RENAL DROPST—BRONCHITIS.
Ann B., aet. 30, married ; admitted April 25, discharged
June 18; in hospital 54 days. Recovery. Winter cough
six years ; cough six months ; previous illness one week;
shivering, vomiting, anorexia, oedema of feet and ankles.
On admission, moderate oedema of le<re; face pasty; urine
one-fourth albumen, containing blood globules, renal epi¬
thelium, and epithelial casts. Headache; pulse 80, respi¬
ration 28 ; cough and expectoration ; rhonchus and sibilus
over lungs, especially at posterior apices ; crepitation at
bases. Twenty-one days later, only a trace of albumen in
urine.
Aromatic spirits of ammonia, ether, and ammoniacum
(three days); chloric ether and sesquichloride of iron;
purgatives.
ACUTE RENAL DROP8T.
W. S., mt. 34, timber porter ; admitted November 18,
1863, discharged January 9, 1864; in hospital 52 days.
Recovery. Previous illness seven days. Had got veiy
wet two days before. Scanty and high coloured urine,
loss of appetite, thirst, headache, and pain in loins. On
admission, • general anasarca; slight dulness ; crepitation
and feeble bruit at bases of lungs. Pulse 52 ; pain in left
side (two days); urine dark, sherry coloured, and albumi¬
nous. Twenty-six days later, pain and pleuritic rub in
left inferior lateral region.
Liq. ammon. acetatis and chloric ether; then sesqui¬
chloride of iron, chloric ether, and quassia; pepsine;
quinine; compound jalap powders; hot-air baths; cupping
over loins ; brandy twelve ounces.
Ann H., set. 31, admitted February 9, discharged Man*
16 ; in hospital 36 days. Relieved. Previous illness six
weeks. Pain in loins, vomiting, dark urine, and oedema
of legs. On admission, general anasarca; cough; rhonchus
and crepitation at bases of lungs ; urine smoky, one-eighth
albumen. Thirty days later, no albumen. Two days
later, free from dropsy.
Compound jalap powder; jalap and scammony; aro¬
matic spirits of ammonia ; liq. ammon. ace tat. and chloric
ether. After March 1, sesquichloride of iron, chloric ether,
and quassia.
(To be continued.)
-4-
literate.
HEIBERG’S RESEARCHES ON SYPHILIS!
It is well known that of late years the questions of the diag¬
nosis and treatment of syphilitic disease has been undergoing
a silent revolution. The spirit of scientific scepticism, which
has done so much for all parts of human affairs, has not failed
to make itself keenly felt in medical science, and the treat¬
ment of syphilis is at this moment one of the most debated
points in the whole range of therapeutics. Our English reader*
are well aware that there have been strenuous efforts on the
part of Dr. Hughes Bennett, Mr. Syme, Dr. R. McDonnell,
Mr. Weeden Cooke, Dr. C. Drysdale, and others, to dethrone
mercury from its high sovereignty in the treatment of syphilis *
whilst our foreign friends are equally aware of the rooted ***'
tipathy to this drug, in the treatment of syphilis, entertained
by Professors Bceck, Hermann of Vienna; and Drs. Depr®
and Dolbeau in Paris.
1 Rgsultat des Rechercl.ds faites a Christianiasur l’effttdu VinuSjpJj-
litique. applique au corps hum sin, exposes par Joh: Heiberg, Chiroig^ D
general de l’Annee Norv^gienne, Christiania, 1868.
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LITERATURE.
October 28, 1808. 373
The pamphlet above alluded to is an interesting rlsinni of
the investigations of comparative treatments of syphilis, which
has been recently made in Christiania, the capital of that
charming laud of summer tourists, Norway.
Fortunately, it will not be necessary for us to go into the
question of the treatment so much favoured by the much
respected Professor Boeck, since his stay in London, and the
criticisms, friendly and antagonistic, which followed his ex¬
periments on the female inmates of the Lock Hospitals, have
made most of us familiar with the details of the process of
Syphilisation.
Our author enumerates some of the occurrences which take
place during syphilisation, as follows :—
The exanthems of the skin gradually dry up. The iritis requires
no peculiar treatment, except to dilate the pupil by atropine.
Tertiary symptoms, such as tuberculo-serpigenous svphilides
and deep ulcers of the mucous membranes, completely dis¬
appear or become much better, and only a little iodide of
potassium is required to secure a complete cure. Osseous
tumours, on the other hand, are rarely absorbed. Some
phenomena, particularly mucous tubercules or ulcers of the
mucous membranes, may sometimes persist or arise again
after that syphilisation has vanished. In newly born children
syphilisation does not take at all, unless practised daily, and
even in this case the reaction does not commence hardly before
a period of fifteen days.
Dr. Hiort, another medical man of Christiania, believing
that the only advantage of the process of syphilisation em¬
ployed by his colleague, Dr. Boeck, resided in the derivation
caused by the pustules formed, employed ointment of tartar
emetic for a like reason, and the results he has arrived at are
summed up by our author as follows :—This process cannot
be applied to newly born-children, since it raises too severe
pustules to be side in these delicate creatures. Syphilitic
symptoms very frequently disappear during derivation, with¬
out any relapses appearing. Consequently experiments were
also made to see how syphilis went on when no remedies
(internal) were employed. “ For this reason several practi¬
tioners in Christiania have abandoned the disease to its own
course, or have simply treated those symptoms whose conse¬
quences could be foreseen. These experiments have shown
that in leaving the diseaso to itself, it develops itself in the
three following ways:— (a .)—The disease may appear with
insignificant symptoms : a slight roseola, some mucous tuber¬
cules, or slight excoriations in the throat. All these phe¬
nomena may disappear in a few weeks, without leaving any
traces. In other words, the universal venereal disease, once
produced by the syphilitic form, may be cured or run through
its natural period without being followed by any relapse.
Consequently, syphilisation may be avoided in certain cases.’'
“ ( b .)—The different exanthem forms which belong to the
secondary period may develope in the course of four to six
months, and then gradually disappear. The general condition
of health is bad for a long time, but when at length the
phenomena commence to disappear it gets better.”
“ ( c .)—The disease develops itself more and more, without
even gradually diminishing. In this case it may last a long
time, and even until the patient may sink under syphilitic
cachexia.”
“ In the two latter cases (b and c), there appears to exist no
remedy by means of which we are able to make the syphilitic
symptoms disappear with so much security and quickness as
by syphilisation, during which the disease passes through its
natural phases. Nevertheless, there is no remedy by which
the organism, once changed by the syphilitic poison, can be
brought to the normal state so as to prevent also the disease
being reproduced in the offspring. Women, and in certain
cases men, attacked with constitutional syphilis may some¬
times, during several years, produce syphilitic children, in
whatever manner the disease may be treated. It is for the
future to determine up to what point the different modes of
treatment may cause different results for the offspring.”
44 As to the health of the patient, the different methods have
shown the most different results. In this respect the testimony
of Dr. Hiort, who has been physician to the syphilitic hospital
for forty-five years, is peculiarly remarkable. He says that
after the mercurial treatment, tertiary symptoms present
themselves pretty frequently, but that they have become rare
during the last twelve years, since the employment of mercury
has been in great part abandoned. He adds expressly that
phagedenic and serpigenous ulcers, paralysis, and epilepsy, and
insanity, and the like have very rarely appeared, and that
even when this has been so, he has recognised that they have
been essentially the consequence of the mercurial treatment of
past epoques.”
These remarks of Dr. Heiberg are remarkably interesting,
and seem to indicate that the efforts recently made by several
among our ranks to abolish the use of mercury in constitutional
syphilis were worthy of all praise.
-♦-
POOR-LAW MEDICAL OFFICERS’ ASSOCIATION.
The following is from the Quarterly Report of the Council,
submitted at the meeting as we go to press (Tuesday) : —
Your Council beg to report that they have been chiefly
occupied during the past quarter with measures for com¬
pleting the organization of the Association, which now num¬
bers 600 members, and is efficiently represented by sixty-six
local secretaries in nearly every part of England and Wales.
This success, great as it is, does not represent the whole truth,
as many names have still to be received from the local secre¬
taries, many of whom have discharged their self-imposed task
with the most commendable energy and disinterestedness. If
every member would take up the cause in the same spirit and
use his influence with friends and colleagues, the number of
members would soon be doubled ; and this is very desirable,
as showing unanimity of feeling and wide-spread sense of in¬
justice among the Medical Officers, which could not fail to
strengthen the Association and increase the prospect of a
successful issue to its labours.
Your Council, having carefully considered the subject, are
of opinion that it is desirable to devote their efforts for the
present to the attainment of two of the principal objects of
the Association, viz., permanence of appointment and ade¬
quate remuneration. With reference to the first subject, it
must be remembered that the Select Committee of the House
of Commons in 1854 recommended that every Medical Officer
should be appointed for life. How imperfectly that recom¬
mendation has been carried out may be gathered from the
fact that many hundreds of Medical Officers are still subject
to annual re-election, whereby their usefulness is sensibly
impaired, and their independence, in the discharge of duties
requiring the exercise in a high degree of that quality, reduced
to a minimum. While on the question of remuneration,
though all competent authorities have confessed that the
general scale is wholly inadequate, no action has been taken
by the Poor law Board to raise and equalize the salaries upon
something like a satisfactory basis. The Association must
appeal to the House of Commons for redress of these ad¬
mitted grievances, and for some measure of long-delayed
justice. This appeal must be by petition, not only from the
Association, but from the Medical Officers both individually
and, in their respective Unions in all parts of the kingdom,
collectively, setting forth the defects and the injustice of the
present arrangements, and praying that it may be made obli¬
gatory on the Poor-law Board to adjust all salaries upon some
such basis as shall really compensate the Medical Officer for
his work. The Board possess this power, and it is but just
that they should be called upon to exercise it, seeing that they
represent the Government which pays out of the public
revenue, for work done on behalf of the public, a moiety of
the salaries of all Medical Officers. At the same time every
member, nay, every Medical Officer should do what he can to
increase the parliamentary influence of the Association, by
securing pledges in favour of Poor-law Medical Reform from
candidates at the coming general election.
-+-
Ovariotomy. —Dr. Dunlop, of Springfield, Ohio, has per¬
formed ovariotomy on 38 patients since 1843. Of these, 13
were unmarried. The operations were all by the long incision,
and only two were without anaesthetics. Nine died after
operation ; one from peritonitis, two from haemorrhage, one
from chloroform, one from accidental overdose of morphine,
one complicated with cancer, one from exhaustion, one from
congestion of the brain, and the ninth from excessive vomiting.
Three of the successful cases have died since their recovery
from the operation, of other diseases ; the remainder are all
now living, and in good health .—Boston Medical Journal .
Novel Treatment op Sunstroke. —Dr. F. G. Herron, one
of the city physicians of Cincinnati, Ohio (Med. and Surg.
Reporter ), has tried in two cases, with success, the following
treatment in sunstroke :—Warm water was applied to the
head, on cloths, as warm a3 the skin could bear without injury.
Consciousness was very soon restored. Liquor ammonias
acetatis was administered internally as a stimulant.
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NOTES ON CURRENT TOPICS.
October 28,1863.
Registered for Transmission Abroad.
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every Wednesday morning. Trice 5 d. Stamped 6d.
By Tost to Annual Subscribers , £12 6
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Annual Subscription, post free, Ten Dollars.
5DJ n IpMatl Jfrcss imb fecwlnr.
“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, OCTOBER 28, 1868.
-♦-
VENTILATION OF TROOP SHIPS.
In the year 1500 the system of side ports for the pur¬
pose of ventilation was adopted from France, and intro¬
duced into British-built ships. The improvement thus
effected in conditions that had up till then existed was of
great importance ; yet that it was far from removing them
is evident from the accounts that have come down to us of
the insanitary state in which vessels continued to be
throughout the greater part of the two succeeding cen¬
turies. In 1748 Mr. Sutton introduced an improved
system of ventilation, in reference to which Admiral
Boscawen wrote that he could not “ help thinking the
air-pipes fixed in the men-of-war have been of great ser¬
vice, by purifying the air between decks, and thereby pre¬
venting the scurvy '* Still later, yet many yeare ago,
Dr. Cutbush recommended that a tube for the escape of
foul air should be introduced next the fore and main
masts. The advantage of deck openings was very soon
recognised by the Admiralty, and minute instructions
laid down in regard to them; and various kinds of appa¬
ratus, of which, perhaps, the best known is that by Dank,
have been in use for causing the removal of foul air and
the introduction between decks of that which is pure and
respirable. More recently still, Gavin Milroy introduced
his system of ventilating steam vessels by means of tubes
communicating with the funnel; a plan similar to that
proposed for schools by Varley was applied to emigrant
Bhips, the intention being that the wind entering at one
end should drive out the impure air by escape openings
at the other; and yet more lately, Edmond’s system has
been introduced into many vessels, the Indian troop ships
among others.
Parkes, in his valuable work on Hygiene (page 580)
adverting to ventilating tubes on board ship, observed
that their proper size and number has not yet been expe¬
rimentally determined ; probably as there is a good deal
of wind, these need not be so large as in houses on
shore ; but it is always best to have plenty of them. If
necessary, some could be closed. Perhaps a tube of eight
inches diameter would do for ten persons, giving five
inches to each for inlet and outlet. Of course, hatches,
windsails, ports, and tubes, should all be in action at the
same time.
The American Sanitary Commission laid down a code
of rules regarding the ventilation of transports, directing,
among other points, that when troops occupy the lower
deck, the a;. ; >f outlet openings for air should be equal
to four square feet per one hundred men ; this, with the
vessel proceeding at the rate of five’knots an hour being
equivalent to one thousand cubic feet of air during that
time. Gordon, also, in his work on Army Hygiene, gives
minute directions regarding this important subject He
describes various methods employed, and details the
amount of ventilating space actually existing on board
some ships that had been taken up by the Emigration
Commissioners, and of others by the Indian Government,
in all of which the plan and extent of ventilation had,
since 1860, been arranged according to definite principle!,
the entire ventilating space being in one instance equal
to thirty-six superficial inches per person embarked, and
then declared inadequate; in another, seventy-three
inches for inlet and outlet. He says, moreover (page 90),
that few vessels have so much as sixty-five or seventy
square inches per person, and only in a very few of the
first-class merchant ships and steamers does it amount to
eighty inches.
From all this, and much more that has been written on
the subject, it was natural to presume that the subject
had been fully considered, not only by medical officers in
our own country, but by professional men in America; it
is, therefore, with some measure of surprise we learn that
the Bombay Sanitary Commission has lately written with
regard to it as if the question were an entirely new one.
Thus, the Lancet of 10th October, 1868, learns from the
Report of the Sanitary Commissioner for Bombay for
1867 that Lord Napier has expressed an opinion that
the ventilation of troop ships should be reduced to a
system ; that there should be throughout five superficial
inches of ventilating opening to every ten and-a-half
feet of occupied deck space, or, in other words, to each
adult ou board; that there should be a minimum of half
a square inch to one square foot of net deck surface, after
deducting for hatchways, masts, lockers, &c. The question
appears to have arisen in connection with the overland
route system of steamers for the conveyance of invalids
and troops between India and this country.
We have not seen the report from which that quotation
is made, but presume that what is hero extracted only
alludes to tube ventilation. It is, no doubt, a very im*
portant item in a system of ventilation, but only as an
auxiliary. Were it to be trusted to more than in an in¬
finitesimal degree, the amount, as here quoted, would
simply cause suffocation of troops, women, and children
on board. Ports and deck openings, including tubes, are
the means to which we must trust, and these combined
must afford ventilating space, including inlet and outlet
of not less than seventy-five inches per person.
-♦-
llcdcs an Current ij&nprs.
Medical Society of London.
The first meeting of the Session 1868-69 of the above
Society was held on Monday evening, the 19th inst., »t
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•Hi* Medical Frew and Circular.
NOTES ON CURRENT TOPICS.
October 28, 1868. 375
George’s street, Hanover square. There was a very large
attendance of Fellows, and as the rooms of the Society
underwent during the summer months re-decoration and
re-arrangemont, they presented on the above evening a
gay and a smart, if not a brilliant, appearance.
The President occupied the chair at eight o’clock, and
after the minutes of prior proceedings were read, and con¬
siderable preliminary business transacted, Mr. Henry Smith
exhibited a patient on whom he performed the operation
of excision of the knee-joint; and Mr. Francis Mason ex¬
hibited a patient from whom he removed a portion of the
tibia. Then the real business of the evening commenced.
Dr. Richardson read a most interesting paper on “ Blood¬
letting as a Point of Scientific Practice.” An animated
discussion followed, which was kept up till long after the
usual hour of adjournment. Very many of the Fellows
present having spoken on the subject; very many, too,
regretting that time did not permit, just then, for their
opportunity to further discuss it. A considerable number
of old medical gentlemen attended the meeting, anxious
to ascertain if the opinion of the profession was modified
and had become less negative as to the advantages of vene¬
section ; and the majority of this section of the Fellows
being in favour of the operation, they displayed in a marked
manner their full appreciation of the sentiments expressed
by those speakers who held like views.
A vote of thanks to Dr. Richardson was passed by
acclamation, and a like honour paid to Mr. James F. Clarke
(who pithily returned thanks) for his gift of a valuable
volume to the Library of the Society.
Alleged Lunatics.
A certain Mr. Mulock informs the Staffordshire Times
that he found five years ago (!) the County Asylum con¬
tained “ imputedly insane inmates and he avers, that as
“ sure as ho holds his pen there are scores upon scores ” of
such persons now confined there. We are not going to
enter into argument with Mr. Mulock. He talks too
wildly for that, and throws ont charges which, we have no
doubt, the authorities will easily rebut.
But that his ideas of proof are apparently innocuous to
anyone, we should have felt inclined to call them delusions
that rendered him a proper subject for restraint.
Such statements, founded on what he saw five years ago,
are most likely as unfounded as they are startling. Still,
one of the Medical Officers may think it right to examine
them.
Homoeopathy.
We have received several communications respecting the
false report that the Emperor of Russia had proscribed
homoeopathists. We should have regretted any such at¬
tempt to put down the delusion, and therefore congratulate
the persons who have escaped persecution. Truth is
the best weapon with which to meet all systems of the
kind. We believe homooopathy is fast dying out. The
dogmas on which it rests cannot survive the rapid rtiarch
of science, and it will soon be a confession of ignorance to
assume the name of homoeo—or any other—path.
The late Dr. Sibbald.
This veteran Edinburgh practitioner is no more. He
entered the profession in 1818 as a Licentiate of the Edin¬
burgh College of Surgeons. In 1824 he took his M.D. at
St. Andrews, and five years later became a Fellow of his
College. Most of his long professional life, which closed
on the 19th ult., was passed in practice in the Scottish
capital, though of recent years he may be said to have re¬
tired. He has left a handsome fortune, and in his will
has not forgotten the public institutions of Edinburgh.
He was for some time an active member of the Town
Council, and always had keen interest in politics.
University of Aberdeen.
At the last meeting of the General Court of the Univer¬
sity of Aberdeen, Dr. Kilgour was elected to the office of
assessor for the ensuing year. Prof. M‘Pherson thought
there was great propriety in putting Dr. Kilgour forward,
as the University Court contained no medical man, and
the Faculty of Medicine should have a representative.
Mr. Humphrey having asked his present views as to throw¬
ing open the meetings of the Court to the representatives
of the press, Dr. Kilgour, in thanking the Court, said:—
“ I still retain the views I formerly held in regard to
opening, under proper and well understood restrictions,
the University Court to reporters of the public press.
With all courts of law, with church courts of every deno¬
mination and persuasion, with all civic corporations and
hospital corporations and charities, and, in fact, every re¬
presentative body open to the press,—I could never see a
shadow of reason for closing the doors of a University
Court against them. And it is the more necessary now
that the proceedings of the Court should be opened, seeing
that there are so many members of the University, and
spread over the length and breadth of the country, who
might expect to know, and who are entitled to know, our
reasons for the decisions we arrive at through the ordinary
channel of newspapers. If I see my way to a harmonious
co-operation in this matter, I shall not fail to bring it for¬
ward, and, in doing so, I think that I shall only be adopt¬
ing your views. But, perhaps, I am speaking and demand¬
ing what is already an accomplished fact. For you have
all read, I have no doubt, in the newspapers this week, the
report of a very able and wcll-considered speech, which
was made in presence of the Court. I am very doubtful,
however, whether there were two or three reporters sitting
taking notes of that speech. I rather suspect that it had
been handed in in well-written MS. by the speaker himself.
I think, however, the demands of the Council in this matter
are likely to be realised. Edinburgh University is suc¬
cumbing—at least a very fine distinction is to be made,
and the Court is to be open to the press when registration
appeals are to be heard and decided upon.”
The Registrarship of the College of Physicians
of Ireland.
By a ludicrous printer’s error in our last issue it was
represented that Sir Benjamin Guinness had been elected
Registrar of the King’s and Queen’s College of Physicians
in Ireland, in the room of Dr. Athill, resigned. The
gentleman who now fills the office is, we need hardly say,
Dr. Benjamin Grattan Guinness, Secretary to the Medical
Association of the College. For Dr. Guinness twenty-
seven out of the thirty-seven recorded their votes, and for
the other candidate only ten.
King and Queen's College of Physicians.
Du. Grattan Guinness, whose appointment as Regis¬
trar we announced last week, still retains the Honorary
Secretaryship of the Medical Society. That body will
hold its second meeting on Wednesday, November 18,
and the other medical societies of Dublin will open in
the following week.
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NOTES ON CURRENT TOPICS.
October 28,1868.
Composition of Welsh Lake Water.
Some time ago Mr. Bateman, the eminent engineer, pro¬
posed to supply the metropolitan district with water col¬
lected from the lakes in Wales. This plan finds favour
with many influential persons in London, and may be
carried into effect before long. The town of Portmadoc,
in Wales, is about being supplied with water from a lake
situated about five miles from the town, and the composi¬
tion and properties of which, according to Dr. Cameron, of
Dublin, are as follows:—
Examination of Welsh Lake Water.
Specific Gravity . . . 1*00018
Colourless.
No peculiar odour or flavour.
A very faint acid reaction.
No suspended matters.
No deposit after twenty-four hours’ standing.
Degree of hardness . . . 1*25
One Imperial Gallon (70,000 grains) contains—
Grains.
Lime
*382
Magnesia
*221
Potash
*240
Soda
*180
Peroxide of iron
•042
Silicce
*041
Sulphuric acid
Chlorine . .
•200
*480
Nitrates and ammonia
. traces.
Organic matter
*501
2-405
Containing organic nitrogen *068 part per 1,000,000
y parts of wate.
The analysis of this water, which is of an extraordinary
degree of purity, is of interest from the fact that London
may yet be supplied with Welsh water.
The Golden Bridge Cemetery, Dublin.
This case came before the Privy Council on Monday
week, but it was announced that the War Office authorities
and the Cemeteries Committee had come to arrangement.
In future, great care will be taken to prevent the over¬
crowding of the Cemetery, especially at the side nearest
the barracks. Dr. Mapother and Dr. Cameron had re¬
peatedly examined the Cemetery, and had reported favour¬
ably upon the state in which it was kept. Dr. Cameron
found that no drainage from the Cemetery contained 13*28
grains of mineral matter and 3*08 grains of organic matter
per gallon. The Camac River, into which the sewage from
the barracks and the drainage from the Cemetery flows,
contains (before it receives these matters) 23 graius of
mineral and 10 grains of organic and volatile matters.
After the sewerage from the barracks find drainage from
the Cemetery pass into it, the mineral matter increases to
50*08 grains, and the organic and volatile matter to 26
grains per gallon. Thus, the amounbof solid matter in the
river is decreased by the drainage of the Cemetery, but is
enormously increased by the sewage of the barracks. Dr.
Cameron states that the Camac River, a few miles higher
up than the barracks, contains only four grains per gallon
of solids. These facts illustrate the enormous amount of
impurities which rivers receive from sewage.
The counsel for the Cemeteries’ Committee, and for
the War Office, have agreed upon the terms upon which
the action of the latter authority before the Privy Council
shall be withdrawn. Interments in the portion of tie
cemetery adjoining the Richmond Barracks shall be only
made under exceptional circumstances.
The Corrigan Election Fund.
We understand that on Saturday a guarantee fund for
the expenses of Sir D. Corrigan’s election was opened,
and that in a few hours over £500 was subscribed by
Dublin practitioners. Drs. Lyons, McDonnell, and Ma¬
pother liave issued a circular to the entire profession in
Ireland, which we feel sure will meet with a prompt and
generous response.
Storage of Petroleum.
The Health Committee of the Dublin Corporation,
having ascertained that many thousand gallons of this
dangerous article were stored in the city, have had several
specimens tested to ascertain the degree of inflammability.
No specimen was procured which gave off an inflammable
vapour at a lower temperature than 114°, so that all were
exempted from the penalties directed by the Acts of Par¬
liament. Considering the great risk of life and property
involved, other municipal authorities ought to be as
active.
The Varty Water Supply for Dublin.
The objectionable dark colour of the new water supply
for Dublin, which has been attempted to be explained by
various hypotheses, still continues, and excites much dis¬
cussion. The waterworks committee declare that it is the
result of the admission of the new water into the old pipes,
while the complainants retort that the water in the reser¬
voir is dark coloured.
Water containing much carbonic acid in solution if left
in pipes will produce a brown water in a very short time.
The peat colouring has been a difficulty before now. At
Manchester they exclude all coloured and turbid water from
the reservoirs, but do not seem to think the black water
necessarily unwholesome. Analysis of a specimen of bog
water collected between Killakee and Loughberay gave
1*20 degree of hardness by Clark’s test,
Organic matter . . . 3*02 grains
Inorganic ditto . . . 1*26 ditto
Total, . . 4*28 in a gallon.
Also a trace of ammonia, but no nitrates or nitrites.
Our belief is that if the Varty water were exposed in a
reservoir in which weeds were allowed to grow, all colour
would be extracted, as the above analysis shows the colour
to be organic matter, in a state ready for assimilation by
plants. At Manchester the black water comes only in
flood and at certain seasons of the year.
Mr. Bateman also says the turbid water is allowed to
settle in reservoirs, where it bleaches. The canal water
now delivered in Dublin is colourless, although we believe
the summit head is at the Bog of Allan ; if so, our idea is
borne out that vegetation will take up the colour. A cor¬
respondent of the daily papers has suggested that the bottom
of the reservoir ought to be paved, bub we never heard of a
reservoir being lined except about the water-liue, where
the lick or action of the water is likely to corrode the edges
of the bank. If any paving were done the whole water¬
shed would require it.
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CORRESPONDENCE.
October 28, 1868. 377
Honour to Surgery.
The University of Dublin has just received the patent
establishing a Regius Chair of Surgery, and the same
instrument nominates Mr. R. Adams as Professor. No
selection could be more unexceptionable, for, besides Mr.
Adams’s position at the head of Irish Surgery, he has
served the University in an honorary professorship for
many years. We trust it may be only the precursor of
further honours from Her Majesty fur the distinguished
Surgeon in Ordinary in Ireland.
Arrival of the Ship “Clara” at Portsmouth.
The hired ship Clara arrived at Spithead on the 17th
instant, with troops on board from Gravesend for Hong
Kong and Japan. The following day she was brought
alongside the Government jetty in the dockyard, for the
purpose of embarking additional troops for Ceylon. The
medical officer in charge and officer commanding the troops
on board then reported to the authorities on the spot
that, in consequence of the extremely offensive state of
the ship’s bilge, they considered it dangerous to proceed
to sea. The principal medical officer concurred, and a
board of naval and military officers having found the con¬
ditions such as they were described, it was determined not
to embark the troops at Portsmouth until the ship should
be thoroughly cleaned. The troops already on board were
not disembarked, hut measures were taken to have the
bilge washed out and deodorised. The process occupied
several days, quantities of rapeseed being pumped up as
the washing went on ; and the vessel being at last con¬
sidered clear, the troops proceeded on board on the 23rd,
and the following day she recommenced her voyage.
The Clara belongs to a class of ships that should long
ago have ceased to be employed for the transport of troops.
It may be considered a fortunate circumstance that she
had to call in at Portsmouth. Had she proceeded to sea
in the filthy condition in which she left the Thames, there
is every reason to believe that severe sickness in one form
or other would havo occurred on board on her reaching
tropical latitudes.
The Dublin Quarterly Journal.
We understand that Dr. Kidd, the Obstetric j Surgeon
to the Coombe Lying-in Hospital, who for many years has
ably and courteously administered the editorial department
of the Dublin Quarterly Journal of Medical Science , has
retired from its proprietary and its editorship. We believe
that the Journal has passed into the hands of a Mr. Fal¬
coner, the printer of the “ Official Railway Guide,” and
that the editorial management has been confided to Dr.
Belcher, formerly Sub-Editor of the Medical Press and
Circular in Ireland. Every member of his profession
will feel regret at the retirement of Dr. Kidd from the
literary labours which he has discharged with so much
benefit to Irish Surgery, and with the marked approval of
the contributors of the Dublin Quarterly.
Woolwich Dockyard Drainage.
This drainage is not connected with the Southern Out¬
fall, and we are glad to be informed that the Local Board
of Health has remonstrated on this fact, in consequence of
which consent has been given, and the next Navy esti¬
mates will contain an item of the cost. Public money
could not be better applied than to so necessary a work.
Bitter Beer.
Foiled in the attempt to raise a new alarm about
strychnine in bitter beer, the sensationalists are suggest¬
ing picric acid. What next ? Did the coloured socks
suggest this lame attempt to get up a new sensation ?
Pauperism.
913,084 persons were in receipt of parish relief on the
last day of July. This is exclusive of pauper lunatics.
The number exceeds that of the same period last year by
36,064.
Sir D. Corrigan’s Candidature.
We beg to draw the attention of our readers to the
announcement in our advertising columns of the election
fund so handsomely inaugurated to meet the expense of
Sir D. Corrigan’s candidature.
We notice that Professor Lionel Beale, F.R.S., is an¬
nounced to give lectures on “ The Anatomical Element or
Cell,” as a course under direction of the trustees of the
Museum in connexion with the Radcliffe Library, Oxford.
These demonstrations on Histology will be an attraction
this term.
South Dublin Union. —Dr. Owens and Alderman
Maiming, having resigned the elected Guardianship of
the South Dublin Union, in consequence of their being
appointed ex officio Guardians as magistrates. The Poor-
law Commissioners have accepted their resignations.
- -4 -
(&oxxts$avi!nxttt.
LYING-IN HOSPITALS AND EXTERN
MATERNITIES.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, — In his admirable letter to the Governors of the
Rotuudo, Dr. E. Kennedy states the objects for which it was
established to be : To preserve tlio lives of poor women and
their infants ; to prevent child-desertiou and infanticide; and
to instruct male and female pnpils and students in the prac¬
tice of midwifery. The hospital authorities have been very
successful in respect to the last-mentioned object, and it may
be useful, just now, to explain how far they have not been so
in regaid to the preservation of the lives of women and their
infants. Assuming that the practice of midwifery as an art,
and as a department of medical science in the curative treat¬
ment of puerperal women and of their infants, required to be
improved in 1756, when the Charter was granted to the
Rotundo, scarcely any better means of effecting that object
could be devised than those which were placed at the dis¬
posal of the Rotundo authorities : labour cases in abundance;
funds sufficient to meet tho necessary expenditure ; a succes¬
sion of well-educated medical men to superintend; and an
hospital with ample accommodation. under these very
favourable circumstances it would be reasonable to expect the
results of the practice of that hospital to show a gradual
improvement in the curative treatment, according as the
medical authorities had acquired the information and expe¬
rience which such au institution must necessarily afford. As
regards the labour cases, the average mortality under the first
five masters, including Dr. Moss, was in the proportion of
1 to 91 births, ranging from 1 in 32, tlio highest in one year, to
1 in 193, the lowest in another. Under the next five masters
the mortality was 1 iu 86 births, the highest in any year being
1 in 35, the lowest 1 in 214 ; with ilie next five the mor¬
tality averaged 1 iu 75 births, the highest in the year being
1 in 30 births, the lowest 1 in 223. Under tho sixteentn
and seventeenth masiers tho mortality averaged 1 in 36J
births, the highest iu a year being 1 in 14 births, tho lowest
1 in 64.
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TRANSACTIONS OF SOCIETIES.
October 28,1818.
With Dr. Moss the mortality of infants in the old hospital
was 1 in 10£, and in the Rotundo 1 in 5$. Under the next
four masters 21,694 children were born alive, aud 3,074, or
1 iu 6J, died ; tho highest mortality in a year was 1 in 4, the
lowest 1 in 25. From 1787 to 1854, both inclusive, 1 child
in 48 died ; the proportions rangiug from 1 in 20 iu one year,
to 1 in 469 in another. In several years the mortality of
infants was not 1 per cent. From 1854 to 1864, both inclu¬
sive, 1 in 30 died ; tho lowest mortality in a year being 1
in 43, the highest 1 in 20.
Whether the enormous mortality of infants under the first
five masters is to bo attributed to the defective ventilation of
tho hospital, bad nursing, or to these and other causes, it is
evident that tho object of preserving tho lives of infants was
not then attained ; for if the mortality had been only 1 in 10^,
as in tho old hospital, 1,177 less would have died ; aud had
it been 1 in 46, as under tho subsequent twelve masters,
only 468 would have diod,2aud 2,761 lives would have been
saved.
The gradually increasing mortality of the women that wero
confined in tho Rotunda is a very remarkable circumstance
iu the history of Lying-in Hospitals, as all the means of effect¬
ing a different result existed.
A Commission, appointed in 1830, to report on Dublin
Charities, states, 14 That the Rotunda is an establishment of
national utility, as it affords instruction to male aud female
pupils ; but they would advert to a topic of much im¬
portance, It appears, from authentic documents at different
periods submitted to tho executive Government, that puer¬
peral fever frequently appears in tho hospital, and carries off
many of the women in it. The mortality at different times
was so considerable, that in the year 1820 the General Board
of Health was directed by the Lord-Lieutenant to inquire and
roport on tho frequency of puerperal fever iu the hospital,
and on the means, in their opinion, to arrest its mortality.”
The Commissioners report that, “Whenever this mortality
was greater than ordinary, it arose from the prevalence of
puerperal fever; that tho disease has existed chiefly in the
hospital, and has not at the same time prevailed to any ex¬
tent in the city; that when it makes its appearance in tho
Lying-in hospital, it generally spreads through the establish¬
ment; and that, in tho opinion of two most judicious physi¬
cians who have acted as masters in the hospital, the frequent
prevalence of this disease is more or less connected with tho
numerous admissions of patients to its wards." The Commis¬
sioners submit a recommendation from the Board of Health of
1820, 44 That thoso females who cannot be admitted, shall bo
attended by male and female pupils, accoucheurs, under tho
superintendence of tho master, and that admissions into the
hospital, as well as tho attendance on women at their own
homes, shall as much as possible be limited to paupers. 5 ’
Tho Commissioners of 1842 state, that 44 In conformity
with a previous recommendation of the Board of Health iu
1820, the Commissioners of 1830 recommended that, in the
event of the admission being limited to 2,000, females apply,
iug for relief, and who cannot be received into hospital, shall
be attended by pupils at home under the master. This recom¬
mendation does not appear to have been extensively acted on.
Wo feel it our duty to repeat it, as calculated to enlarge the
usefulness of the institution. ”
These Commissioners ask the two immediately previous ex-
Masters, 44 What means have been taken since 1829 to check
the spread of puerperal fever ? ” 44 In what degree have those
means proved effectual?” and 44 Does puerperal fever appear
to have prevailed more extensively when any general epidemic
has prevailed in Dublin ? 55 Dr. Collins replied, “In February,
1829, when I was Master, puerperal fever prevailed, and for
several months had prevailed, iu tho hospital, now increased
with much intensity. On consulting with the Medical Com¬
mittee, it was recommended that no jmtients, except such as
were absolutely destitute , should be admitted, but that attend¬
ance should be afforded to all that wished at their own homes,
until the entire wards should have been thoroughly purified.”
“This was done.” 44 In the hospital, the sick were invariably
placed apart from the healthy. To this precaution too much
attcutiou cauuot bo paid. I am satisfied that instant sepa¬
rating is of great importauco to both.” 44 The disease be¬
came epidemic in the hospital on several occasions when typhus
and erysipelas prevailed in the city. I know two remarkable
instances where patients in a bad form of typhus fever were
admitted at night, and placed in beds adjoining other lying-in
women, who were shortly after attacked with puerperal fevdr ;
in the first instance, the two females in the adjoining beds
were attacked, and both died ; in the second, there were only
three women in the ward with the patient in typhus—all were
attacked, and two died. Both tho patients had been only a
few hours iu the ward with the other women. But I have
known several similar instances without any bad effect.”
Dr. E. Kennedy replies, 44 Strict separation from patients
attacked with puerperal fever was adhered to. The history of
my mastership proves that, as yet, we possess no effectual
means of prevention in this disease. In no ono year was 1
free from it, though I did everything that human ingenuity
could devise. I must add my conviction, that the only check
to its spread in the locality in which it appears is to refuse
patients admission within the sphere of its fatal influence.”
The Rotundo authorities did not, as recommended by these
Commission Boards, limit the annual admissions to 2,000:
they increased them. Iu 1820 the admissions were 2,674;
in the next year 3,052 were admitted ; and in each of 27
subsequent years more than 2,000 were admitted. Neither
did they give attendance to labour cases at their own homes
when puerperal fever prevailed in the hospital, as recom¬
mended by tlieso Commissioners; for instance, in 1863, only
two extern labour cases were attended, though 32 died of
puerperal fever in the hospital; and in the four years ended
March, 1867, only 60 labour cases were attended at home,
though 83 died of puerperal fever in tho hospital: 20 in the
first year, 15 iu the next, 22 in the third, and 30 in the
fourth. And the very important preventive measure of sepa¬
rating the healthy from the sick has not been practised lately,
os we learn by Dr. Telford’s letter quoted in my last.
The character of the Rotundo, and that of its Medical Staff,
is, aud always lias been, so high, that I have felt it necessary
to quote these returns and official recommendations to show
the results of the practice of that institution, as these results
would not, perhaps, otherwise be credited. I confess that,
when I began to examine the Registry Abstracts, I did not
expect these results; and as, perhaps, most, if not all, that
are connected with the hospital, are not aware of them, to
the full extent, at least, their publication may help to clear
the way for improving the ineaus of attendance on the class
in question in Dublin. This, I believe, can best be effected
by a judicious, but not an indiscriminate, admission of fit
objects to hospital, and by giving attendance on those that
chose to remain at home, so as to save thorn from ignorant
mid wives and ignorant neighbours.
Iu Mr. Simon’s roport to the Privy Council he observes,
44 Labour is a natural process, aud only a comparatively small
number of cases calls for tho special exercise of skill in nurse¬
tending or medical treatment There are, therefore, generally,
in the case of puerperal women, none of the30 special objects
to be gained by becoming the inmates of a lying-in chanty,
which the diseased and maimed seek by admission into general
hospitals.” Had tho sixteen women, alluded to by Dr. Telfonl,
that died of puerperal fever iu tho Rotundo, acted on this
view, probably most, if not all, would have done well at home.
I may, perhaps, soon offer a few suggestions for improving
the means that exist in Dublin to assist this poor lying-w daw,
and to make better hospital provision for another, which can
bo adequately attended only bv experienced midwifery practi¬
tioners : I mean thoso afflicted with particular female diseases.
Denis Phelan.
28th September, 1868.
-♦-
toiMcfimifs of
MEDICAL SOCIETY OF LONDON.
Oct. 19th, 1868.
B. W. Richardson, M.D., F.R.S., President, in the Chair.
Thirty-five new Fellows having been proposed for election,
Dr. Sansom, Hon. Sec., read the following letter :—
“ 23 Gerrard Street, Soho.
44 My dear Sib, — I am desirous of presenting to the Medical
Society of London, a black-letter copy of the works of Hip¬
pocrates. It is in good condition, and is rare. It was given
to me by the late Mr. Travers. It appears to me that such a
work should be placed in some public library. I have selected
that of the Medical Society as the most proper one to reoeiye
it. That library is probably the richest in the kingdom m
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TRANSACTIONS OP SOCIETIES.
October 28,1868. 379
rare medical works ; and this will, I hope, do no discredit to
the collection. Moreover, I wish, in retiring from my public
duties as a journalist, to show some mark of my gratitude to
the Fellows of a Society amongst whom, for nearly forty years,
I have laboured, and from whom, on all occasions, I have
received the utmost kindness and consideration.
M Believe me, my dear sir,
“ Faithfully yours, J. F. Clarke.
“Dr. Richardson, President of the Medical Society of
London.”
The President said : I put it to the Society that a vote of
thanks be recorded to Mr. Clarke for his presentation. No¬
thing could be in better taste than a presentation of so valuable
and rare a work to the library of the Medical Society of
London. That library is specially rich in such works. There
is a rare copy of the great work of Michael Servetus, in which
the discovery of the circulation of the blood is foreshadowed.
There are Ward’s Diary , containing the only account of the
death of Shakespeare ; a manuscript copy of Areteeus ; the
whole of the works of Hoffman ; and many of the works of
Michael Albertus, the author of the essay Dc Curat ionc per
Similia . This new addition of Hippocrates will add to the
rare literary wealth of the Society in no mean degree ; and we
are much the debtors of Mr. Clarke on that account. But this
is a small debt compared with what is due to Mr. Clarke for
years of continued labour and anxiety on behalf of the Society.
I am told by our elders—for the events I am about to refer to
must have been ages before I was born—that forty years ago
Mr. Clarke commenced to report the proceedings of the
Medical Society of London. He had to contend against many
difficulties, and he was not at first even allowed a front seat in
the library ; but he persisted ; he reported honestly, fearlessly;
by his courteous and upright conduct he won his way ; he
became one of the most respected Fellows of the Society, and
has filled every office, save the distinguished office which I
have now the honour to hold. It is no exaggeration, gentlemen,
for me to say that, in some critical periods in the history of
this Society, Mr. Clarke has done more than any other Fellow
to hold it together, and that his devotion, I may say his love,
for the Society has known no change, no abatement. We
accept, therefore, with peculiar pleasure this last mark of his
goodwill ; and, although your acclamation assures me that the
formal duty is unnecessary, I ask that those who are in favour
of a vote of thanks to Mr. Clarke will signify the same in the
usual manner.
The proposal was carried by acclamation.
Mr. Hancock, in a speech showing the gratitude due by the
Society to Mr. Clarke, moved: “ That the best thanks of this
meeting be given to Mr. Clarke for the benefits he has ren¬
dered to the Medical Society of London duriug the long period
of fortyyears.”
Mr. Hunt seconded the motion.
Mr. Streeter commended Mr. Clarke’s reports of the old
Westminster Medical Society.
Mr. J. F. Clarke, in reply, said : Mr. President and Gentle¬
men,—I cannot without emotion recall to mind my first ap¬
pearance in this Society many years ago, and contrast my
position then with the proud one I occupy to-night. That
emotion is not diminished by the fact that I see present on
this occasion a few of the very Fellows who, nearly forty years
since, were active members of the Society. The number is but
too Bmall, and “ the snow on the mountain top” has succeeded
to the black or brown heather of other days. Gentlemen, I
sincerely thank you for the manner in which you have received
and carried the motion before you. It is very gratifying to me
to think that my long labours in your service are appreciated
by so many. I have alluded to my first appearance in this
Society. I succeeded a gentleman who had been expelled your
ranks for what was regarded unprofessional conduct, and whose
report of a celebrated case of lithotomy gave rise to an equally
celebrated trial. I went to the Society, young and inex¬
perienced, with a kind of ban upon me. I was naturally sus¬
pected, and accordingly avoided ; I was placed on a back seat,
and, with rare exceptions, never spoke to a Fellow of the
Society. This went on for some time ; first, my reports gave
satisfaction ; I was thanked, became a Fellow of the Society,
and, as your distinguished chairman has told you, have occupied
©very post in the Society except that of President. This was
within my reach, but I had made up my mind never to be
president of any society so long as I was connected with the
press. I need not Bay that my path was often one of difficulty,
not only calling on some occasions for bold and decisive conduct,
but on others requiring tact and conciliation. Well, the result
of all this is, I am here to-night to receive your kind and too
flattering demonstrations in my favour. Gentlemen, I do not
retire from public life from decay of either mental or bodily
powers, and it may be that if, in my retirement, I should, like
the old but not worn-out hunter, hear the sound of the horn
and the baying of the hounds, I shall be in the field again, as
active, if not so young, as I was “ forty years since.” Gentle¬
men, in the course of that long period, many facts and circum¬
stances have become known to me—facts and circumstances of
the deepest interest to the profession—and of these I am the
sole living depository. A great number of my friends have
urged upon me the publication of these reminiscences, and it is
my intention to meet their wishes. I shall have leisure now
to complete the main work of my life. If, like the shield of
Achilles, the workmanship be equal to the material, I trust I
may make a valuable contribution to our professional literature.
Gentlemen, it is a great relief to me to be even for a time out
of harness ; to be employed usefully and honourably in public
life is gratifying and invigorating, but power has its drawbacks
and its sufferings, and we all sigh for “ the happier hour.” It
is in retirement that we have true enjoyment, and I can bear
out the truth of the distich of Pope,
“ And more real joy MarceMus exiled fee’s.
Than C»sar with the senate at his heels."
Mr. Clarke sat down amid loud and continued cheering.
Mr. Henry Smith exhibited a case in which the knee-joint
had been excised eight months since ; a good result had been
obtained, the limb having previously been condemned to
amputation.
Mr. Francis Mason exhibited a case in which he had removed
a necrosed mass from the tibia.
The President read a paper “ On Bloodletting as a point of
Scientific Practice.” He reviewed the history of the controversy
concerning bloodletting, which, from the contradictory opinions
of authorities at various stages, demonstrated the fallibility of
so-called “ experience ” when untempered by scientific deduc¬
tion. The cause of the decline of the practice could be traced
to the gradual introduction of the sciences of chemistry,
physiology, and pathology into the art of medicine. There
was a crash among the idols of twenty centuries, and it was not
strange that at such a time scepticism should arise. It was
time now to inquire whether the practice of so long a period
was baseless and futile. This could only be done by inquiring
categorically into the conditions of the practice, and the causes
for which it was employed. It had been used to relieve over¬
action in acute fevers, to diminish tension, to relieve the more
chronic congestions until the lapse of time wrought a cure ; to
stay the acute pain of serous inflammation, to arrest muscular
spasm, check hemorrhage, and remove effects of shock by re¬
inducing circulatory motion ; to control irregular action of the
heart, and to subdue convulsion. In regard to these, the
ancients saw no danger in the use of the remedy. The point
in which they mainly erred was in treating convulsion by
bleeding. In urremia, 'however, the practice was singularly
successful. On the whole, the author concluded that the
custom in the present day of refraining under every circum¬
stance from bloodletting was as cowardly as it was founded
upon error.
Dr. Hare, Mr. Lord, Mr. Hunt, and Dr. Crisp took part in
the discussion.
Mr. Hancock, on being appealed to as to the practice of the
late Dr. Clutterbuck, remarked that on the occasion when Dr.
Clutterbuck broke his thigh he (Mr. Hancock) was sent for.
They differed as to the advisability of performing venesection,
and he retired. Dr. Clutterbuck was bled, and died the next
day.
The President replied on several points mentioned in the
discussion.
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The late Mr. Mitch eel. —The West Briyhon awl Corn¬
wall Advertiser announces the death of Mr. Mitchell in the
following terms. At Truro, on the 10th instant, a^ed 51
years, Mr. Slyman Mitchell, surgeon, a town councillor and
magistrate for the borough of Truro, one of the honorary
surgeons of the Cornwall Infirmary, and one of the founders
and for a long series of years, one of the most active sup¬
porters of the Truro Dispensary. Mr. Mitchell had a very
extensive practice, and his loss will be deeply felt by a large
circle of mends. His remains were interred at Kenwyn
Church on Thursday morning, the funeral being attended
by the Mayor and magistrates, the corporation, and a large
number of the inhabitants. The shops were partially closed
throughout the town.
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380 The Medical Press and Circular.
SOCIAL SCIENCE ASSOCIATION.
October 98,1868.
HEALTH SECTION.
Spirits*
BY
H. W. RUMSEY, ESQ., M.D.,
President of the Section.
(Continued from page 863.)
The second is a very vexed question. What is sufficient
ventilation ; and how is it to be obtained ? The verdict in
each case must depend on circumstances which in different
cases are most diverse and complicated ; for on the particulur
temperature of the climate, the season, the house, the work¬
shop, the chamber, depends the demand for the more or less
rapid circulation of air. In winter, or at night (exhalations
being more readily condensed in cold air), several persons
might remain not seriously injured in a room, the atmosphere
of which would be dangerously vitiated by one person in a hot
summer or within the tropics, when and where the exhaled
organic matter is volatilized and thus prepared for quick re¬
admission into the living body.
The question of temperature is so intimately connected with
that of air-circulation, that a long and complete series of
scientific observations, in a great variety of places, would seem
to be necessary to frame even elementary formuhe of ventila¬
tion. If old-fashioned people are more anxious to warm their
houses and rooms than to secure purity of air, advanced sani¬
tarians are perhaps sometimes too eager to ventilate without
sufficient attention to warmth. Both extremes may be avoided.
An authorised allowance of cubic space might be insufficient
for healthy existence, without the introduction of currents of
air so swift as to injure the weaker inmates of the house.
Women, children, and the sick especially, would then be the
chief sufferers.
Should any one desire to see what an amount of discrepancy
may arise in a controversy on this subject, let him examine
the Report of the Commission, appointed by the President of
the Poor-law Board, on the cubic space necessary for the in¬
mates of workhouses—one of the most useful contributions to
the sanitary literature of the past year. If the Report itself
sometimes betrays the weakness of a compromise, the memo¬
randa attached to it, containing the views of high authorities
and original thinkers, are of immense value. Among these is
a spirited discussion between Professor Parkes and Dr.
Angus Smith (mighty men —“fortemque Gy an fortcmquc
Cloanthum ”), in which both have brought forward so many
weighty arguments that it would be presumptuous in me to
attempt to decide between them. As far, however, as military
hospitals are concerned, I think that my friend, the Netley
Professor, has established his case.
But, in crowded cities, the free circulation of pure air is
■imply impossible. The air outside the house, i.e. the air to
be admitted for ventilation, is often, as we have seen, only a
few degrees less vitiated than the air to be expelled. The air,
which sustains the life of 200 or 300 persons on every acre of
a large district (including, for instance, more than a square
mile), can never act properly upon effete organic matters ;
while invading currents of air, from the open suburbs, very
rapidly lose their power to oxidize.
Existing legal provisions against overcrowding in single
houses and rooms—good as they are and better as they might
be—only touch the surface of this tremendous question. Over¬
crowding, when prejudicial to health, is now defined to be a
“ nuisance,” and so brought under legal action. But who is to
judge of the danger to health in any particular case, and by
what law ? Will the same rule apply to every town ? May
not a degree of room-crowding be tolerable, and perhaps justi¬
fiable, in some openly-built town (as we know it to be in the
country), which would be pestiferous in a thick population ?
Possibly, by some despotic decree, you might succeed in
compelling every inhabitant of a vast city to open his windows.
Or, in a scientifically-built lodging-house, you might adopt
the most approved appliances, the cleverest air-shafts and
valves, the best directed currents. But what, I repeat, if the
air which you are so studiously circulating is already vitiated,
if it has become a disseminator of poison? Again, as Dr.
Lankester and others have shown, if the government formula
of 600 cubic feet per head were enforced at once in many dis¬
tricts, the neighbouring parishes would either be more fearfully
crammed by evicted emigrants, or the poor wretches must
remain homeless vagabonds.
I am thus led on to the third means of obtaining atmospheric
purity, viz., the supply of a sufficient quantity of pure air to
every citizen.
Hardly anything has yet been attempted in this direction,
whether by the Legislature or by private enterprise, except in
promoting the formation of public parks, and protecting in some
small measure open spaces in the metropolis and elsewhere
from invasion by house builders.
That something more ought to be done in this direction can
now hardly be a question, and I am happy on this point to be
supported by Mr. Simon, who in 1866 advised that where it
might be necessary to purchase and destroy the poorer dwel¬
lings as unfit for human habitation, the local authorities Bhould
provide equivalent new dwelling spacein the suburbs of the town. 1
Mr. Beggs has well shewn that increased facilities should be
afforded by Parliament for the development of freehold land
and Building Societies, so as to enable the working classes to
provide themselves with extra urban dwellings, on the co¬
operative principle.
It is true that some legal facilities for the purchase of land,
e.g. power to borrow money of the Public Works Loan Com¬
missioners, have been granted, under the Labouring Classes
Dwelling Act of 1866, to local boards and voluntary associa¬
tions ; and it does not appear that the land to be purchased
must necessarily lie within the overcrowded boundaries. But
I hear that this Act is almost inoperative.
Again, the Artisans and Labourers Dwellings Act of the
last session is very unlikely to provide a cure for the evils of
overcrowding. This enactment (approved by some, but not
generally understood) seems to be open to the following objec¬
tions. The operation of the measure is confined to those places
which throughout the United Kingdom (except in the metro¬
politan divisions of England) are isolated by town boundaries
from the general population of the country. The whole burden
and cost of its execution, with its compulsory purchases, de¬
molitions, and reconstructions, are imposed wholly on the most
suffering groups of population, and its administration is left
to the local authorities of the most crowded locahtes. The
operation of the Act being limited to places containing not
less than 10,000 inhabitants, the smaller towns, with the
districts under boards of Guardians, are under no such re¬
sponsibility, with regard to labourers’ dwellings, as are towns
with the specified population. Yet the reports of the Medical
Officer of Privy Council, that of Dr. Hunter especially, prove
the urgeut necessity for a sweeping reform in the house
accommodation of the poorer classes in rural districts.
The extreme of error in this Act is attained by the pro¬
vision which commits, almost unconditionally, the choice of
sanitary advisers in this matter to bodies containing in force
the representatives of the owners, tenants, and ratepayers of
these places. Thus, duties of no common difficulty in the way
of inquiry, report, etc., may be entrusted to ill-informed, de¬
pendent, and unlearned persons, although questions of. high
scientific moment are often involved in such investigations;
and therefore the thorough qualification and official indepen¬
dence of the reporters should have been a chief concern of the
Legislature. The amendments, good in themselves, made in
this measure by the House of Lords do not touch. these
weighty points. The rights of a life-tenant or owner in fee,
the possible injury to proprietary interests, were. apparently
held to be matters of greater importance. Far be it from me
to question or even to doubt the humanity, zi al, and sympathy
for the working classes which actuated the framers and pro¬
moters of this enactment. It is, moreover, a great thing to
have obtained from the Legislature some recognition of the
principle that the dwellings of the poor ought no longer to be
left to the chances of uncontrolled employment of capital
we must hope that this is only a tentative measure^ana
that the necessary corrections and extensions may he speedily
made in an Act which, I confess, appeared to me at first hke
a great sanitary sham,—and which, even now, unless it be
amended, will prove, as far as it may operate, seriously o
structive to a rational system of sanitary organisation.
State governments, concerned only with the immediate m*
terests of trade and commerce, have, inconsiderately or
knowingly, permitted the growth of aggregation, withou
1 Eighth Report, p. 17.
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SOCIAL SCIENCE ASSOCIATION.
October 2S, 1868. 381
milking any adequate provision for the safety of the thickening
populations. On the State, therefore, as I venture to conclude,
rests the responsibility of taking the initiative, and in some
degree lightening the local burdens, by a really permanent and
efficient reform—such as would extend town areas, by a gradual
distribution of their poorer classes over larger surfaces of land.
If, by the adoption of this principle, some boundaries of feudal
origin might have to be superseded, some antiquated divisions
and political restrictions to be removed, the gain to the country
might be still greater.
By State aid, I do not mean advances out of the national
funds. The capitalist only requires some security for outlay
upon undertakings which, though vast, are really prudent, and
ought to be ultimately remunerative. A public guarantee for
the payment of moderate interest upon private or corporate
advances, or a charge upon the county rate, would surely pro¬
vide more than the required capital, the repayment of which
need not be limited to forty years, as it is in the Act to which
I have before referred. The benefij of a larger measure would
be enjoyed chiefly by the next generation : why, then, should
the present be required to bear the whole responsibility ? If
the creation of a permanent “stock ” were undesirable, might
not ultimate repayment of capital be limited to a century ?
Slow, of necessity, must be such a process of social recon¬
struction, but every step taken by the Legislature for the
better house-accommodation of the poor ought, I think, to
keep in view the enlargement of inhabited area*.
In reply to some minor objections still urged against the
adoption of this principle,—I would observe that proximity to
work and the labour-market in these days is measured by time
rather than by space. The labourer within a mile of his work
may require a quarter-of-an-hour to walk to it. Give him a
cheap railway, and he may travel from five to eight miles in
the same time—that is, he is practically as near to his work as
though he lived within ten or fifteen minutes’ walk of it. But
we are told that railways are either wanting or unavailable ;
that existing companies will not come to terms ; and that new
companies would not pay.
To all this I reply ; if the wealthy classes are still to be at
the mercy of a railway despotism, at all events, let the work¬
ing man be freed by some public measure, which might enable
him to get quickly out of town, by railway, at a low fare. Let
him have at least the option of breathing fresh air, of resting
his weary eye upon the green of nature, of scenting the newly
up-turned earth, of growing his vegetables, and of housing his
wife and children away from town abominations. How long,
I ask, is the suburban residence to be solely the luxury of the
moneyed classes ?
There can be no doubt of the financial economy of the prin¬
ciple. The weekly railway ticket, plus the rent of a cottage with
from five to twenty poles of garden ground, need not equal the
present cost of a stifling lodging on a flat of some old house in
a dark street, reeking with moral and physical impurity ; or
amidst heaps of manure in some mews, impacted between the
backs of lofty town mansions ; nor need it equal the rent of
rooms in some vast block of model lodgings. The saving of
health, and the prolongation of life, would be clear gains in
the financial comparison.
There will always be, I grant, a mass of unemployed la¬
bourers, waiters on Providence, who must reside as closely as
possible to the labour markets—to the wharves and docks of
great ports. But how much less expensively, and more safely,
might this class of labourers be housed on the very spot, if the
other class, in constant work and able to leave town for their
villages, were no longer to compete for the miserably small
living space within the town precincts.
For those who are compelled to dwell in these centres, a
greater number of well-contrived blocks, such as are now
raised by societies and philanthropic individuals, may be found
necessary. But their site, distribution, height, and proximity,
Bhould be subject to safe municipal regulations. They should
not be allowed either to be erected on improper or unhealthy
sites, as they sometimes have been, or to obstruct the free
circulation of air.
If the required extension of inhabited area should be prac¬
tically impossible in the case of London, that huge exception
to all known methods of local management, we may surely beg
the metropolitans not to interfere to prevent the principle
from being carried out where it may be practicable.
Professor Kerr’s plan for a simpler and humbler class of
dwellings to shelter the lowest of the poor, commends itself to
public favour. No doubt, when the people are more generally
and more rationally educated, when useful facts of elementary
physiology are taught in our primary schools, they will not
fail to appreciate as they ought the superior advantages of an
out-of town cottage. I pray that the opportunity may be
afforded to them.
Surely, then, we need not speculate upon bringing mountain
or sea-air, by enormous pipes, into town centres. We should
more wisely, with due regard for existing interests, pro¬
mote legislative provisions for the judicious distribution of the
labouring classes over wider areas of habitation.
^ II. — Water : the flowing, sparkling, refreshing, and
cieansing element—second only to air as a necessary of life,
and bounteously supplied by nature in abundance and whole¬
some purity—has been long subjected to grievous neglect and
outrage. The natural rights of the dwellers upon land to the
water it furnishes have been usurped by monopolists, indivi¬
dual and corporate.! That which wo might almost call ferae
nuUurar, has been se r zed, imprisoned, and sold to those who
could afford to buy it ; withheld from the poor, yet wasted
by its proprietors and consumers.
Then, tho original sources of water have been neglected
and sometimes suppressed, tho channels of its natural flow
injured and obstructed, the banks of its courses abandoned
to decay from natural causes, and to reckless wear and tear
by unregulated industries ; while the streams themselves have
been deliberately converted into disseminators of poison to
the riparian populations.
But before 1 touch on tho injuries which man has inflicted
on water, and,has been forced to receive back again with
ruinous usuiy; I would remark ou the serious and progressive
diminution in tne natural supply of water, in most parts of
this country.
As tho land has become more thoroughly disforested and
drained, for social and agricultural purposes, the water from
springs ^whether surface or subsoil), and from ponds and
marshes, has, of course, passed more rapidly off, and through
the drier soil, into main channels and rivers. Less having
soaked into the soil, less rises in vapour, there is less of cloud
and mist, aud therefore a decreasing rainfall.
Profossor Ansted, in a recent masterly essay, 3 has shown
how universally these changes are progressing in civilised
countries, and how important are their effects upon supplies of
water. Whether or not, in the coming golden age of science,
man will be able to call down rain at will—as has been lately
predicted by my accomplished predecessor in this chair—it is
certain that man can both diminish the annual rainfall in most
places, and lie can again restore it. Unquestionably he has
diminished it, in some regions, to an extent which threatens
the safety of great communities.
Yet, improvements iu agriculture, producing a drier and
more tractable soil ill plains and valleys, with a thorough
drainage of fever-breeding marshes and fens, cannot be other¬
wise than beneficial to any country—provided the hill sources
of water are protected.
The most important measure of redress for tho growing evil
of which I speak, is to preserve, with more sedulous care, tho
great natural reservoirs of our water supply, the elevated
sponges of those mountain and hill ranges, which are the
marks of our watersheds and points of attraction for atmo¬
spheric moisture.
Theso high sources of running water—sources which are
too hastily assumed to be perennial, yet which have kept our
great rivers tolerably full during the longest droughts—arc
lessening it. produce in many districts. The wild rills, which,
within the memory of a generation or two, used to dash and
leap down tho hill-sides, are now, too often, things of tho
past, only fitfully running, after a storm or long-continued
rain. We know both the fact and its cause. The heights,
from and under which the streamlets sprang, were once wood
crowned. They are now bare. The iorest and brushwood
of old with their accompanying herbage—which largely con¬
densed the mists floating upon tho hill-tops, which retained
tho moisture, allowing it to oozo through porous rocks uutil
1. A recent essayist—anil a very able writer he is—on the future water
supply of London, speculates on the acquisition of gather! g grounds,
containing more than 3,000 square miles, and incln ing other water beda
than thay of the Thames, from which he coolly proposes to dn»w, by
various croftr expedients, some 250 000,uOO gallons of water per diem.
Of this, theij own natural provision, lie generously offer* to allow the
unfortunate dwellers in the land on > fourth part, before carrying off as
much of the remainder as he cm to metroi olltan reservoirs !
2. Royal Agricultural Journal, 1806, p. 62 ; 1867, p. 65.
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382 The Medical Press and Circular.
SUMMARY OF SCIENCE.
OctoVer 28,1888.
held by some impermeable stratum for the service of living
creatures, and which checked rapid evaporation from high
ground and thin soil exposed to sun and wind—have been
felled. On tho western ranges, summit after summit has been
cleared of wood. Tho proceeds of tho wood-sales may not
have been dissipated, but much of the hill water—the natural
wealth of the region—has disappeared.
These results of forest clearing are yet more manifest in
other parts of tho world. The diminution of rainfall in tho
Canary Ifeles is, perhaps, as apposite an instance as any of
those adduced by Professor Ansted. Tho failure of water in
tho plains of Central India, from tho same cause, has now,
wo learn, arrested the serious attention of the Indian Govern¬
ment, and some of tho hill-sides are to bo replanted.
In this country, the effects of tho liill-clearing are felt, not
only by agriculturists, but (what is moro directly to my point)
by those who now endeavour to obtain improved supplies of
water ior the great town populations, spreading over plains
and valleys.
Another cause of tho diminution in the flow of streams, as
well ns of their waste, is the prevailing neglect of their
channels and of the ground immediately adjacent. Obstruc¬
tions of various kinds are permitted to form and grow from
the refuse of mines, manufactures, and commercial processes,
raising tho river-beds with silt and indurated deposits, de¬
structive alike to animal and vegetable life, and subversive of
tho purifying functions of running water. These evils are
accompanied by greater liabilities, both to floods and to
water-logged land.
Happily this great subject is now being comprehensively
and judiciously liaudlcd by tho eminent men who constitute
the Royal Commission on river pollution, and who are adding
to our sanitary literature reports of immense value. Some of
their recommendations bearing on sanitary administration
deserve most particular attention. Already, wo owe to that
Commission the Thames Navigation Act of 1866; and wo
are thus encouraged to hope that every watershed and river-
basin will in time be brought under a body of able and intelli¬
gent conservators.
A scientific administration of tho entiro valley of the
Thames, under this Act, may effect much, if not all, that
was anticipated by my friend Dr. Acland,l to whom chiefly,
I believe, we owe the origination of measures now in progress
for the conservation of rivers. But in referring to the leaders
of this movement, it would be ungrateful to omit one, no
longer among us—the father of our founder—who contributed
to our first meeting (and in this town) an admirable paper on
the condition of tho Severn. Tho Thames Conservancy Act
is, indeed, a great step in sanitary legistation, for it recog¬
nises tho necessity of extending the areas of administration,
in conformity with the natural topography of the country.
(To bo continued.)
-♦-
of
(Specially Edited and Compiled for the Medical Press and Ciroular.)
By C. R. C. TICHBORNE, F.O.S., F.R.G.S.I., Etc.
rrhe Editor of this Summary wishes it to be understood that he is
not responsible for the ideas, theories, or the correctness of statements
made in any of the papers quoted in the compilation.]
BRITISH ASSOCIATION.
Norwich Meeting, 19th August, 1868.
Tiie savantf gathering may be considered as perfectly suc¬
cessful, if wc take into consideration the miscellaneous cha¬
racter which the papers of such a meeting must always present.
We refer to quality, for although most of them are of great
valne to their respective sciences, there is a class of scientific
men who think it absolutely necessary to “ cork" up a paper
for the annual gathering, irrespective of any consideration as
to whether they have materials for even a small dish.
The inaugural addresses of the President and the respective
chairmen of the different sections, were all good, and strictly
appropriate, because the men who delivered them were in
their right places.
The President’s (Dr. Hooker) address is principally taken
up with a review of Darwin’s theories on natural selection,
particularly as regards its botanical aspect. Dr. Hooker stig¬
matises Fossil Botany (at present) as the most unreliable of
1 “ Acland on the Cholera at Oxford,” p. 114.
of Medical Officer of Privy Council, p. 18.
See also 10th Report
sciences. Professor Tyndall’s address to the members of the
mathematical and physical section was an oration in the
strictest sense of the word. It was, as a composition, the
paper of tho meeting, although we cannot endorse all Pro¬
fessor Tyndall’s deductions. We may cite, as a specimen of
this paper, his reasoning upon the construction of organisms:
Tho Pyramids of Egypt were built by human forco applied
externally—“ slave power, or labour,” as it is termed by Pro¬
fessor Tyndall. If we take a crystal of salt, it is an exact
imitation. “ The human mind is as little disposed to look at
these pyramidal salt crystals without further question as to
look at the pyramids of Egypt without inquiry whence they
came. By analogy you may suppose that swarming among
the constituent molecules of the salt there is an invisible
population, guided and coerced by some invisible master, and
placing the atomic blocks. This, however, is not tho scien¬
tific idea, nor do I think your good sense will accept it as a
likely one.” The scientific idea is that tho molecules act upon
each other without the intervention of slave labour—that they
attract each other and repel each other at certain definite
points, and in certain definite directions, and that the pyra¬
midal form is tho result of this play of attraction and repnl-
sion. While, then, the blocks of Egypt were laid down by a
power external to themselves, thin molecular blocks of silt
are self-posited, being fixed in their places by the forces with
which they act upon each other. The formation of a crystal,
a plant, or an animal, is in the eyes of scientific thinkers a
purely mechanical problem, which differs from the problem of
ordinary mechanics in the smallness of tho masses, and the
complexity of the processes involved. A beam of polarized
light, if passed through a crystal, reveals an inner structure
peculiar to itself, and if wc pass from this, which we are ac¬
customed to regard as a dead mineral to a living grain of corn,
we shall find, on examination by polarized light, chromatic
phenomena similar to those noticed in the crystals, because
the architecture of the grain resembles in some dcgr«« the
architecture of tho crystal. “ But what has built together
the molecules of the corn ? You may, if you please, consider
the atoms and molecules to be placed in position by a power
external to themselves. The same hypothesis is open to yon
now. But if, in the case of crystals, you have rejected this
notion of an external architect, I think you are bound to re¬
ject it now, and to conclude that the molcculc-s of the corn
are self-posited by tho forces with which they act upon each
other. It would bo poor philosophy to invoke an external
agent in the one case and to reject it in the other.”
As before stated, tho formation of a crystal, a plant, or an
animal, is equally a purely mechanical problem.
Professor Fraukland’s address (Chemical Section B) was a
summary of the work that had been done in England during
the last twelve months. He especially drew attention to the
works of Perkins, Duppa, Graham, Maxwell, Simpson, Crum,
Brown, Ac., and also dwelt at some length upon the fin?
scientific schools of tho Continent, particularly as regards the
magnificent laboratories, the Berlin Laboratory alone haviug
C 03 t £47, 715. His opinion, which is endorsed by me pojntH,
is, that if wo are to keep up with continental countries as
regards their arts, manufactures, Ac., we must bestir our¬
selves. We do not, however, think that London is so badly
off in this respect. What is required is that the science
schools should be moro scattered through the kingdom, and
that the sciences should bo taught iu different schools with
more definite views towards specific calling. This is the
system more in vogue in France, Ac. Thus, in London, we
have tho following excellent institutions in Chemistry alone,
besides the University and Medical Schools The College of
Chemistry, which, we may say, is devoted to pure Chemistry;
the Laboratory of Professor Perry (School of Mines) for me¬
tallurgy instruction; Pharmaceutical Society—a Laboratory
for Chemistry in connection with Pharmacy ; also Veterinary
and Agricultural Laboratories.
In Section 2 (Biology) the following papers were of especial
interest:—“On Some Effects of Extreme Cold on Nervous
Action,” B. Richardson; “Report upon the Physiological
Action of Mercury on tho Secretion of Bile,” Professor Ben¬
nett ; “ Report on tho Investigation of Animal Substances by
the Spectroscope,” by Dr. E. Lankester ; and Professor Heyn-
sius “On the Albumenoid Substances of the Blood-Cor-
r mu uc in
puscies. me general papers on cneimstiy <_
BRITI8H PHARMACEUTICAL CONFERENCE.
The meetings of this Society, which are held cceval with
those of tho British Association, have proved most useful
They have tended towards raising the dignity of pharmacy,
Digitized by
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The Medical Frees and Circular.
SUMMARY OF SCIENCE.
October 28, 1868, 383
and hare brought prominently before the public the importance
of that art. There are few countries in Europe where that de¬
partment has been so neglected as in this kingdom ; at least,
we are certainly far behind France and Germany. The papers
read possessed more than ordinary interest, particularly those
connected with the adulteration of drugs. Among many
others ol considerable merit, we must especially draw atten¬
tion to the following :—
ME. 8TODDABT’s PAPER ON HONEY.
This paper is an excellent one upon the subject. The cha¬
racteristics of honey, when fresh from the hive, is that of a
thick, yellow liquid, having a specific gravity 1 *423. It does not
give a blue colouring with iodine, even when only just depo¬
sited from the honey-bag of the bees into the corah, although
the immature or unripe “nectar” of flowers sometimes gives
a blue reaction. After collection, the honey gradually thickens
and deposits crystal. This is due to solid particles, which
are floating in a syrup. These crystals are those of dextro-
glucoso, interspersed with pollen-granules. Honey originally
is formed from a solution of cane-sugar (sucrose), which is
gradually changed into grape-sugar (glucose), also forming a
small quantity of acetic acid, formic acid, and alcohol. The
author had analyzed samples adulterated with pea or bean-
flour, pipe-clay, turmeric, sulphate of lime, also largely with
sugar.
The next paper, by Dr. Fluokigcr of Berne, was upon the
subject of Rose-oil , in which he seems to say that the stearop-
tene of ros' -oil is a paraffin.
Papers also appeared upon the microscopic examination of
the alkaloids by Mr. Ellwood.
Granular citrate of magnesia by Mr. F. Clayton, in which
he describes the articles now in the market under this name ;
“Senna,” by Mr. Gracus ; “Notes on lemon-juice and its
decomposition,” by Mr. Stoddart; and last, but certainly not
the least important, “ A paper on the estimation of Tannic
Acid,” by Mr. J. Watts. Messrs. Brough, Proctor, Reynolds,
Ac., contributed papers to meeting for 1868.
CHLORIDE OF METHYLENE.
Mr. Perrins prepares chloride of methylene from chloro¬
form, by acting upon an alcoholic solution of chloroform with
zinc and a little ammonia. Oil mixing the rc-agents the tem¬
perature rises, and the whole enters into ebullition, and much
gas is given off. The chloride is not formed in large quantities
Tetrachloride of carbou treated in the samo manner gives
chloroform and marsh gas.
ACTION OF LIGHT UPON CHLORIDE OF SILVER.
If in a tube of white glas3, from 14 to 15 inches long, you
enclose moist chloride of silver (freshly precipitated by
means of a solution of chlorine in water), and exposo it to
the direct action of the solar rays, it will be observed, th&t
while the chlorine solution is yellow, the chloride of silver
remains white ; but after the chloriue solution becomes
colourless, the chloride decomposes the water under the
action of light As soon as the chloride of silver blackens at
the surface, it should be agitated from time to time, and left
exposed for a few days to direct light, until the whole be¬
comes of a fine black colour.
If the tube is now taken into a dark place the blackness
will disappear by degrees, chloride of silver becoming re¬
formed, and the contents of the tube becoming perfectly white
again ; and this experiment may bo repeated indefinitely. It
is an evidence that in their successive reactions tho chlorine,
oxygen, hydrogen, Ac., preserve properties of combination
and re-combiuation. Bromide of silver (and, probably, cya¬
nide) present the same re-action. Iodide of silvor only
blackens in the sun, after being sensitised by means of pyro-
gallic acid. It does not blacken visibly without a reducing
agent .— Foreign Correspondent of the “ Chemical News."
- 4 *-
WITHDRAWAL OF DR RICHARDSON FROM
THE CONTEST FOR THE UNIVERSITIES OF
EDINBURGH AND ST. ANDREW’S.
In a second edition of the last number of our Scottish
supplement, we announced the retirement of Dr. Richard-
Bon in the terms in which it was supplied to us, viz.,
the resolution of his committee as follows :—
“ The Committee, having come to the conclusion that
Dr. Ricliaidson’s return cannot on this occasion be
secured, recommends, with Dr. Richardson’s concurrence,
his retirement from the present contest.”
We have been further informed that the supporters of
this eminent gentleman have handsomely defrayed all the
expenses that have been incurred, a course which will be
looked upon as most honourable by all parties. It is
very commonly reported that only a small proportion of
the medical graduates gave Dr. Richardson the support
he expected. This must be due to the number of candi¬
dates iQ the field, and the large number of promises that
had already been made. It is no secret that an active
canvass had been for months going on—in fact, ever since
the first proposal to enfranchise the universities—on
behalf of two eminent Scotchmen of opposite parties.
Only a little while ago, Dr. Prosser James nad been per¬
suaded by a large number of medical friends, supported
by the section of politicians who were not satisfied as to
the thoroughly Liberal views of Professor Playfair, to
enter the field as an advanced Liberal and medical
reformer. We gave our tacit support, as we have done to
every medical candidate, and would gladly have given it
also to Dr. Richardson, as against any non-medical
candidate.
Now that Dr. Richardson retires from the contest, the
question is whether the other medical candidate will
have the great proportion of his supporters. If so, he
has a fair chance. If not, we should doubt the probability
of his success. We regret to hear, on good authority,
what we hope may, after all, prove not correct. It is to
the effect that Dr. Richardson, while professing his re¬
tirement to be neutral, has not only not tendered his
aid to the other medical candidate, but is giving bis
personal influence to the Conservative lawyer. This may
be consistent enough so far as general politics go, but
Dr. Richardson came forward on other grounds. He
deliberately set medical affairs above politics, and refused
allegiance to either party in the -State. If a man making
such professions, does not help another medical candidate,
when can we hope to see the profession represented in
Parliament ? Dr. James from the beginning, it is true,
avowed himself a party man, but he gave so much im¬
portance to medical politics, that he excited the opposition
of many of the A i ts graduates and thereby imperilled his
election.
It is to be hoped that medical electors will refuse to
desert their profession, and will rally round their re¬
maining candidate. Otherwise we shall look upon the
contest as virtually lost, and consider that the profession
has only its own members to blame.
ROYAL COLLEGE OF SURGEONS IN IRELAND.
OPENING OF THE WINTER SESSION.
On Monday Professor Hargrave delivered the Introduc¬
tory Address before the President and Council, a great
number of professional gentlemen, and a very large at¬
tendance of students.
Professor Mapother afterwards delivered the opening
lecture of his course on Physiology, and selected, in ac¬
cordance with the usual practice, the classification of the
animal kingdom. He began by urging the importance of
zoology as a branch of general education, ana dilated at
some length on the advantages to be derived from its
intimate investigation bv scientific medical men. Many
important maladies owe<l their origin to the lower forms
of animal life, and from other higher classes, some of the
most valuable agents in the treatment of disease were
derived. It was announced that the first ten lectures of
the course, which treat only of comparative physiology,
were open to the public.
- 4 -
ELECTIONS AT THE KING’S AND QUEEN’S
COLLEGE OF PHYSICIANS IN IRELAND.
The day sacred to St. Luke, the beloved physician, is
that which the King’s and Queen’s College of Physicians
in Irelend have from time immemorial set apart for the
annual election, but this year as the day fell on Sunday,
the meeting of the college was necessarily adjourned until
the Monday following. The following officers were
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384 The Medical Press and Circular.
ADVERTISEMENTS.
October tt, 1988.
elected President—Dr. Churchill. Vice-President—
Dr. Freke. Censors—Drs. Foot, Little, Atthill, and Freke.
Treasurer—Dr. Dwyer. Registrar—Dr. Guinness. Repre¬
sentative on General Mecical Council—Aquilla Smith.
Professor of Medical Jurisprudence—Robert Travers. Ex¬
aminers in Midwifery—Dr. Johnston ; Dr. Jennings.
The College then proceeded to the selection of Fellows
and Honorary Fellows. Of the latter, were chosen Dr.
Minter, Deputy-Inspector General of Hospitals and Fleets,
Surgeon to Her Majesty’s Yacht, and Surgeon Extraordi¬
nary to His Royal Highness the Prince of Wales, and Dr.
Maxwell Simpson, well known as a chemist of the highest
attainments. Three ordinary Fellows were added to the
list ; Dr. S. L. Hardy, ex-President of the Dublin Obste¬
trical Society ; Dr. C. F. Perceval, Assistant-Physician to
the Incurable Hospital ; and Dr. Fleetwood Churchill, son
of the President of the College.
NOTICES TO CORRESPONDENTS.
Dr. 8. T. Haslett Lahky. —In order t> expose the swindle of which
you complained having been the dupe, we procured one of the little
instruments styled “The Scientific Wonder/' and submitted several
small objects—atomic.?, auimaleulue, a drop of blood, Ac.—to tc^t its
power. As these tests answered as well or better than could reasonably
be expected of so tiny an instrument, we cannot but think that the lens
in the one you purchased must have become iu some way injured in tran¬
sit or otherwise.
We are equally jealous of our advertising ag of our news columns, and
are at all times only too happy to expunge anything that partakes of
quackery or swindling; and assuredly the case in question would not
escape the lash, could we jus! ly joir. in your condemnation.
That this “new light ’’ is likely to aid any scientific investigation, or
usurp the position of a Harley, a Smith-Beck, or a Steward, is of course
out of the question ; but as a “ scientific toy," which by the way would
have been the more correct title to have given it—still s *me licence
must necessarily l*o allowed to manufacturers—it is unquestionably an
adjunct to the laboratory of the junior members of the community, and
a boon to the poorer classes.
The following letter has been addressed to the many members of the
Profession. We here reproduce it for those of our readers who may not
have seen the same.
THE CORRIGAN ELECTION FUND.
Dublin, Oct 26, 1868.
Bib,
Believing the election to Parliament of an able and independent
member of our profession to be an object of the highest importance, in a
public as well ns a professional point of view, we beg leave to ask y^ur
support and contribution towards a Guarantee Fun l for the purpose of
aiding tho return of Sir Dominic Corrigan, Bart., for the City of
Dublin.
The following genthnv n have already given us their names with the
subscription jdared opposite to them. We shall feel much obliged for
an early reply, and will thunk you to aid us amongst our professional
brethren in yonr neighbourly >d.
Yours truly,
R. £>. Lyons. S Merrion square, West.
R. McDonnell, 14 Low<r Pembroke street,
E. D. Mapother, 125 Stephen's green.
Post-office Orders or cheques may be made payable to any one of us.
Mr. J. Aston (new subscriber) is thauked. The back numbers have
been forwarded.
Pancreatic Emulsion. —In reply to the questions of several corre¬
spondents, we arc requested to state that the Pancreatic Emulsion pre¬
scribed by Dr. Freke with such favourable results, as described in this
Journal of Oct. 7th, was manufactured by Messrs. Savory and Moore, of
New Bond street, London.
- + -
BOOKS, PAMPHLETS, See., RECEIVED.
Hy&res and Cannes. Second Ed tion. By Edwin L e, M.D.
Health Resorts of the South of France. By Edwin Lee, M.D. London:
W. J. Adams. Fleet street
The Nursing Schedule. Arrang d by Dr. norace Dobell.
The Croouian Lectures on Matter and Fo ce. By Henry Bence Jones.
A.M., M.D.. F.R.S. London : John Churchill and Sons.
The Westminster Hospital Introductory Address. By Francis Mason,
F.R.C.8. London : John Churchill and Sons.
mtir jBjRrflra.
BIRTHS.
Beatty.— On October 13th, the wife of Dr. J. Guinness Beatty, Senior
Assistant Physician of the Rotunda Lying-in Hospital, of a
daughter.
DEATHS.
Alexander.—O n the 15th Inst, H. D. Alexander, M.D., of St.John
street Edinburgh.
Bowe.— Ou the 14th inst., at Leeds, JchnBowe, M.R.C.8.E, of Rich
mond, Yorkshire, aged 67.
Mabsdbn.— On the 17th inst, Wm, Marsden, M.R.C.S.E., of Skipton-in-
Craven, Yor kshire, aged 70.
Myers.— On the 14th in-t, nenry Myers, M.R.C.S.E., of Milton street,
Dorset square, late surgeon in the Portuguese army, aged 84.
Williams. —Ou the 11th inst., from the effects of a fall from his horse
on the preceding day, William Williams, F.R.C.S.E., of Dolgelly,
Merionethshire.
Williams — On the 18th inst, at Drim, near Fisguard, Pembrokeshire,
WilliamG. Williams, M.R.C.S.E., of Salisbury, aged 33.
We believe we are correct in stating that Dr.
John M. Minter, F.R.C.S., Deputy-Inspector-General of Hos¬
pitals and Fleets, Surgeon Ext to H.R.H. the Prinoe of
Wales, &c., will accompany H.R.H. and the Princess in their
tour through Germany, Denmark, thence through Greece, a
portion of Asia Minor, and finally up the Nile. The Royal
party will probably leave about the middle of November.
g&btrtistmtnis.
URGENT APPEAL.
TIHE Members of the Medical Profession and the bene-
X volent public are earnestly requested to contribute to the
relief of Dr. Aldridge and family, who are reduced to a state of deiti-
tution.
It in hoped that a sufficient sum may be eollectod to enable the family
to join their relations in Australia.
Contributions in aid of this object, will be thankfully received and
acknowledged by the following gentlemen :—
Bir W. R. Wilde, Dr. Stokes, Dr. O’Fcrrall, Dr. Croker, Dr. Gordoa,
Dr. Hudson, Dr. W. O. Barker, and Messrs. Bewley and Hamil-
tua * SUMS ALREADY RECEIVED.
Henry Bewley, Esq., £100.
Dr. J. T. Hamilton
£15
0
0
8. Nalty, Esq.,
0 10 0
Dr. A. Hudson,
10
0
0
Per Dr. Cronyn,
0 10 0
Dr. O’Ferrall, .
10
0
0
James Haughton, Esq.,
0 0
E. Long, Esq., .
10
0
0
Dr. Oldham,
t 0
Dr. Croker,
5
0
0
Dr. Barton,
1 0
Dr. Duncan.
6
0
0
Dr. Bevan,
9 0
Dr. Every Kennedy,
5
0
0
Dr. Harvey,
0 o
Dr. M'Donnell,
5
0
0
Dr. Banks,
0 0
Sir W. Wilde, .
3
8
0
Dr. Hildige,
6 0
Dr. Gordon,
3
3
0
Dr. Binyly,
0 0
Dr. Cruise,
2
2
0
Dr. Lipsett,
1 0
Dr. Mapother, .
2
2
0
Dr. Duigan,
0 0
Dr. P. Smyly, .
1
0
0
Dr. Cronyn,
0 0
Dr. Naltv,
1
0
0 I Dr. Branker.
0 0
Dr. Dwyer,
1
1
0
Dr. Collins,
0 0
Dr. Doyle,
1
0
0
From a Friend,
0 0
Dr. Bennett,
1
0
0
Dr. E. Bewley, .
1 0
Dr. Smallinan, .
1
0
0
Dr. E. Hamilton,
0 0
Dr. West,
1
0
0
Dr. Barker,
0 0
Dr. Thornhill, .
1
0
0
Dr. Denham,
0 0
Dr. E. Bradshaw,
1
1
0
Dr. Hardy,
0 0
Dr. Forrest,
1
0
0
An*lrew Armstrong, Esq.
9 0
Dr. W. Stokes, Jr.
1
0
0
Dr. F. Kirkpatrick!
0 o
Dr. Churchill, .
1
0
0
Dr. Kidd, .
0 o
Dr. Fit /.patrick,
1
0
0
Dr. James Armstrong.
0 3
Dr. Harrison, .
1
0
0
Ben Thos. Patterson, Esq. 3
0 o
It. J. Swift, Esq.,
1
0
0
Dr. Chaplin,
0 o
Mrs. S. Hinds,
1
0
0
Dr. Mollan,
0 o
Dr. Bateson,
1
1
0
Dr. Stewart,
0 o
Dr. Beatty,
1
0
0
Dr. M. Burke, .
1 0
Dr. C. H. Leet,.
1
0
0
, Dr. Elliott,
0 o
Amicus,
0 10
0
The Editor Medical Prsss
G. H. Forter, Esq.,
0 10
0
and Circular,
1
l o
J. Strongv, Esq.,
0 10
0
! Dr. John A. Fergusson
1
0 o
CITY OF DUBLIN ELECTION, 1868.
VfEDICAL SUBSCRIPTION towards a GUARANTEE
M FUND, for Expenses of Sir D. J. CORRIGAN, Birt.,
M.U.
Dr. Robert M‘Donnell .
£100
0
°l
Dr. IsaaeAshe
£5
0
Dr. Robert l>. Lyons .
100
0
0 I
Dr. Wm. M'Cormac,
Dr. E. D. Mapother .
50
0
°l
Belfast
5
0
Dr. Fr. R Cruise.
50
0
0 1
Dr. J. Cuming Belfast
5
0
Dr. John Hughes .
20
0
°i
Dr. lieory J. Gogarty .
5
0
Dr. Robert Cry an
20
0
0 1
Dr. P. C. Little .
5
0
Dr Henry J. Tyrrell .
20
0
°l
Dr. W H. O Loary
4
0
Dr. J. K. Forrest .
20
0
0 ■
Dr. Jam s Brady .
S
0
Dr. T. H-ivdon
20
0
0 1
Dr. D.iVys. Swords
8
0
Dr. J. 8. Ilu. lies .
10
0
0 j
Dr. S. M. M'Swiuey
9
0
Dr. James Daly .
10
0
o I
Dr. Michael Shanley
9
0
Dr. W. J. Martin .
10
0
0 I
Dr. Lyuam .
9
0
Dr. Walshe .
10
0
o 1
Post office Orders or Cheques to be made payable to—
E. D. LYONS, 8 Merrion square West, Dublin.
R. McDON'NELL, 14 Lower Pembroke street. Dublin.
E. D. MAPOTHER, 135 Stephen's Green, Dublin.
FURNISH YOUR HOUSE
WITH TBS BEST ARTICLES AT
DEANE’S
Ironmongery * Furnishing
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DEANE & CO.Cw^sfJLONOON BRIDGE
EtlMtiud A.D. 1700.
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“SALUS POPULI SUPREMA LEX.”
WEDNESDAY, NOVEMBER 4, 1 868.
CONTENTS.
LECTURE.
Lectures on Stricture : with Special Refe¬
rence to its Treatment. By Rawd.m
Macnnmara, Vice-President and Pivfes-
sor of Materia Medica in the Hoyal Col¬
lege of Surgeons of Ireland, and Surgeon
to the Meath Hospital . 385
ORIGINAL COMMUNICATIONS.
Experiences of a Regimental Surgeon in
India. By C. A. Gordon, M.I)., C B.,
Deputy Inspector-General of Hospitals 887
HOSPITAL REPORTS.
King's College Hospital—
Cases under the care of Dr. Bea!e, P.R& 388
Westmoreland Lock Hospital—
Primary Uterine Sores. By Mr. Morgan,
Professor of Anatomy, R.C. 8 . t., surgeon
to the Hospital, and to Mercer's Hospital 889
Edinburgh Rotal Infirm art—
Cases or Aneurism treated by Iodide of
Potassium. Under the care of Dr. Geo.
W. Balfour. 390
PAGE
FOREIGN MEDICAL LITERA¬
TURE.
Case of H^miopia. Communicated by Dr.
M. K. Loewegren. Translated l«y W.
D. Moore, M.D., Dub. et Cantab.,
L. K.Q.C.P.I., M.R.I.A. 390
LITERATURE.
On Consumption and its Treatment by the
Hypophosphites. ByJohnL’.Thorowg(»od,
M. D. Lond. 390
CORRESPONDENCE.
Scarciiy of Medical Officers in the Navy .. 891
LEADING ARTICLES.
Married Soldiers. 892
Professional Autocracy in Medical
Journalism . 894
The Edinburgh Association tor Improv¬
ing the Condition of the Poor . 391
NOTES ON CURRENT TOPICS.
Army Medical Officers and Reduction in
the Army . 895
Certittcates of Purity. 395
Royal College of Physicians of London .. 395
PAGE
Tobacco. 898
Royal Commijsion on Sanitary Organisa¬
tion and I awa . 393
Asyimn for the Imbecile Poor. 896
The Late Mr. Henry Brown. 896
The Quarterly Return of the Registrar-
General . 396
Verdict of Murder against a Suigeon...... 396
Military Hospitals . 397
Sir D. Corrigan’s Candidature. 397
Death of Dr. Hardy, of Dublin . 397
Beaumont Medical Society . 397
The Scotch Universitie* . 397
Social Science Association—
Health Section.—Address by H. W. Ram¬
sey, Esq.. M.D., President of the Section 898
Poor-law Medical Officers’ Association (of
England). 400
GLEANINGS.
A Word for Introductory Lecturers. 400
Parish Nurseries. 400
The Medical Calling . 400
Medical News, Notices to Correspondents,
See ..... 401
Sirtura
LECTURES ON STRICTURE.
with special reference to its treatment.
By Rawdon Macnamara,
Vice-President and Professor of Materia Medica in the Royal College
of Surgeons of Ireland, and Suigeon to the Meath Hospital.
LECTURE III.
Almost as if it were to be a commentary upon our last
lecture, gentlemen, a case has been sent up to me for
treatment from the country* which you have had an
opportunity of examining. The case to which I allude
is that of A. B., net. forty-six. A subject of congenital
phymosis, eight years ago he had been circumcised in
one of our metropolitan hospitals. Subsequently, he goes
down to the country, gets retention of urine, and the
highly intelligent suigeon who is called upon to relieve
him fails in finding the meatus irrinarius extermis, for
reasons which are perfectly patent to you on examination,
and to which I shall presently more particularly allude.
By operative interference he gets a glimpse of the meatus,
introduces an instrument, gives the patient temporary
relief, and tlieu recommends him to place himself under
my care for more perfect treatment. What, now, is this
patient’s present condition ? The foreskin is drawn
tightly down over the glans penis, and its orifice is a very
small cartilaginous ring, scarcely capable of admitting the
passage of a director, perfectly incapable of distension,
and which no amount of manipulation or skill permits
of seeing the meatus urinarius. You may well now in¬
terrupt me and soy, “ But you tell us that eight years
ago this man was circumcised.” Yes, gentlemen, he was
subjected to the operation, but ic was imperfectly per¬
formed. That very point to which I drew attention in
my last lecture was not attended to, and the mucous
membrane was not divided to gn extent corresponding
with the division of the cutaneous structure ; the result
was that it has gradually contracted again, as you see it
now, aud with this additional inconvenience—extensive
adhesions between the prepuce and glans penis. Our
duty now is to introduce the director, and slit up the pre¬
puce on its dorsum, to break down the adhesions, remove
all the indurated cartilaginous tissue, and leave the elana
penia as uncovered as the unfortunate condition of the
parts will admit of. Well then, gentlemen, you have seen
me trying to carry out the steps of the operation I have
just sketched out for you. You must have observed how
very intimately and extensively the glans was attached to
the prepuce, with what extreme difficulty the attachments
were broken down ; and none of you can have failed
to remark the dense, cartilaginous structure of the
tissue which I removed with the assistance of the excellent
scissors recommended by that distinguished surgeon, Mr.
Butcher, for the operation for harelip, and which bears
his name. You may also have observed that, with some
difficulty, I introduced into the patient’s bladder a No. 3
gum elastic catheter, some little time having been first
expended in discovering even the orifice of the urethra,
and that I finally dressed the penis with a small roller
of dried lint, without any effort to connect the mucous
and cutaneous surfaces by points of suture. As you look
at the result of this operation, you can readily perceive
that the glans penis is now fairly exposed, and no reason
exists why the operation should not now be permanently
of use to him. Why l made no effort to connect the skin
and mucous membrane together by points of suture, I
shall now explain to you. In structures so altered by
disease, union by the first intention would be hopeless ;
therefore sutures could be attended with no benefit, and
might only complicate the further progress of the case. I
preferred bringing the parts into position by the strap
of lint, and I shall leave everything undisturbed for the
next forty-eight hours. By the introduction of the gum
elastic catheter, and by leaving it also in the bladder
undisturbed fur the next forty-eight hours, I look for two
advantages, one connected with his stricture, a poiut which
I shall again have to revert to ; the second, and perhaps
at this moment the most important, is that I shall 60 con¬
duct the urine out of the bladder as not to allow it to
come into contact with the raw surfaces of the wound,
and so produce in them irritation.
We now come to cousider the impediments to micturi-.
tion caused by stricture of the urethra. Strictures have
long been divided into three great classes—organic, spas¬
modic, and mi^ed ; terms, the first two of which explain
themselves, the third being supposed to be a compound
of the two first. Although these term* bear so self-evident
an interpretation, it may perhaps be as well to enter more
fully into their con&uterati 01 *. When most strictly inter-
preted> an organic stricture is conceived to be a narrowing
of the urethra frqm its nouffal or healthy calibre by some
adventitious growth or deposit within or without it* wali§.
386 The Medical Press and Circular.
LECTURES ON STRICTURE.
November 4,1801
By this narrowing an impediment is presented to the free
egress of the urine, and this impediment is permanent in
its character. Slowly progressive in its tendency,
gradually, though surely, increasing in intensity, the
purely organic stricture, so understood, is free from exacer¬
bation ; it is not better one time, worse another, but is
always present, exhibiting the characteristic phenomena
and symptoms of the disease. This, to my experience, is
the very rarest form of stricture ; and why it should be
so you will thoroughly understand when you advance
further with me in the study of the disease. Spasmodic
stricture, on the contrary, is supposed to exist perfectly
independent of any structural alteration whatsoever in the
calibre of the urethra ; to be dependent upon extraneous,
constitutional causes, which, when removed, leave the
anatomical conformation of the part as perfect and as
unaltered as they were previous to the presentment of the
first symptom ol the disease ; whilst tne mixed stricture
is understood to be an organic stricture upon which has
been superimposed an attack of spasmodic stricture. This
last form of stricture—the mixed stricture—is admitted
by every surgeon of any practical experience as being by
far the most frequent kind of stricture which w r e are called
upon to treat in our everyday practice. This classifica¬
tion, originally proposed by John Hunter, has by no
means been accepted as perfectly satisfactory by succeed¬
ing surgeons. Ii meant to include all the causes of diffi¬
cult micturition, it is not comprehensive enough, inas¬
much as it excludes many, acute gonorrhoea for instance,
which may produce such a result; and if it be meant
only to refer to cases of difficult micturition dependent
upon structural change, it is too comprehensive, including,
as it does, cases of pure spasmodic character, in which no
such structural change is supposed to have occurred.
Various other divisions have been suggested by successive
authors on the subject, but somehow I do not attach
much importance to such classifications, and shall con¬
tent myself with referring to special treatises upon stric¬
ture, where you can readily make yourselves acquainted
with these points. In practice, it will be sufficient for
you to know that there are such things as organic stric¬
tures, and that they are subject to exacerbations at times
from extraneous influences ; and that independent of
stricture, strictly so understood, we have many other
causes which may give rise to difficult micturition, or, in
fact, impede the act altogether, the principal of which I
alluded to in my former lectures.
The existence of Hunter’s spasmodic form of stricture
has been denied by some authorities, and yet I am as con¬
vinced of its existence as I am of the existence of oiganic
strictures. Over and over again has the passage of a
catheter in my hands been impeded, if not altogether pre¬
vented, by powerful spasmodic contractions of the walls
of the urethra, immediately after it had passed that por¬
tion of the urethra corresponding to the glans penis.
These powerful contractions have been experienced by
me as my instrument traversed the entire length of the
urethra on into the bladder; and even on the withdrawal
of the instrument have I been made sensible of the grip
with which the spasmodic contraction of the walls of the
urethra still held it. Occasionally some of my patients
have been well aware of the existence of this tenaency to
spasm in their individual cases, and have warned me of
this peculiarity. But it is in infant boys that you will
best observe this spasmodic form of interference with
micturition. Often nave I been sent for to see a little
fellow of some six or eight months old, screaming with
pain, and unable to pass one drop of water in spite of the
most violent muscular efforts on his part. That the case
is one of retention, and not Suppression of urine, will be
quickly evidenced by the presence of a palpably dis¬
tended bladder. The edup a'mit which not uairequently
presents itself to the surgeon upon entering the room in
such cases is not a little funny. The struggling, screeching
child, tying On its anxious and terrified mother’s lap near
theffre; the nurse her knees before the little fellow
practising a plan which, by the Way, frequently proves
successful, and which is to breathe her warm breath upon
his little genitals, and for her success in which she is
frequently rewarded by receiving either in her mouth or
eye the first iet of urine which at length escapes from the
little patients bladder. What but spasm is the cause in
such a case as this of the impediment to micturition ?
The possibility of the existence of any form of organic
stricture is precluded by the age of the patient, as well as
eventually disproved ny the subsequent history of the
case. Nothing but spasm, pur et simple , can account lor
these not very unfrequent phenomena. In such a case we
need not have much apprehension as to the result
Fortunately the symptoms are readily amenable to treat¬
ment ; a warm bath and a little nitre punch will speedily
afford relief. By nitre punch I mean a mixture composed
of two drachms of sweet spirits of nitre, two ounces of hot
water, and a lump or two of white sugar. A teaspoonful
of this given the little sufferer every ten or fifteen minutes
will quickly relax the spasm and allow the urine to flow.
In adults, also, I have repeatedly met with cases of reten¬
tion of urine, in which also extreme difficulty has been
experienced in the introduction of the catheter, all attri¬
butable to spasm, and perfectly independent of organic
stricture. This form of difficult micturition is to be dis¬
tinguished from that which occurs as the result of the
over distended bladder, to which I made allusion in toy
first lecture. Here the difficulty is situated in the urethra,
and is due to inordinate spasm—a spasm which makes its
existence be recognised by the decided resistance it
gives to the introduction of the catheter, and upon the
subsidence of which the urethra presents as healthy an
appearance as if it had never existed. The treatment for
this condition is the warm bath, the opium suppository,
the inhalation of chloroform, the administration of the
muriated tincture of iron, and, should all this fail, in urgent
cases the introduction of the catheter. Allow me to say a
few words, gentlemen, upon these several remedies.
The warm bath should be entered at first at the tempera¬
ture of 96° F., and cautiously raised to 108° F. By ao
proceeding, in the majority of cases, uncomplicated with
organic stricture, the spasm will be allayed, and the patient
most probably will pass his water in the bath, and especi¬
ally so if an opium suppository had been introduced into
his rectum pervious to immersion in the bath. This sup¬
pository should be composed of one grain of watery ex¬
tract of opium and two of camphor. The muriated tincture
of iron, originally suggested by Mr. Cline, the surgeon to
whom Sir Astley Cooper served his apprenticeship, has
great virtues in such cases. In my practice, I have derived
signal service from its administration. It should be ad¬
ministered in fifteen minim doses every ten minutes, and
rarely indeed has it disappointed my expectations. Not
unfrequently I employ a mixture of the muriated tincture of
iron, and of laudanum, in equal proportions, and of this 1
give thirty minims every twenty minutes, until relief be
experienced. Chemists may object to the compatibility of
these two medicines, and talk to you of decomposition;
let not such remarks, however, influence you ; the combi¬
nation has sufficient practical value to recommend its exhi¬
bition in such cases, and the end, in this instance, justifies
the means. I could cite many cases which have occurred
in my own experience which would illustrate the great
value of the muriated tincture of iron, either perse, or com¬
bined, as I have described to you, with laudanum. I shall
content myself, however, with but two ; the first, illustra¬
tive of its value, when employed alone; the second, when
combined with laudanum. The first case occurred many
years ago in the person of a dearly loved fellow student,
now a distinguished provincial practitioner ,- he had been
paying billiards all the evening, and, upon proceeding
to empty his bladder, to his horror, he found himself un¬
able to do. so, from excels of spasm. He never before had
experienced the slightest difficulty in micturition, bol
now was unable to void it, save in drops ; and to add to hi
embanasment, the time was approaching for the d op e* t o re
of the last train for Kingstown, where he resided. Be
hurriedly rushed off to a neighbouring chemist, wh m he
Digitized by v J °°8 le
The Medical Prc^s and Circular.
ORIGINAL COMMUNICATIONS.
November 4,1868. $87
E rocored half-an-ounce of the muriated tincture of iron, and
e commenced at once to take sips of it at hap hazard, with
such an amount of relief, that before the train reached
Boolerstown, or, in other words, within half-an-hour from
the time he commenced the treatment, he was compelled
to give relief to his over-distended bladder in the very rail¬
way carriage itself. Now this gentlemen never had a
symptom of stricture before that evening, nor has he ever
had one since, although many years have elapsed since the
period to which I am now alluding. In this case, I have
no doubt on my mind but that the relief experienced was
due to the action of the medicine, and yet are we told that
the muriated tincture of iron is of no use in such cases !
This case, gentlemen, is by no means an exceptional one ;
in many other similar cases have I employed it, and though
in some few instances it has disapointed my expectations,
still I have great confidence in its remedial power.
With respect to the value of the combination of muriated
tincture of iron with tincture of opium, employed in the
manner I have described, I shall give you but one example ;
but it, however, is a striking one. Some months ago, a
gentleman came to my study requesting me to relieve a
very much over-distended bladder. He never had suffered
in a similar way on any previous occasion, nor had he ever
any symptoms of organic stricture. The invasion of his
disease was sudden, and probably attributable to wet feet
and cold exposure ; his agony was unmistakeable, and when
proceeding to examine him, I found plentiful evidence of
previous surgical efforts, his person and linen being covered
with blood, He stated that he had applied to several
medical men before coming to me, and that all had failed
in passing even the smallest instrument, and that these
abortive efforts were the source of his bleeding. I declined
to attempt to pass any instrument as matters then were,
but requested him to accompany me in his cab, which was at
the door, up to this hospital, where I hoped to be able
to give him some relief, He eagerly assented, and upon
our arrival here I directed a warm bath to be prepared as
expeditiously as possible, and meanwhile gave him thirty
minims of the tincture. About twenty minutes, or a little
more, elapsed before the bath was ready. I repeated the
dose, and just as he got into the bath a few drops of urine,
attended with much scalding, came away. With very little
difficulty indeed I slipped a gum elastic instrument into
his bladder, and in a few moments his relief was complete.
Apprehensive of any unpleasant results following the com¬
ing into contact of the urine with the urethra, which had
undoubtedly been lacerated in one, if not in several, places,
I fastened the instrument in his bladder, and left it there
until the following morning, when I removed it; I saw
that gentlemen but on one subsequent occasion, when I
introduced a No. 10 silver catheter into his bladder, with¬
out meeting with any impediment whatsoever. Surely,
gentlemen, such a case cannot be looked upon as one of
organic stricture. This gentleman mentioned to me a fact
which must be accepted as curiously illustrative of the
agony both of mind and body under which he was suffer¬
ing previous to the unloading of his bladder. It was this :
that repeatedly had he sent me patients to treat for stric¬
ture in consequence of the little reputation I have acquired
on this subject; but that when his own hour of suffering
came, he forgot all about me, his agony put everything out
of his mind, but the desire to get immediate relief, and
that it was due to the accidental meeting of one of those
parties whom he had advised to consult me, and whom he
met as be left the abode of the last surgeon, that he came
near me at all. I mention this fact, gentleman, in no spirit
of wain glory, but to prove to you how intense must be the
sufferings of a patient in such a condition. And, in con¬
clusion, allow me to give you this practical hint : when a
patient has had several ineffectual efforts made by other
su£e6ne to pass an instrument, where there is evidence of
'violence having been employed affbrded by the quan¬
tity of blood he has lost, try some such palliative treatment
aft 1 employed in this case previous to attempting to pass
the catheter ; otherwise, you also may add to the mischief
aTtnhflj iftflioted upon his urethra.
(foammuniwiion*.
EXPERIENCES OF A REGIMENTAL SURGEON
IN INDIA.
By C. A GORDON, M.D., C. B.,
Deputy Inspector-General of Hospitals.
(Continued from page 868.)
The histories of all military expeditions teem with
illustrations of the effect of active service in enabling
soldiers for a time to resist the ordinary causes of disease.
In August, 1857, a body of soldiers was dispatched from
Dinapore to Arrab, partly to avenge the disaster to which
allusion has already been made, and partly to relieve the
small force that was besieged at the latter place. The
rainy season was then at its height The men were for
upwards of twenty days employed in marching, or in
fighting their Sepoy enemies. During the aay and
during the night they were without shelter of any kind.
Fortunately, the military operations were successful.
Had they been otherwise, disease to an alarming extent
would doubtless have appeared among the troops, exposed
as they were to drenching lain, fierce sunshine, great
bodily fatigue, irregular and badly cooked meals, want of
regular sleep, and other hardships incidental to expedi¬
tions such as that in which they were engaged. But
although at the time, while the excitement of military
service enabled the men, as it always does, to undergo
fatigues and hardships that under other circumstances
would be impossible, no sooner was this moral stimulus
permitted to subside, as it did on the return of the detach¬
ment to the comparative ease and comfort of barrack
life, than severe sickness attacked the majority, carrying
off a very large proportion. The disease that unaues-
tionably proved most intractable was dysentery oi the
haemorrhagic type, but of this more will be said in its
proper place. In circumstances such as those in which
this detachment was placed, the ration of ardent spirits
authorised by the regulations of the service to be issued
to the soldiers is, in my opinion, to be recommended as a
sanitary measure ; for, however prejudicial undiluted
spirits may be at other times, there is no doubt that to
soldiers—wet, hungry, and exhausted—the dram of rum,
by the direct stimulus it imparts, decreases their liability
to diseases of a debilitating nature, to which these
depressing conditions predispose them. It must be under¬
stood that it is only under particular conditions of service
such as have been enumerated that the ration of spirits
to soldiers is advocated ; and I may here observe that
the views expressed on the subject have received ample
confirmation in the reports of more recent field opera¬
tions. Among such I may mention the expedition to
Bhootan, several medical officers connected with which
were led to believe that a moderate allowance of spirits
acted as a protection against malaria in that most
malarious country ; and during that to Magdala, the
medical officers have recorded the circumstance that after
the soldiers had been some days deprived of their stimu¬
lant an evident deterioration in health began, attended
by diarrhoea, and inability to completely digest and
assimilate their food. It is further borne out by the
experience of American medical officers during the late
civil war in that country, as related by Dr. Hammond
in his work on military hygiene.
For several weeks the regiment to which my present
remarks more immediately refer had to hold itself at all
times prepared for a sudden attack to be made by the
rebel sepoys upon the station which it occupied, and for
the very probable contingency of an attack on the part of
the native inhabitants of a neighbouring city 1 , in which
were situated the Government opium stores, containing a
quantity of that drug valued at two millions sterling ; thus
l Pitas.
Digitized by
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388 The Medical Press and Circular.
HOSPITAL REPOETS.
November 4,1868*
its duties for that time were very severe. It moreover
became necessary to locate a company of men in a close,
111 -ventilated building connected with these stores, and
the result was that in an incredibly short space of time
a large proportion became attacked with haemorrhagic
dysentery and phagedenic ulcers, to both of which diseases
they had doubtless been rendered predisposed by previous
exposure and fatigue, but which were directly excited by
the insanitary condition iuto which they were thrown.
As the principal loss sustained by the regiment occurred
during the three first months in which it was occupied
in the operations against the mutineers, it may be
interesting, in a medical point of view, to record the
amount of that loss during July, August, and September.
From the records of the hospital, it appears that the
decrease in the regiment, exclusive of the 47 killed as
already mentioned, included—seven died of cholera, five
of hepatitis, and 18 from various other causes of a mis¬
cellaneous nature ; thus giving a total of 77 deaths in
three months in an average aggregate strength for the
same period of 837; or, to state the rates of mortality still
more explicitly, an average rate of upwards of 36 per cent,
per annum. During the same three months, no fewer
than 426 cases of disease and injuries were treated in
hospital, instead of 311 in the same period immediately
preceding.
During the months of October, November, and Decem¬
ber, the duties were considerably lightened by the pre¬
sence of detachments of others sent for that purpose. The
hot and rainy seasons had gone ; the most healthy period
of the year set in ; and, as might be expected, the num¬
bers treated and died in hospital materially diminished,
the former being 330 and the latter 5.
From the latter part of December to 31st March, 1858,
the entire regiment was employed on field service.
During that time it marched a distance of upwards of four
hundred miles, going to and returning from Lucknow, at
the siege of which it took a prominent part. For some
time it occupied a standing camp ; several times it was
engaged with the rebels ; and finally made continuous
forced marches to the relief of Azimghur, where they
were besieging a small British force. Thus, then in
quarters, on field service, during a siege, in an unfortu¬
nate surprise, and in a rapid military advance—the 10th
Regiment was employed during the first year, of the
Indian mutiny in nearly every variety of service that
infantry can be called upon to perform.
The sanitary condition of the troops while employed on
those different services was good, the severity and preva¬
lence of disease being considerably less thau in quarters.
Unquestionably, the regularity of the life the soldiers
were under the necessity of leading, the want of opportu¬
nity to indulge to any great extent in drunkenness—
that saddest bane of the army—more than compen¬
sated for the effects of exposure and fatigue to which they
were subjected. I may mention, however, that during
some months embracing the hot season of 1858, when the
regiment was on field service, and when the summer heat
ranged to 116 Q F. in the shade, the men imperfectly sup¬
plied with changes of clothes and with tents, they suffered
m health to a great extent. Tired and exhausted as they
were on such occasions, after long marches, they were
unable to obtain that amount of rest and sleep that was
necessary to renovate and refresh their energies. The
closeness and heat of the atmosphere almost completely
banished sleep from them as they lay on a pallet of straw,
or had not even that substitute for a bed The powers,
thus prevented from recovering from the depression of the
previous day, were still further lowered by the march and
exposure, and, it might be, the attack on the morrow.
Appetite next began to fail. The ordiuarv rations,
coarsely cooked as they necessarily were, no longer w*ere
eaten with relish. There was indifference, then absolute
loathing felt towards them; and thus, while duty and cli¬
mate continued to exercise their depressing effects, the
system obtained no support, because food was almost
entirely eschewed,
Added to these, the chilopoietic functions became
deranged ; secretion of bile, at one time checked, at
another became inordinate ; irregularity of the bowels
was the result—at times constipation, but more frequently
diarrhoea—which reduced the remaining strength with
marvellous rapidity. The ratio of attacks of diarrhoea
and dysentery increased ; fevers of more or le38 severity
became more numerous ; and giddiness and congestive
headaches indicated, even in the absence of more severe
symptoms, the effects of continued exposure to the terrific
sun during May and June.
On service in India, troops are seldom deprived of their
ordinary quantity of vegetables. During almost the whole
of our operations potatoes were served out to the soldiers,
but, as a matter of course, no variety in kind of vegetable.
Fruit was not obtainable, and although no actual out¬
break of scorbutus or purpura occurred, yet in not a few
instances the deprivation of fruit produced a very distinct
effect upon them. In some officers so distinctly was this the
case, that the desire for fruit actually amounted to a perfect
craving, the teeth became coated with tartar ; and when
at last a supply of mangoes, grapes, leech ecs, and peaches
was brought to camp, these were devoured with an avidity
and in quantities scarcely credible. Not only did no evil
result follow, but iu many instances the attacks of
diarrhoea became less urgent, and our bodily sensations
plainly told us that a want previously felt by the system
had been supplied.
Although, under ordinary circumstances, the means of
providing for wounded soldiers during a campaign aie
probably better than they are in any other country, never¬
theless circumstances may in rare instances occur in which
the wounded cannot be given the advantages of those
arrangements. An example of this occurred in July ana
August, 1867, on' which occasion many of the soldiers
who were wounded could not receive hospital treatment
till some days afterwards. The condition of some,
especially those suffering from injuries of the more
important hones, was deplorable. Extensive suppura¬
tion, discharges of extremely offensive matter, mortifica¬
tion, and the occurrence of maggots were found in all;
and what rendered matters little better than they were,
even with those conditions, was the fact that in the
hospital at Dinapore, being filled as it was with wounded
men, hospital gangrene made its appearance among them
in a manner familiar only in the days of the Peninsular
war. Of the hospital attendants, it too often happened
that they were in no way qualified for the duties required
of them. Not only were they natives of the country, with
all the inherent apathy and indifference to the value of
life which characterises the race to which they belonged,
but they had no training whatever for their vocation ; so
that, except for the few soldiers who, under the exigencies
of the occasion, could be spared to assist their wounded
comrades, the latter were very badly oft. Some attempt
has, it is true, been made of late years to remedy thisve^
sad state of affairs, but it has, I fear, not yet advanced to
maturity.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. Beale, F.R.S.
(From notes by Dr. Tonge.)
ACUTE RENAL DROPST.
H. R., set. forty-nine, blacksmith ; admitted July 13, dis¬
charged August 7; in hospital twenty-five days. Was in
Kind’s College Hospital last April, with dropsy; when dis¬
charged, had slight haematuria and oedema of legs. Previous
illness one month. On admission pallid, legs oedenratous,
slight ascites, breath short, sibilus over back of lungs; urme
scanty, slightly albuminous, containing blood casts, Wood
corpuscles, and renal epithelium; six days later much nM$e*
Digitized by ^ ^.ooQle
The Medical Press and Cirouiar.
HOSPITAL REPORTS.
November 4,1668. 389
and vomiting ; fifteen days later drowsiness, gradually
deepening into coma; very scanty urine. Died in convul-
sions two days later.
Post-mortem examination. —Much fluid in pleure peri¬
cardium and peritoneum ; lungs cedematous, bronchi
choked with mucus ; left ventricle hypertrophied and
slightly dilated; warty growths on two of the aortic valves ;
atheromatous patches at root of aorta; kidneys large, eight
and-a-half ounces each, congested, fatty.
Sesquichloride of iron and quassia ; bicarbonate of soda
and hydrocyanic acid ; carbonate of ammonia and chloric
ether ; Sesquichloride of iron and chloric ether ; podophy-
llin ; compound jalap powder ; pepsine.
H. T., set. forty-two, smith ; admitted, December 17,
discharged March 5. In hospital seventy-nine days;
relieved. Is exposed while at work to draughts of
air and sudden changes of temperature. ' Previous
illness thirteen days ; began with headache, catarrah,
and cedema of face. On admission face puffy, con¬
siderable cedema of scrotum and legs ; slight lumbar
pain ; urine pale, one-third albumen, with renal epithelium
and washy casts ; a little blood five days later ; forty-five
days later urine as before, but no blood, and a few granular
casts, some containing oil ; twenty-nine days later only a
trace of albumen, ankles still oedematous.
Liq. ainmon. acetatis and aromatic spirits of ammonia ;
then sesquichloride of iron and chloric ether ; afterwards
quinine, scammony and jalap ; hot air baths ; loins dry
cupped.
HEMATURIA.
E. B., set. forty-three, groom ; admitted February 22,
discharged February 27 ; in hospital five days, discharged
because unruly. In King’s College Hospital with uric
acid gravel under Dr. Beale some months ago ; hiematuria
fourteen days. On admission, urine very dark with blood
(blood casts and free blood globules seen under micro¬
scope), deposits uric acid, is not albuminous ; systolic bruit
loudest over base of heart; indistinct diastolic murmur
over base ; mine free from blood four days later.
Sesquichloride of iron and quassia.
PEMPHIGUS.
Elizabeth W., zet. thirty-five ; admitted November 18,
discharged February 24 ; in hospital ninety-eight days ;
relieved. Had typhus four months ago ; previous illness
four weeks. Shivering followed by heat of skin, and the
next day a crop of bulke about shoulders. On admission
recent bulke on shoulders, arms, back, chest, buttocks and feet
and ankles, interspersed with red patches left by old bulla?.
Fresh blebs continued to appear while she was in hospital,
but became smaller. The excoriated surfaces healed rapidly
under plain water dressing.
Sesquichloride of iron and hydrochloric acid ; acetate of
ammonia, aromatic spirits of ammonia and ether chloric ;
sesquichloride of iron and chloric ether ; bicarbonate and
nitrate of potass. Locally, benzoate of zinc ointment, and
water dressing.
WESTMORELAND LOCK HOSPITAL.
PRIMARY UTERINE SORES.
Under the care of Mr. Morgan,
Professor of Anatomy, R.C.8.1. ; 8 irgeon to the Hospital, and to
Mercer’s Hospital.
Amongst the difficulties of arriving at a true appreciation
of the history of a syphilitic infection, is that of fixing
the time of the initial introduction of the poison ; in the
male, from the occurrence of urethral, or hidden sores, and
in the female from their formation internally and out of
view, save with the aid of the speculum. Ricord gives
some excellent illustrations, and refers to the complications
and difficulties that may arise in recognising this source of
infection. Several cases of hidden primary sores have come
under my care in the hospital wards, where the ulcer was
found on the uterus or upper part of the vagina. I select
the following as amongst the most interesting ; and as the
patient has been under my observation since the first re¬
ception of the poison, the history is accurate.
K. B., aged twenty-six (ward No. 2, bed 7), admitted
May 5, 1868. Four years unvirtuous ; presented hardened
tender inguinal glands on both sides to such an extent
that she was greatly inconvenienced in walking, though
not so as to cause lameness. There were no other
signs of syphilis, no sore of the genitals, no abrasion,
and but little vaginal discharge. She had given birth to
a child three months previously ; the child was perfectly
healthy, and she continued to suckle it till her admission
into the hospital. The glands had been swollen and tender
for two weeks previous to application. These being the
only signs, I made a speculum examination, which showed
a well marked small sore on uterus about one-quarter of
an inch from the os externum ; and another sore of the
same character on the vaginal wall about two-thirds the
distance within. Both these sores were clean looking and
small, nearly the size of a threepenny piece, not smeared
with pus or bleeding easily, and completely insensible. I
practised auto-inoculation from each sore, on each
thigh, and cauterized the sores with nitrate of silver, not
with a view of their destruction, but of vigorous stimu¬
lation. The inoculations failed completely. In another
week I repeated the inoculations with the same negative
results ; and again in a week when the sores were inclined
to heal, but without success.
I did not give mercury in any form, but by local appli¬
cations, injections, and tonic treatment succeeded in heal¬
ing the sores and improving the general health. The
swelling of the inguinal glands abated by fomentations
and pressure ; the patient was discharged cured, June 6th,
1868. A drawing was taken of the sores as first seen,
which shows admirably their condition and appearance.
On the 31st of July, 1868, this woman again presented
herself for admission. She states that she had not lead a
dissolute life since, and that she was not in needy circum¬
stances. She is now a capital illustration of syphilitic
poisoning ; with the skin pallid and murky looking, alopecia
well marked, enlargement of the cervical glands, small
ulcer of the right tonsil, pains in the shoulder-joints, and
covered with a copious crop of papulo-squamous eruption,
well marked on the palms of the hands and soles of the
feet and over the body generally. She had in arms her
child, the most perfect specimen of a boy in complete
health and splendid condition that could possibly be seen ;
she states positively that she still partially suckles him
and the breasts no doubt still secrete.
On admission the child was put on spoon diet and not
allowed to suckle. The patient was treated by the Calomel
Vapour Bath, which she got three times a week for three
weeks, fifteen grains of calomel being used for each bath,
and the bath continued for twenty minutes. The bath was
then ordered but twice a week for six weeks longer ; ten
grains of saccharrated carbonate of iron were administered
three times a day, and generous diet given. On the 12th of
October, 186tf, the patient was allowed to leave the hos¬
pital, the eruption which was exceedingly obstinate to
treatment having all but disappeared.
The calomel bath in this case acted most beneficially.
In three weeks there was a slight foetor of the breath dis¬
cernible, and some salivation. With regard to the child
there is no doubt but that it was nourished altogether'
by the mother, though she was suffering at the time from
two primary sores, and there is but little doubt that it was
partially nourished at all events by the mother while the
subject of intense constitutional taint, yet the child was in
splendid condition without a sign of anything syphilitic,
showing that though the mother was herself the subject of
primary syphilis with consequent glandular excitement,
yet that the lacteal secretion not only wa3 harmless, but was
capable of giving abundant nutrition ; and again, that
though afterwards she was suffering from syphilitic fever,
and the full excitement caused by the development of well
marked constitutional symptoms, that even then there was
no unhealthy taint communicated to the child. With re¬
gard to the latter circumstance, no doubt the child was but
partially supplied by the mother, and its chief food was
artificial.
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390 The Medical Rress and Circular.
FOREIGN MEDICAL LITERATURE.
No? ember 4, IS*
EDINBURGH ROYAL INFIRMARY.
Cases of Aneurism treated by Iodide of Potassium.
Under the care of Dr. George W. Balfour.
We are able to furnish later information as to Case 3 to
the following effect:—
In the beginning of August, this man presented himself
at the Infirmary, having been working at his trade as a
mason since his discharge. He stated that he now suffered
from no discomfort nor inconvenience, but had called to
thank Dr. Balfour, and to inquire if the air of Leith would
be likely to be injurious or the reverse. Dr. B. pointed
out that the aneurism had not disappeared, but that it had
ceased to swell up and inconvenience the man; he stated
that this seemed to show that the iodide of potassium had
restored the arterial tissue to a state of comparative health,
and to bear out Dr. King Chambers' idea that, whatever
other actions it might have, it was certainly a restorative
of the white tissues; the man had no longer an aneurism,
but only a dilated, but quite elastic, artery where the
aneurism had been. He has not since been seen, and as
he lives at Leith, and would certainly return if uncomfort¬
able, the probability is that he is feeling well and able for
his work.
-♦-
CASE OF HEMIOPIA.
Communicated by Db. M. K. Loewioren.
Translated from the Hygica for May, 1868, by
W. D. MOORE,M.D.,Dub. et Cantab.,L.K.Q.C.P.I,M.R.I.A.,
HONORARY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIANS J OF
THE NOBWEOIAN MEDICAL SOCIETY; AND OF THE ROYAL MEDICAL
SOCIETY OF COPENHAGEN; SECRETARY FOR SWEDEN, NORWAY AND
DENMARK, TO THE EPIDEMIOLOOICAL 80CIETY OF LONDON.
Per Nilsson, labourer, of the parish of Skurup, aged fifty-
four, was admitted into the hospital at Lund, on the 29th of
March, 1867, for weakness of sight.
The patient stated that he had enjoyed in general particularly
good health, and had never been confined to bed by illness. He
had however, of late years occasionally been troubled with head¬
ache, which sometimes lasted for several days consecutively,
but in the intervals he had been completely free from it. The
pain was seated principally over the vertex and in the fore¬
head, without being specially concentrated in or about the
eyes. During the last two or three years he has remarked that
the power of vision was constantly diminishing, but so that he
at times saw better, at times worse. Last Christmas he says
he was for a short time almost totally blind in both eyes, so
that he could scarcely distinguish whether a candle was lighted
or extinguished in the room. Subsequently, however, the
power of vision increased gradually during January and the
early part of February, but after that time he thought that no
change took place. The patient says that he has always led a
regular life and that he never had syphilis.
Present State .—The patient is of ordinary build, and has,
with the exception of a rather flaccid and puffy condition, a
tolerably healthy appearance. There is nothing particular to
remark in the state of his circulatory, respiratory, or digestive
apparatus. Urine not albuminous. The organs of sense, with
the exception of that of vision, present nothing abnormal.
The intellect is clear. The patient complains now only of
great diminution of the power of vision, so that he even finds
difficulty in making out where he is. He has no headache.
Externally his eyes exhibit nothing abnormal. Their mobility
in all directions is unimpaired. The pupils are uniform in
shape, of moderate size. They react rather languidly to the
light. Their fixation is correct. On closer investigation of
the power of vision, the following conditions are found to exist.
With the right eye he could, although rather uncertainly,
reckon fingen at the distance of about ten feet. When the
left eye was covered and the patient was told to fix, with the
right, an object held straight before him at the distance of a
foot, he could not describe the movements of the hand on the
outside of the fixed point, nor could he do so when the hand
was carried upwards and outwards, or downwards and out¬
wards. On the inside of the fixed point, as well as upwards
and inwards, and downwards and inwards, he could, on the
contrary, distinctly perceive the movements of the hand (with
the exception, however, of the most peripheral parts of the
field of vision,) and in the neighbourhood of the fixed point
at this distance.\ even reckon the fingers. When the field of
vision was examined in a dark room with the aid of an
ordinary oil lamp the defect in its outer part was
still more distinctly visible, and the boundary toward
the inner and still retained half of the field of vision was
particularly acutely marked. When the patient fixed an
object at about a foot’s distance, he could not Derceive the
slightest glimpse of the lamp burning with a full flame, so long
as it was held ou the outer part of the field of vision, not even
when the flame was brought quite up to the fixed point The
boundary between the thus defective outer part of the field of
vision and the still somewhat retained inner part was formed
of a slightly curved vertical line with the concavity to the
nasal side and passing through the centre of the fixed point
So soon as the flame passed this boundary from without
inwards it became quite evident to the patient. The investi¬
gation of the power of vision of the right eye, therefore, gsve
the following results ; the central vision considerably lowered
(to about l-20th of the normal), the eccentric vision in the
inner part of the field of vision rather lowered, thus showing
that the outer half of the retina, had, to a certain extent, re¬
tained its integrity; the eccentric vision in the outer part of
the field on the contrary, had totally disappeared, thus exhi¬
biting complete anaesthesia in the nasal half of the retina.
With the left eye the patient could easily reckon fingen st
the distance of twenty feet, and at the distance of one foot he
could read separate words of No. 10 of Jaeger. The eccentric
vision was limited and bounded in the same manner as in the
right eye. In the inner part of the field of vision he could,
however, everywhere easily reckon fingers; in the outer he
could not see the movements of the hand. He could, never¬
theless, on investigation with the lamp, occasionally perceive
a glimpse of the flame, when this was carried round in the
outer half of the field of vision. But so long as the flame wm
held peripherally this was not possible ; on the contrary, so
soon as it was brought nearer to the vertical line of division in
the field, it became occasionally evident to the patient, even
when it was lowered to one-half. The examination of the Wt
eye, therefore, showed that the central vision was considerably
lowered, though to a lees extent than was the case with the
right eye ; that the eccentric vision in the inner half of file
field was almost intact, in the outer half on the contrary, it was
deficient in the more peripheral parts, and extremely depressed
in the parts of the field of vision bordering on the inner half, and
that consequently the boundary between the outer efficient
part of the retina and the inner anaesthetic part of the latter,
although quite distinct, was not here so accurately marked as
in the other eye.
Examination with the ophthalmoscope showed that the media
were perfectly clear and transparent. The fundus of the left
eye exhibited nothing abnormal. In the right eye, on the con¬
trary, the nasal part of the papilla of the optic nerve wae
rather white and shining (atrophic), and the calibre of the re¬
tinal vessels on the same side was perhaps rather diminished.
These changes were however but slightly marked.
(To be continued.)
iterate.
On Consumption and its Treatment by the Hypophos-
phites. By John C. Thorowgood, M.D. Lond., Assistant-
Physician to the City of London Hospital for Diseases of
the Chest, Victoria Park; late Physician to the Royal
General Dispensary. Second Edition. London: John
Churchill ana Sons ; Dublin : Fannin.
This pamphlet before us is composed of two parts. Part L
contains the author’s first series of observations on the use of
the bypophosphites in pulmonary disease ; and Part H. con¬
tains a new and more extensive series of cases and observa¬
tions.
It is well known that, mainly in consequence of the extra¬
vagant, we had almost said ridiculous, manner in which the
hypopliosphites were at first lauded up to the skies by Dr.
Churchill, of Paris, they fell into disrepute, and were discarded
as useless by some practitioners as far as their curative powers
in consumption went.
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CORRESPONDENCE.
November 4, 1868. 891
Dr. Thorowgood seems for several years to have employed
the hypophosphitcs of soda and lime in the treatment of
phthisis, and to judge by the cases he has published, the
success attending the treatment seems beyond a doubt.
The case of F. A., given at page 11, is peculiarly instruc¬
tive. ^ This man’s illness commenced with cough and haem¬
optysis. Under ordinary routino treatment he got worse, ,
and he then was ordered five grains of the hypophosphite of
soda, with glycerine and water; he had no cod-liver oil or
cough pill, and recovered completely. About a year after the
same symptoms returned, and were again arrested by the
same medicine.
The case of Wm. G., at page 26, is a good one to show the
fair way in which the powers of the hypophosphite of lime
were treated. The man had distinct phthisis in the left lung,
and was improved by a course of the hypophosphite of lime.
Subsequently this was changed to the simple liquor calcis sacc.
of the B. P., but there was no marked effect on the pulmonary
symptoms till the hypophosphite was added.
Dr. Thorowgood believes that phthisis in its early stages is
a disease of the nervous system (page 7), and his idea is to
endeavour to regenerate exhausted nerve force by the admin¬
istration of phosphorus in such a form as shall be readily assi¬
milated. How tar this theory may be true wo do not profess
to say, but certainly his work is honestly written, and all due
credit given to other observers in the same field. We would
hope it may serve to stimulate to further trial of these hypo-
phosphites in consumption, and also in chronic nervous affec¬
tions ; for a remedy which has the confidence of so careful a
physician as Dr. Thorowgood has proved himself to be, ought
not again to fall into disuse. Of tne rapidly rising physicians
of the younger generation. Dr. Thorowgood is generally es¬
teemed one of the most able, and, we believe, the confidence
of his brethren in him is well placed. His little work, like
all that proceeds from his pen, is not showy, but is full of
sonnd and reliable information. It is not a pamphlet to
amuse one’s self with tor a few minutes, but is one which anyone
seeking to learn all that is known about the hypophosphites
shonld possess and study. Authors would do well to bestow
on their productions the trouble that Dr. Thorowgood has not
spared on his.
fonttyavtomt.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sib,—T he pressing want of efficient medical officers for her
Majesty’s fleets, and the constantly increasing scarcity of
candidates, has now become bo Berious a matter that unless
measures are forced on the Admiralty for remedying this state
of things, a very large increase in the number of men yearly
lost through want of professional attendance will surely take
place. Allow me, through the medium of your columns, to
draw attention to the causes of this unpopularity of the navy.
By a long system of mismanagement and injustice, the
number of naval medical officers have been reduced from 1,207
in 1828 (when there were but 30,000 men to attend)
successively to 1,025 in ’38, 990 in ’48, 890 in ’58, 870 in ’64,
and finally to 750 at the present time ; and of whom not
more than 350, or at most 400, are fit for active service at sea.
There are now 60,000 men distributed all over the world in
320 ships, large and small ; and even these officers are so
hampered that the full value of their services is not obtained.
This necessarily leaves very many vessels without surgeons,
especially on the pestilential coasts of Africa and China, where,
from the very nature of his duties, the doctor so frequently
falls a victim during epidemics ; then for many months, until
his successor joins, men wounded by accident or in skirmishes
with the natives, are lost for want of skilled attendance.
There can be no doubt that the chief cause of the wide¬
spread discontent in the service is a want of honesty on the
part of the Admiralty, who have so constantly broken faith
with their medical officers by invariably interpreting their
ambiguously worded warrants against them, and in favour of
executives. The next cause is the struggle to perpetuate their
exploded dogma that surgeons must come from a social class
different and inferior to themselves, and are therefore to be
treated, not according to the laws of justice or gentlemanly
feeling, bat as slaves to their will ; so, shonld a Medico dare
to maintain his opinion on any question, even though he had
been specially educated on the point, yet it is “ gross dis¬
respect ” if it does not happen to accord exaotly with the plans
of the Executives, and he renders himself liable to be dismissed
from his appointment at a moment’s notice, as, indeed, lately
occurred at the Cape of Good Hope. The medico being right
and the executive wrong, even according to the written rules
of the service, is of no avaiL
Another very important sore is relative rank for age.
An executive is promoted to lieutenant at 20, frequently at
19, the surgeon to the same rank at 30 ; although, the
former is educated at the country’s expense, the latter at his
own. For instance—a naval cadet, aged 13, who left the
service, was sent to school, college, and hospital, took his
degree with honors, and joined again as an assistant-surgeon,
aged 24. During those eleven years he had expended £1,500
(five years at school, £400 ; six years at college, £720 ;
diplomas, fees, &c., £180; outfit, instruments, and books, £200).
Had he remained an executive, he would have spent £310 (six
years' allowance at £40, and outfit £70), aud received from
Government £1,820 4s. 2d. (two years’ cadet’s pay, £33 9s. 2d.;
four years’ midshipman’s, £127 15s. ; two years’ sub-lieu¬
tenant’s, £182 10s. ; three years’ lieutenant’s, £547 10s. ; and
eleven yeare’ allowances for lights, servants, provisions, etc.,
£429)—hence he would have received £1,000, instead of
spending £1,500. Now from the age of 24 the executive will
rise to the rank of commander, on an average, after five years’
sea service, at the age of 31 ; the medical officer to the same
relative rank after 17 years’ sea service, at the age of 47. The
executive’s pay from the age of 19 or 20 to 80, is 10s. a day,
with allowances of from Is. 6d. to 6s, The medical officer’s
pay from the age of entry, 24, to 30, is also 10s. a day, but
with no allowances whatever. The placing educated gentle¬
men in an inferior position to, and under the authority of
unruly boys, is one of the greatest annoyances of medical
officers at sea, and must be remedied .
The choice of cabins is still a subject of dispute; in none
of the harbour ships, and but few of the others, have the
medical officers their proper ones. In the new class of gun
vessels, the triangular space under the captain’s ladder is
allotted to the medico, although, with the exception of the
lieutenant, he is the only officer entitled to a cabin. In the
training ships, pupil teachers have cabins on the main deck;
the surgeons are “ stowed away in the cockpit.”
The unfair favouritism in giving away desirable appoint¬
ments, the invidious distinction in uniform, the difficulty in
getting leave, poor pay, and incomplete recompense for loss in
cases of wreck—all help to deter promising young surgeons
from joining a service where the best part of their lives will
be spent in exile, and in compulsory association with a few,
perhaps, uncongenial messmates, cut off from all home ties,
and subject to all the miseries and privations and greatly
increased mortality incidental to a sea life.
If the following reforms were honestly carried out, I feel
sure the present discontent in, and unpopularity of, the service
would vanish, and again a good class of candidates would apply
at Somerset House, and the stigma of leaving our sailors and
marines to die through neglect in out-of-the-way parts of the
world would be removed.
Firstly. The Medical Department should be made a sepa¬
rate and distinct corps, managed entirely by the Director-
General, who should have a seat at the Admiralty Board, and
be responsible solely to the First Lord or Minister of Marine,
and have nothing to do with “ middle men.”
Secondly. A roister should be kept to ensure fairness in the
appointments (as is now done in the Marines, Artillery, and
Engineers), and all dockyards, yachts, harbour and drill ships,
victualling yards, hospitals, sick quarters, marine and marine
artillery appointments, be held for three years, and never
twice by the same officer.
Thirdly. To compensate those assistant-surgeons affected
injuriously by the unjust warrant of May 7, 1867, clause 13;
they must be promoted in their turn, viz.—when the first of
the new class of candidates attains five years seniority (July,
1872), the new class afterwards in rotation; their age would
then be about 80, or a few years senior to those of correspond¬
ing executive rank.
Fourthly. Surgeons should be promoted to the rank of staff-
surgeon after fifteen years’ service; their age would be about
40, then nearly nine years older than their executive brethren,
five years older than navigating officers, and the same age as
paymasters and engineers.
Fifthly. Retirement on £1 a day should be optional after
1 twenty years* service.
Sixthly. The pay of surgeons to be the same as At 'present,
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MARRIED SOLDIERS.
November 4,1841.
to commence with (on promotion), but to increase sixpence a
day for every year’s service afterwards.
Seventhly. That full pay leave be granted to the extent of
one day for every six days’ service—to be taken altogether or
separately, or to reckon towards length of service for pension ;
this 2 years and 11 months leave, and 17 years and 1
months actual service, to count for twenty years—if no leave
has been taken, and proportionably, if less than the full leave
has been taken.
Eighthly. That a Deputy Inspector-General be appointed
for charge of all small hospitals now under the management
of Staff-Surgeons and Surgeons, and the trick of putting the
medical officers of hospitals on the guard-ships’ books, to de¬
prive them of their allowances, be discontinued.
Ninthly. That the uniform be either abolished altogether or
made like that of executive officers, with the Geneva badge
within the curl on the sleeve, as the distinctive mark.
These reforms would cost the country little, and would en¬
sure efficient medical attendance for the sailors of our fleets.—
Your obedient servant, R. N.
Registered for Transmission Abroad.
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„ 3, Lincoln-place, Dublin,
Maclaciilan & Stewart, South Bridge, Edinburgh.
Sole Agents for the United States.
Messrs. Kelly and Piet, Baltimore.
Annual Subscription, post free , Ten Dollars.
§ptal ffress Hirir Similar.
“SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, NOVEMBER 4, 1868.
-♦-
MARRIED SOLDIERS.
The Queen’s Regulations and Orders for the Army in
a laconic but very emphatic manner, direct that marriages
among soldiers are to be discouraged. And so they are by
every possible means. How far, however, this discourage¬
ment is effectual, either in conducing to the military effi¬
ciency of individuals, or in the cause of public morals, are
questions to which the answers are various, according to
the point of view from which they are considered. If we
compare the extent to which marriage is permitted in the
various armies of Europe, we find that, taking our own
first, all regimental staff sergeants, and seven per cent, of
rank and file, are allowed this privilege everywhere
except in India, and there the proportion is increased
to twelve per cent. In Spain, during the late regime , no
man could marry until he had served six years, and the
woman had to prove that she had sufficient means to main¬
tain herself. In the Imperial Guard of France, the prohi¬
bition to marry is absolute ; and in the line, not more
than two or three soldiers per regiment of 3,000 strong
have wives. In Sardinia, much the same principle pre¬
vails. In Austria, the privilege is confined as far as pos¬
sible to non-commissioned officers. In Prussia, no soldier
is permitted to marry during his first three years of service;
and in Russia, on the other hand, marriage is both per-
mitted and encouraged.
As regards the British Army, it is found that, inasmuch
as love laughs at locksmiths, so Cupid, as represented by
the soldier, sets regulations and orders, in matters Hyme¬
neal, at defiance. It accordingly so happens that, besides
those whose wives are what is called, “ borne on the strength
of the regiment,” a number, varying according to circum¬
stances, are “ married without leave,” and being so, enjoy
none of the privileges, such as they are, that are permitted
to the others. Taking both classes, statistics show that
among the soldiers serving in the United Kingdom there
are of those between twenty and twenty-five years of age
10*4 per cent, married ; of those from twenty-five to thirty,
24*8 per cent. ; from thirty to thirty-five, 37 ; and above
forty, 48*3 per cent.—very large proportions, no doubt;
but we must not forget the fact, that the proportion of
soldiers in any regiment gradually decreases after thirty
years of age. We, moreover, learn from statistics, that
the circumstance of young men becoming soldiers itself
exerts to a considerable extent a deterrent influence as re¬
gards marriage. Thus, among the civil population of
England and Wales, the proportion of husbands of twenty
to twenty-five years of age is 22*3 per cent.; twenty-five
to thirty, 58*7 ; thirty to thirty-five, 75*5 ; and forty to
forty-five, 82*6.
According to the statistics from which we quote, a very
striking difference exists between the longevity of married
men in civil life as compared with that of bachelors. For
example, in Scotland, where alone the subject has been
systematically examined, it has been observed that whereas
the average age attained by married men is 59J years, that
of bachelors is only 40 ; in other words, after the age of
twenty, married men are likely to live nineteen years and
a-half longer than bachelors. Such being the case in civil
life, it is reasonable to conclude that similar results occur
in the army. With regard to the relative efficiency as
soldiers of married and unmarried men, it must be confessed
that statistics on an extensive scale are not available; so
far, however, as the subject has been investigated the re¬
sults indicated are, that for every two days’ duty performed
by a bachelor soldier, he who is married performs three—a
proportion that, in the mass throughout the army, assumes
a very important shape.
Nor is the question of less importance in its bearing
upon morality. In a regiment, not only are vice and crime
principally confined to single men, but it is a well-known
fact that among them, the better disposed seek to marry
with the desire to thus avoid temptation, which, in their
single state, they find themselves unable to resist. Then,
again, with regard to the public, let us but allude to the
seduced girls, the amount of disease and suffering propa¬
gated among them and among the unhappy children to
whom many give birth ; let us, moreover, point to the
vagabond population which owes its origin to the soldiery
in our garrison towns, and we must acknowledge that the
question of marriage of soldiers is in reality of importance,
not alone as affecting the military classes, but in its bear¬
ing upon a large portion of the civil population.
As to the condition of the married soldier in the British
Army at the present time, it has been well said that he
cannot support himself, that he is to a certain extent
a pauper, receiving relief which is never quite suffi-
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MARRIED SOLDIERS.
November 4,1668. 393
cient to meet his ever increasing wants ; if he has a
large family he is even insufficiently fed, and becomes
actually physically inefficient as a soldier; if he be
willing to work to increase his means he has but little
chance of employment. It is true that the picture here
drawn refers chiefly to the United Kingdom ; yet what a
melancholy state of matters does it display? And yet
hard as are those conditions, they are far less injurious to
health and efficiency than are those to which the bachelor
soldier is exposed.
In India, the conditions of a married soldier, as well as
of his wife and children, are very much more favourable
than they are in this country, although even there room
exists for improvement, more especially in extending to
the families the privilege, now for the 'most part restricted
to the single men, of being sent to Hill Sanatoria for the
preservation or recovery of their health—a deprivation
which of itself accounts for most of the greater mortality
that yearly occurs among them as compared with the
soldiers. It is this great mortality among them, combined
with the comparatively unprolific marriages in that country,
that render the actual number of married soldiers in regi¬
ments some years in the country fewer than are permitted
by regulations; for as the proportion of girls is exceedingly
small who attain womanhood, and our soldiers have a
natural repugnance against matrimonial alliances with the
black inhabitants, the supply soon ceases to be equal to
the demand, and men have to submit to enforced celibacy
as well as to its various consequences. These remarks, it
is true, refer to recent times. Some thirty or forty years
ago matters were different. Soldiers in India then married
native wives, sometimes from choice; others lived ia a
state of concubinage; drink of the most pernicious kind
was nightly introduced by their wives or concubines, and
the scenes, orgies, crime, and disease that were the conse¬
quences was described at the time as something horrible.
All that, however, is of the past. The conditions of the
present day are happily very different, and it is to them
that these remarks are intended to refer.
Marriage having thus been shown to conduce to longe¬
vity, to add to the military efficiency of soldiers, to the
diminution of crime among them, as well a3 of vice, dis¬
ease, and misery among the civil population, the questions
naturally present themselves—by what means can it best
be extended? and how are those drawbacks by which it
is now beset to bo remedied?
Most undoubtedly one of the greatest difficulties that
beset the entire question of marriage among our soldiers
arises from the conditions of military service, which are
unlike those of any other army; thus, whereas no other
troops are exposed to anything like the extent of foreign
and tropical service that ours are, the remuneration given
to our men for this almost perpetual banishment and ex¬
posure to pestilential climates is less than what can be
earned by an ordinary field labourer at home ; our system
of so-called voluntary enlistment chiefly secures as recruits
either the very lowest strata of society, the thoughtless
who have been entrapped while in a state of intoxication,
or the improvident and worthless, who are unfitted to
u hold their own” in civil life. Such men have, as a rule,
neither pride nor interest in the army further than that,
while serving in it, their daily wants are supplied. They
soon come to learn that even for the steady men, those who
endeavour by regular attendance at the regimental school,
and thus endeavour to fit themselves for even the non-eora-
missioned ranks, their chances of advancement are small;
as for promotion to officers, the chances are so much against
them that they really can never be taken into account by
a recruit of the ordinary class. Life in the barrack room
is too often deprived of all pleasure by the continual super¬
vision and interference of indiscreet corporals and ser¬
geants; petty foibles are too often recorded as crimes;
and the soldiers learn from their comrades, as they come
to be discharged, that the rates of pensions awarded to
them are not only very different from what they had been
led to expect, but that they are inadequate, as a rule, to
supply their most ordinary wants should health hav e been
lost. They see, in fact, that, constituted as the army is,
there is little to bind them to it, but much to give rise to
the belief that, however long they may serve, their actual
or prospective conditions are hut little, if at all, improved.
If, then, the social conditions of soldiers are to be in any
considerable degree improved, the first and most important
step to bo taken is to render the army attractive to a
better class than that which is now represented by our
soldiery and recruits ; the conditions of a soldier’s life *
must be such as to attract men of reputation and character
to the ranks, and to render it a misfortune to be excluded
therefrom. Some of the means by which this end may be
attained have recently been discussed by the author of a
pamphlet on the state of the British Army in 1868, and of
the practicability of the measure, not only without adding
to, but actually with a decrease of, the army estimates,
there need not exist a question. Were service in the un¬
healthy colonics diminished, and the army opened up as a
career for the yeoman classes, two of the most important
measures to this end would have been attained.
Major Bannatyne believes that a great object would be
gained if we could make the soldiers’ marriage and return
to civil life more certain and less distant than they are at
present. He recommends that soldiers serving in the re¬
serve force should be permitted to marry, and when they
are called on permanent duty a daily actual allowance of
3d. for each woman, and ljd. for each child under fourteen
years of age, should be granted to their wives and families.
With reference to this proposition, it is to be observed
that experience has yet to prove the readiness with which,
did need arise, discharged soldiers would give up their
homes, their little plots of grounds, their wives and chil¬
dren, to take their place in the ranks on active service.
History does not record instances where they have done
so, and it is to be feared that were the experiment now
tried with the present description of men who serve as
soldiers, not only would their services be lost at the very
time when they should be most efficient, but they could
not afterwards be reckoned upon with confidence.
Military colonies, according to McCulloch, are generally
admitted to have been a failure. The soldiers get attached
to their farms and families ; they become unwilling to leave
them, and impatient of military restraint. Herr Yon
Haxthausen, in his comparison of the military colony
system of Russia with that of Austria, says that in most
places the idea of making both a soldier and a peasant out
of a Russian was soon given up. Similar results followed
a similar measure when some years ago it was tried in
New Zealand and elsewhere. Pensioner colonists became
dissatisfied with the very government to which they owed
the domestic comfort and independence that they enjoyed;
with comparative wealth came to them a voice and in¬
fluence in the community of which they formed a part, and
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November 4, 1888.
these they were not slow to employ against their benefac¬
tors. Hence the system was abandoned. Nor is it likely to
be entertained again.
“Brown Bess” asks the question, Why not make the
permission to marry one chief advantage of the re-engage¬
ment of soldiers, the soldier devoting his whole future life
in consideration of the provision made for his wife and
family? This proposition implies that Government should
make direct provision for the wives and children of its
soldiers, thus acting towards them in an exceptional and
very different manner from what it does towards any other.
free classes of her Majesty's subjects. The plan is there¬
fore not likely to be adopted; yet it may become matter
for consideration how far permission to marry, with good
quarters for the wife and children, might not be held out
as an inducemement for deserving men who have com¬
pleted their first term of service to re-engage. But here
two difficulties meet us, the first being in reference to the
reckless or the thoughtless, who, as young soldiers, marry
without permission, and whose families are usually in a
state of absolute destitution ; the other as to how far
the extra expense thus incurred by encouraging old soldiers
to continue in the army would be repaid to the State by
their greater efficiency. There is every reason to believe
that it would not, and that therefore arrangements directed
to only one class would end in failure.
What then seems the most practicable way of meeting
this important and difficult question ? The improvement
in the prospects and position of the soldier to which allu¬
sion has already been made being once effected, it would
then become practicable to make terms with candidates for
enlistment. Our army, if numerically smaller than at pre¬
sent, would gain in respect to quality. It might then be
made a condition of engagement that the recruit should
for the first five years of his service remain unmarried on
pain of dismissal, if serving in the United Kingdom, or
any of our possessions having a temperate climate, admit¬
ting of manual labour. It is moreover to be observed that
among other shocks given to many of our cherished
notions, the campaigns in America and Prussia have shown
how unnecessary is the extent of continuous drill to which
it has been the custom to subject soldiers. Would it not
therefore be possible to permit soldiers who are able to
work at handicrafts to do so for their own individual profit; j
those who desire to learn being trained to particular trades
and the proceeds placed to their credit in the regimental
savings bank ? They would thus, in the event of marriage,
be in a position to earn the means of maintaining their
wives and children in comparative comfort; it being under¬
stood that most, if not all the work now executed by con¬
tractors should be given to regiments. Another very im¬
portant means to the same end would be that of reducing
to a minimum the moves of regiments, which at present are
such a source of expense to the soldier ; and another would
be that of making better provision than has hitherto been
made for the families of soldiers, while the latter are em¬
ployed in active service. The direct outlay occasioned
would be inconsiderable, while the increased efficiency of
the soldiers would, it is calculated, far more than repay the
State for the first expense. Sickness and crime being
diminished, so would the expense and loss of service in¬
curred by curing the one and punishing the other. Soldiers
would feel that their labour was remunerative to them¬
selves ; and in course of time their sons would enter the
ranks, not only educated in the regimental school, as at
present, but with some knowledge of mechanical art, such
as would occupy their spare time and enable them to earn
a fund for their future requirements. The question is
doubtless of far too great importance to be exhaustively
discussed within the space allotted to these remarks ; all,
therefore, that can be effected is to direct attention to some
of its more prominent phases.
PROFESSIONAL AUTOCRACY IN MEDICAL
JOURNALISM.
The members of the profession in Ireland, who are ac¬
customed to the freedom of buying their newspaper when
and where they choose, have learned a new lesson this
week at the hands of the British Medical Journal , which
they are slow to realise, and unlikely to forget.
The British Medical Association has pressed its invita¬
tion to Irish doctors to come to its arms, with all the
blandishments and all the promises of future benefits
with which the election atmosphere is now so fulL The
heavy British father is ready to take back his recreant
Irish offspring to his embrace; but he must be satisfied
beforehand that the prodigal son is duly purified and dis¬
infected, and that no aroma of outside barbarism shall
offend the nostril of the condescending pstfenk The
“British Medical Association,” forsooth, will have no
Irish doctor unless he has passed quarantine, and cast his
Celtic slough; and accordingly, the following certificate,
or clean bill of health, is considerately supplied to eveiy
member of the profession in Ireland :—
II.— -Certificate.
We, the undersigned, hereby testify, from our personil
knowledge, that the above-named.of.
is a gentleman of good professional character. We therefore
recommend him for election as a member of the British
Medical Association.
To be signed by at least three persons already members of
the Association, and whose names and addresses must he
attached, we presume, as a material guarantee.
We assume that this requirement must be a solenm
farce, conveniently provided for by the signatures in low
of the editor, sub-editor, and secretary; yet, nevertheless,
it conveys an insult to the profession m Ireland, which
their status, beside that of the members of the British
Medical Association, renders even less called for.
The physicians and surgeons of Ireland are well aware
that the British Medical Association is justified by no
lofty professional position in requiring credentials of
respectability from them ; and we imagine they are lime
likely to go out of their way to produce their title-deeds
to professional respectability for no higher a reward oi
merit than the patronage of the British Medical Associa¬
tion.
THE EDINBURGH ASSOCIATION FOR
IMPROVING THE CONDITION OF THE POOR.
In every civilised country, in proportion to the increase
of the population, great di Acuity is found in dealing with
the poor. Legislation has hitherto by no means lessened
the difficulty. Our parish system as it at present exists^
not equal to the emergency; if it lids not rather increased
the evil by the mode in which it lias been administered.
At all events, the subject cannot escape the attention of
thoughtful and benevolent minds, who feel naturally w*
the destitute and helpless around them, but who turn
themselves perplexed by the diverse and apparently
irremediable condition of the class to which they would
extend their aid. The Edinburgh Association has unde£
taken a work of no easy performance, and purposes to
invite a conference with the employers of labour in tw
city to consider the best method of carrying out their
object. In anticipation of this, Mr. David Curror.wno
regulates the employment committee, has addressed a°
important letter to the Lord Provost, the chairman of tne
association. Mr. Curror has long studied the peculiarities
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NOTES ON CURRENT TOPICS.
November 4, 1S68. 395
and claims of the poor. From his position, as chairman
of the City Parochial Board, all that he advances on the
subject has a value and bearing well worthy the attention
of everyone interested in the great question of Poor-law
management. He commences by answering some objec¬
tions, and correcting some misapprehensions with regard
to the establishment and agency oi the association, showing
that it is “ an honest and zealous attempt to reform and
ameliorate the existing system and then proceeds to
classify the recipients of public charity under the three
following principal heads :—
“ (!)• The poor who are poor by the allotment of providence.
That is the ‘ cruiked folk, seek folk, impotent folk, and weak
folk,* of the old Scotch Poor-law Act, and embracing in the
description ‘old folk’ and ‘daft folk.’ These are the poor
that are never to cease out of the land. The burden of their
relief is light, and not disagreeable to bear in any Christian
community.
“(2). The poor who are poor in consequence of accident, or
the visitation of God prostrating their energies for a time, but
who were not horn to be poor—such as the working bread¬
winner of a family who meets with an accident at his work
and is lxud aside from it for a while. Nothing is coming in,
and the little he had spared from the immediate wants of his
family is soon exhausted; and when exhausted, his family,
under the Poor-law system, seek relief from the Parochial
Board, and get it. Once broken in spirit to seek what he has
not wrought for, he continues on the Board, and under the
present system he and his become permanent paupers. A
family driven to abide in some of the hovels your Lordship
is razing from the face of old Edinburgh, may be visited with
fever, and the same process goes on till the whole family get
upon the poor’s-roll, and, as ‘ once pauper, aye pauper,’ become
permanent burdens on the rates, and so ail of them become
paupers by accident.
“ (3). The third and last class is what may be called self-
imposed pauperism. These are the somers, the sturdy beggars
of the old Scotch Acts, who are able but most unwilling to
work, and to repress whom the old Scotch Acts were passed,
and the sturdy pains and penalties therein specified inflicted.
He considers that a treatment proper to each class
should be adopted, and not, as under the present Poor-
law system, all be subjected to the same regimen, how¬
ever widely different their circumstances may be. The
association, it appears, is attempting to carry out the
general principles which he suggests, and may perhaps
eventually’ show that there is a better and more effective
method of dealing with pauperism than that which up to
the present time has been attempted.
- ♦ -
Ujcrhs an €nxxmt rs.
Army Medical Officers and Reduction in
the Army.
We have always been the strenuous advocates of the
rights, and exponents of the grievances, of our brethren in
the public services. No journal can boast greater con¬
stancy in this, and some have been apt to desert the colours
occasionally.and leave us alone. Still we have never hesi¬
tated to carry our banner to the front.
We have been deeply interested in a good deal of talk
that has come to our knowledge respecting proposed reduc¬
tions. The public journals, of course, teem with vogue
rumours as to the course likely to be adopted by the pre¬
sent Government—if permitted to continue any length of
time in office—a contingency which will be regarded with
different views by different parties.
A scheme has been whispered about that embraces the
following reductions. Of course we give it with all due
reserve, but we are credibly informed that it is under the
consideration of important persons.
Reduction promoted .—The Military Colleges, Sandhurst
and Woolwich, to be abolished, to make room for private
e “ ter Prise. The whole of the dep6t battalions to be struck
off. The whole of the 2nd Battalions (equal to twenty-five
regiments) to be struck off. The 2nd Majors, Comets, and
Ensigns of Regiments to be put on half-pay list and ab-
sorbed. r *
Upon the policy of this measure we have nothing to say.
Doubtless the authorities have well considered the matter,
and the improved equipment of the troops should render a
smaller force more effective than the larger number armed
with the weapons of the past age.
There are, however, questions upon which the medical
officers should be prepared to express an opinion. The
sanitary condition of the array, at all times important, will
become especially so when the number of men under arms
is so materially reduced ; and it is clearly their duty to
consider whether, by improving the lodgment of the men
and other regulations, it will not be practicable to reduce
the percentage of inefiectives from sickness and preventible
disease. They should be prepared to take advantage of
the increased accommodation placed at the disposal of the
Horse Guards to secure every possible convenience for the
men under their charge.
Again, the position and accommodation of army surgeons
and their staffs is not such as their talents and services
entitle them to expect.
Commanding officers too frequently regard their non-
combatant brethren as impediments to be got out of the
way until their services are required. It may be well to
consider whether some of the quarters vacated by officers
placed upon the half-pay list could not be placed at the
disposal of the surgeons without detriment to the public
service.
We recommend these suggestions to the consideration of
our brethren, urging them to be prepared to press their
views upon the authorities in the way most likely to prove
effective.
Certificates of Purity.
Professor Frankland has publicly protested against
the practice of advertising certificates granted by certain
institutions. The case which attracted his attention was a
gross one. A firm advertised some preparation as inoc-
cuous " under certificate of the Royal College of Chemis¬
try.” Neither the Professor himself nor his predecessor
had granted such a certificate. Neither he nor Dr. Hof¬
mann would be likely to do so. A reply was given that
an assistant in the laboratory, eleven years ago, stated a
certain specimen of essence of almonds to be free from
Prussic acid. Granted this were so, what proof is that of
the quality of what has been sold since ?
We think that Professor Frankland’s courageous expo¬
sure of this system deserves the thanks of all. There has
been so much nonsense talked about adulterations and so
much iniquity exposed, that we can understand an honest
firm desiring to fortify their own guarantee; but it is
obvious that analysis for such purposes as advertisers de¬
sire, is of little use, and in many cases is most unreliable.
The system is, in fact, altogether bad.
Royal College of Phyaioians of London.
The debate on the proposed reform in this body has
taken place. Dr. C. J. B. Williams, at the Comitia
Majors, last Thursday, brought forward his proposals in
the following form:—
“ 1. Before the Council proposes the list of members to
be proposed for the Fellowship, it shall be open to receive
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396 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
November 4, 1865.
for consideration the name of any member or members of
a certain standing recommended by two or more Fellows
with a statement of the grounds of their recommendation.
“ 2. Further, if not satisfied with the list of names re¬
commended for election by the Council, it shall be open to
any of the Fellows to add to the names on the list; the
list so altered shall be suspended in the hall of the College
for a fortnight, at the end of which time a Comitia Majora
shall be held, and shall proceed to a ballot; and all those
members shall be elected to the Fellowship who have the
votes of a majority of the Fellows present.* 5
We are glad to report that reason has been so far heard
that the first proposal has been substantially carried. The
latter has, however, been again postponed, and it is impos¬
sible to say when it will be again taken up. Some people
express satisfaction that something has been done. They
look upon it as a step. Verily, they are thankful for small
mercies. To those who love the status quo we would
whisper the assurance that there is no fear of the College
in Pall Mall “ shooting N iagara.”
Tobacco.
We have not heard the last of the tobacco controversy,
though the confirmed devotees of the weed go on their
way, in spite of counterblasts, as comfortably as meat
eaters pursue their habits against the warnings of vege¬
tarians, and beer, wine, and spirit drinkers against the
ravings of the teetotallers. A popular writer on physio¬
logical questions has offered his explanation, in St. Paul's
Magazine, of the effects of nicotine on the health. The
article in question is well worth reading, though we con
fess not to have found anything new in it. The writer
points out how, as a rule, secretion of nicotine by the
kidneys must rapidly remove the poison if taken. We
recently had occasion to show how great is the error of
fancying that smokers take the nicotine into the system to
any extent. The case of those who snuff or chew is not at
all parallel. These habits are far more capable of inflict¬
ing injury.
Royal Commission on Sanitary Organisation
and Laws.
We understand that a Royal Commission is about to
* issue to inquire into the operation of the present sanitary
lavs, as well as the manner in which the various offices
connected with State Medicine are carried out. It was at
first intended only for England, but at a meeting of the
joint Committees of the Social Science and British Medical
Associations, the President, Dr. Acland, was requested to
urge on the Home Secretary the importance of extending
the Commission to Ireland and Scotland, and he did so
successfully.
Rumour assigns to Dr. Stokes, Professor Haughton,
and Dr. R. McDonnell the honour of seats at the Com¬
mission, but there are surely other names identified with
sanitary science.
Asylum for the Imbecile Poor.
The foundation stone of the first asylum for the recep¬
tion of the imbecile poor of the metropolitan district was
laid on Saturday afternoon. This is part of the scheme
provided for in Mr. Gathome Hardy's Bill for the Im¬
provement of the Administration of the Poor-laws for the
Metropolitan District. The site, at Leavesden, near Wat¬
ford, is well suited for the purpose, on account of pure air
and a surrounding picturesque country. The edifice con¬
sists of three detached parallel rows of building, covering a
large area. There will be on the female side five general
blocks, each for 160, and one infirmary block for 60
patients, affording accommodation for the reception of 660
females in all. There will be on the male side four blocks
of 1G0 each, which, with the infirmary block, give 700, or
a total accommodation of 1,560 patients of both sexes.
The length of the corridors on the one side is 166 yards,
and on the other 13S. A detached infirmary for infections
diseases is to be erected in the rear. The ground floor on
each block, which will be used as a day-room for the pa¬
tients, is 105 feet long, 36 feet wide, and 14 feet high,
while the dormitories will be spacious and thoroughly well
ventilated.
The Late Mr. Henry Brown.
The late Mr. Brown, of Windsor, who had so long
enjoyed the confidence of the loyal family, was a student
of the London hospital, and a dresser under the late Sir
William Blizard. After qualifying, he became a partner
with Mr. O’Reilly, surgeon to the royal family and house¬
hold at Windsor. He succeeded that gentleman on his
death, in 1833, and lias, throughout his career, profes¬
sionally attended various members of the royal family,
including three reigning sovereigns, George IV., William
IV., and Her Majesty. The Duchess of Kent and the
Prince Consort were also his patients, and all seem to
have been much attached to him. He died on the 24th
ult., aged sixty-six. He introduced the use of chloride of
lime in cancer, and of quinine in acute rheumatism.
The Quarterly Return of the Registrar-
General.
Following from week to week the returns, much of
the information of the quarterly report is anticipated.
The following summary may, however, be interesting.—
During the three months ending Sept. 30 there were
255,199 births, and 165,728 deaths in the United King¬
dom. The recorded natural increase of population during
the quarter was therefore 89,471, and the native emigrants
were 40,672. Both births and deaths in England were
above the average number ; but the marriages, which are
given for the June quarter only, were fewer. The average
price of wheat was 59s. Id., to which it fell from 71s. 10d.
in the previous three months. The mean temperature
throughout the quarter was 63‘9, and on the 22nd of
July the thermometer in the shade rose to 96 6—the
highest temperature ever recorded at Greenwich. The
mean summer fall of rain is 767 tons to an acre of land;
but in the last summer the deficiency was 252 tons an
acre.
It is to be remembered that since the close of the
quarter a more unhealthy period has set in, so that the
next return is likely to be less favourable.
Verdict of Murder against a Surgeon.
The awful case of Mr. Powell has caused plenty of
comment in the columns of our contemporaries. We
have no desire to dwell upon the sad details of a case
which possibly no human being would be able honestly
to judge, even did he know the facts, and these, let ns
remember, are at present involved in dense obscurity.
Let us draw a veil over the errors and sufferings of one
who was evidently so sensible of his position that no
human punishment could be greater than what he most
have already endured.
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NOTES ON CURRENT TOPICS.
November 4,1868. 397
Military Hospitals.
Sir Jolm Pakington has expressed his intention of
Eiipplying military hospitals with the most perfect system
of female nursing, and arrangements have been made
with the Nightingale Committee for the education at St.
Thomas’s Hospital of a certain number of nurses specially
with this object. After many remonstrances on the part
of the military authorities at Woolwich, Sir John Paking¬
ton has consented to change the system of treating the
sick in the Herbert Hospital. From tha 1st November
the regimental plan of work commenced, and each medical
officer assumed charge of the sick men of his own battery
or brigade. It is not, however, intended at present to
interfere with the general organisation of the hospital
under the governor, although, doubtless, many alterations
will be necessary before a satisfactory combination of
regimental and general hospital systems can be obtained.
eastern part of the metropolis, and its meetings are most
cordial—more so, perhaps, than most pro fessional gather¬
ings. Dr. Herbert Davies, Senior Physician to the London
Hospital, presided at the last meeting.
The Scotch Universities.
The constituency of Glasgow University is 2,360, that
of Aberdeen 1,988, giving 4,350 as the number entitled to
vote at the next election. For Edinburgh and St. Andrews
conjoined the numbers are rather higher.
Two convictions against women under the Contagious
Diseases’ Act have been obtained at Plymouth.
Oxford is to have nn hospital for incurables.
Tns patients in hospital for injuries received at the late
boiler explosion are going on favourably.
Sir D. Corrigan's Candidature.
It is generally allowed that Sir D. Corrigan’s success
is certain, as his medical brethren of opposite politics are
favourable, and by the Liberal party he is enthusiastically
supported. The constituency exceeds 12,000, and the
contest is therefore most expensive, owing to the great
number of polling places and officials which are needed.
It is, therefore, much to be desired that he should receive
the generous aid of his professional brethren, for, iu seek¬
ing to advocate their claims, he will make a large pecuni¬
ary sacrifice. His address to the profession, which we
give elsewhere, proves how able an advocate he would be
in our cause, and there can bo no doubt that his sphere
of usefulness in the House of Commons would be most
extensive. Any gentlemen who have not received the
circular from the treasurers will please attribute the
omission to the unavoidable mistakes in addressing so
many letters.
Death of Dr. Hardy, of Dublin.
When we recorded last week the election of Dr. Hardy
to the Fellowship of the King and Queen’s College of
Physicians, we little anticipated that we should discharge
the painful duty of recording his sudden and premature
death in our issue of to-day. From robust health, scarcely
two days intervened to Dr. Hardy’s removal, and the sud¬
denness of his death has painfully enhanced the universal
regret which the announcement evoked.
Dr. Hardy has been a Fellow of the Royal College of
Surgeons for just a cpiarter of a century, and would have
resigned that position in a few days, as the regulation
necessitated that he should before accepting the Fellow¬
ship of the College of Physicians last year. He held the
office of President of the Dublin Obstetrical Society, and,
both as an author and as an ex-Assistant-Master of the
Rotundo Hospital, and Physician Accoucheur to Dr.
Stevens's Hospital, he occupied a front position in the
rank of Irish obstetric surgeons. He had been a frequent
and valued contributor to our columns, and leaves behind
him a memory as a scientific obstetrician not less respected
than that which his social qualities had long secured to
him.
Beaumont Medical Society.
This is a most useful Society, as it takes in not only
practical subjects, but discusses medioal ethics and politics,
numbers upwards of eighty members, resident in the
The Exeter Local Board have under consideration plans
for preventing the river being polluted by the refuse of
paper mills. We are glad to see that the Exeter Gazette
reports the proceedings, which have been adjourned.
Earthquakes in England. That is the last sensation.
The disturbance in Ireland was thought rare. Now we
have to report that at Bristol, Worcester, and Leamington
slight shocks were felt last Friday night. It is proper to
add that there is no reason at all for an immunity of this
island from earthquakes, and in the eleventh and twelfth
centuries they were, so to speak, frequent.
The Southampton Times contains some correspondence
on the health of the borough. It is pleasant to see such
topics excite discussion.
Tiie King of Prussia has presented N^laton with a
handsome porcelain vase from the royal manufactory at
Berlin, as a token of his appreciation of the learned doc¬
tor’s professional services to Coimt von Goltz.
Some discussion as to economy in the Royal Mail Steam-
packet Company leads some to object to the pay of the
captains. It is justly replied that in a service in an un¬
healthy climate, which is known rapidly to injure the best
constitutions, £800 or £1,000 a year for the ablest com¬
manders is very moderate. We think so too.
At the Royal Institution of Great Britain, on Monday
last, W. Pole, Esq., F.R.S., in the chair, Musgravc Bristo,
Esq., was elected a member of the Royal Institution.
Faculty of Physicians and Surgeons of Glas¬
gow. —At a meeting of this corporation held on the 5th inst.
the following officers were elected:—President: Dr. Andrew
Anderson. Visitor: Dr. Harry Rainy. Councillors: The
President, ex officio; the Visitor, ex offeio; Drs. Fleming,
Robert Scott Orr, John Coates, George Robertson, and Win.
Weir. Treasurer: Dr. John Coats. Honorary Librarian :
Dr. George Rainy. Vaccinator: Dr. James Dunlop. Board
of Examiners : Drs. William Lyon, Andrew Buchanan, James
Morton, Robert Perry, R. D. Tannahill, J. B. Cowan, Andrew
Fergus, George Buchanan, R. Scott Orr, and Wm. Leishman.
Clinical Examiners: The Physicians and Surgeons of the
Royal Infirmary. Examiners in Arts: Dr. John Coates and
James Steven. Clerks: Laurence Hill, LL D., and William
Henry Hill. Secretary and Librarian : Alex. Duncan, B.A.
We have to announce that an Infirmary is to be
established at Oldham, in consequence of the grant of £1,000
from the Mansion House Cotton Famine Relief Fund, which
has been supplemented by subscriptions to the amount of
nearly £2,000 more at a meeting convened for th? purpose of
aiding the objeot,
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SOCIAL SCIENCE ASSOCIATION.
November 4, i m.
HEALTH SECTION.
QiliTtas
BY
H. W. RUMSEY, ESQ., M.D.,
President of the Section.
(Continued from page 382.)
Before passing on to another topic, I uould ask whether it
might not be advisable by special re-adjustments of local
taxation to encourage the planting and growth of timber on
the bare hills of the West and North of Great Britain. I
would also strongly recommeud that large reservoirs, for the
storage of water at the heads of our principal valleys, should
be safely constructed at the public cost.
The sources of water thus decreasing, do we, as a people,
take the greater care of that which Nature still beneficiently
provides ? Just the contrary. Within the last thirty years,
almost all the great water-courses of the land have been for
the present defiled, and even converted into, distributors of
disease, by measures of town sewerage contrived hastily and
executed unscientifically. .
So eager were most of our earlier sanitarians to get rid at
any cost of human refuse, that, without due consideration of
the possible results of the methods adopted on the future
water-supply of the people, they advised the pouring of
abominations of all kinds into the nearest water-courses
having first rendered subsequent measures for the recovery of
what was truly valuable in this so-called refuse almost im¬
practicable by diluting it with floods of water, both that
which had been artificially stored at enormous expense for
town distribution, and the natural rain-fall.
In vain did physiologists and scientific agriculturists protest,
for various reasons, against this rash dilution aud wrong disposal
of organic matter. The skill and enterprise of our great civil
engineers, supported by the energy of leading sauitavy re¬
formers, were triumphant. The effete products of manufac¬
tures and trades, the animal aud vegetable debris of towns,
mineral detritus, all that comes under Lord Palmerston’s
celebrated definition—“Matter in the wrong place”—was to
be got out of the way by water-carriage, which was assumed
(and not without reason) to be the most expeditious and eco¬
nomical mechanical power for the purpose.
The result of this remarkable movement was, however, that
communities have had to encounter a more serious difficulty
than at the very beginning of sanitary reform. To glanco at
some of the perplexities and losses which followed. There
were fish in the rivers, good for food, but they might take
their chance ; so, being deprived by decomposing nitrogenous
matter of the oxygen naturally existing in the water, they all
perished. There wero human communities down the stream,
suffering from an increase of sickness and mortality,—some
in large towns, many in hamlets and villages, who were crying
out for drinkable water ; well, they were advised to filter the
river-water, or to boil and then aerate it—or, if all this were
too troublesome and expensive, they might sink wells or
tunnel the nearest hills for a safer supply. No substantial
relief or help was afforded them.
But there wero also landowners and large occupiers with
riparian rights on the land through which these streams,
shamelessly converted into open sewers, flowed. And these
found their remedy in the old laws of the kingdom—laws
which had not become obsolete, prescriptive rights which
had not been invalidated by recent sanitary enactments.
Accordingly, Boards of Health (so called) have been re¬
strained by injunctions issued by the Court of Chancery from
discharging their refuse into the streams in question. These
prohibitions have multiplied; and some places, as Banbury
and Tunbridge Wells, have suffered sequestration for dis¬
obeying the injunction.
Municipal authorities throughout the country have^ there¬
fore, now to choose between leaving their towns undrained in
contravention of sanitary enactments, suffering legal penalties
for draining them into rivers, or making very coetly experi¬
ments upon sewage, in the hope of satisfying both liabilities.
There is, at a leading Wmalisieaye, a “sanitary dead lock.”
Meanwhile, the inhabitants of both town and country are, in
numerous places, calling out for pure drinking water. Water
there may be, perhaps in plenty ;
“Water, water, everywhere,
Nor any drop to drink,”
for it has become sewer-water !
Now, excepting certain first-class towns in the north, and
especially on the older geological formations, where the water
supply is pure and abundant, it is indisputable that the con¬
dition of drinking water in most parts of England is deterio¬
rating. Village supplies are very generally scanty and bad.
Here I may digress for a moment, to note the great advan¬
tage which might accrue to scattered populations from the
use of Norton’s American tube well9, wnich economically tap
the subsoil strata to a depth of from ten to thirty feet. Every¬
one knows how valuable they proved in the Abyssinian expe¬
dition. They possess the sanitary advantage of testing the
quality of the water [issuing at different depths in the same
boring ; and they may be used, I think, as registers of fluc¬
tuation in the level of the subsoil water.
Complaints of town supplies are also on the increase.
I may take one instance of many. Only last year, Professor
Frankland reported of the Lincoln supply, that not one
of the three samples sent for his examination was fit for
domestic purposes, that they were all excessively hard, and
that one was frightfully contaminated with sewage. Even at
Croydon, the pet specimen of drained towns and sewage
utilization, the water supply is complained of as deficient and
intermittent.
In these and other towns where the supply is short and of
very indifferent quality the community has no protection, no
redress. The water monopoly entrenches itself behiud its
statutory rights. The ground being pre-occupied, no rival
undertaking has a chance ; and there is no law to compel the
water*traders to surrender their monopoly on fair terms of sale
to the public. I agree with Professor Gairdner, that whereevet
water has become a matter of private sale or barter, there has
been a dereliction of duty on the part of the community,
represented by the local authorities.
A constant supply at high pressure is rare in the South of
England ; yet Mr. Beggs informs ns that there are about 150
towns in this Island which enjoy the benefit of a constant.water
supply. It has now, therefore, been proved to be practicable.
Its sanitary advantages are unquestionable. The entire abo¬
lition of cisterns and water-butts in houses would be a reform
scarcely inferior to the abolition of cesspools. The change by
no meaus involves a loss of water. For instance, in Bull,
where half the town is supplied on the intermittent, and
half on the constant system, the waste is found to be grea’er
in the former. In Manchester, the adoption of tho constant
system lias resulted in a saving of seven gallons per head
daily. Of course, on this system, due precautions must be
taken to prevent waste, e.g., by taps and water fitting* of
the best construction. A recent most useful pamphlet, cir¬
culated gratuitously by this association, contains evidence,
especially that of the eminent civil engineer, Mr. Bateman,
which settles both the practicability and the economy of a
constant water supply.*
I have it, on Mr. Liddle’s authority, that in the Whitechapel
district, the machines called “water-waste preventers ” havebeen
in operation for several years, and answer perfectly their in¬
tended purpose, so much so, that the East London Water
Company is desirous of promoting their use.
The relation of water supply to the prevalence of certain
forms of zymotic disease is a question far too wide to admit
of more than a few cursory remarks. Yet I cannot avoid
noticing two very remarkable instances of this connection,
afforded by the events of the last two years.
1. After the clear light which has been thrown upon the
history of the cholera epidemic in the eastern parts of the me¬
tropolis in 1866; first, by the weekly statements of the Regij*
trar-General, fortified, as they were, by Professor Frankland*
analyses ; next, by Dr. Lankester in his forcible exposition of
the effects of the water supply upon cholera in the East»
London * then, with great fulness of detail and accuracy*
research, by Mr. Had cliffs, cheeked as the form of his cooota-
1 The case of Glasgow may perhepe he jcited byjrecusimt
the wastefulness of the spvem.
pmiesaa evidence
nearly 47 gallon! per head are daily consumed
It appear* that
_^_ that eity; mom, pw*
b»biy, than in any other place. The citisema of Glasgo w ong htjo B*
remarkably clean. Perhaps Dr. Gairdner can fcvwu ns with r
pUnaUon of this apparent anomaly.
8 Quarterly Journal of flounce, January, 1867,
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SOCIAL SCIENCE ASSOCIATION.
November 4, 1868. 399
sions was by the cautious logic of Mr. Simon, who, neverthe¬
less, aocepted the substance of those conclusions ; and now,
lastly, by the luminous and exact records of Dr. Farr ;—it is
not too much to affirm that the most destructive force of that
epidemic was spent upon the precise area supplied by the East
London Water Company. We cannot go into the disputed points of
that elaborate controversy, for it would not then be fair to ig¬
nore the counter statements and arguments of Dr. Letheby and
Mr. Orton. But, explain the circumstances and events as one
may, there are broad facts which remain undisputed. I need
only mention the following. The deaths from cholera and
diarrhoea in the field of this water supply amounted to 89 in a
population of 10,000, while in no other single company’s field,
north of the Thames, did such deaths amount to more than 18
in 10,000. Taking the reported deaths from cholera only, the
mortality in the East London Company’s field was nine times
as great as in the New River sub-districts, and twenty times
as great as in the North-Western sub-districts.
“ Of the total mortality of 5,915, no less than 4,276," says
Mr. Radcliffe, “ occurred in the East district of the metropolis
and adjacent suburban districts of West Ham and Stratford."
“ In those districts immediately prior to the outbreak
impure water was known to be distributed over this field of
supply. Neither the meteorology of the period, nor altitude, nor
the nature of the soil, nor density of population, nor filth, nor
the state of the sewerage, nor locality, affords any explanation
of the peculiar localisation of the outbreak, in the East dis¬
tricts. There is but one condition known which might become
capable of propagating cholera, common to the whole area of
the outbreak, namely, the water supply."’
2. Other most confirmatory evidence of the connection be¬
tween zymotic disease and water supply is furnished by the
outbreak of typhoid fever in 1867, at Guildford. The fatal
force of the epidemic fell upon that portion of the population
which dwelt on the area, supplied by what is there called the
“ High Service Reservoir." From this tank was distributed
on a particular day—such was the horrid fact—actual sewage
matter, which, owing to some engineering defect, had leaked
into the well supplying the reservoir. 11 No other condition,"
says Dr. Buchanan, in a remarkable correspondence with Mr.
Radcliffe on the East London cholera, “ on careful and detailed
inquiry, is at all coincident with the outbreak of fever.”
Again, Dr. Stevenson Macadam’s report, at our last anni¬
versary, on the relation of disease to the water supply of
certain populous places in Scotland, shows plainly enough
that the ravages or cholera were coincident in time and place
with the use of water from impure wells.
But on this point, as on many others, the reports of the
medical officer of Privy Council are full of facts and recom¬
mendations, which I cannot now even enumerate ; yet all of
the utmost significance and value.
Mr. Simon has especially dwelt, with great force, on the
moral responsibility and legal liability of water companies,
and has pointedly suggested that the distribution of fouled
water by a local board or water company is a proper case for
judge and jury on a claim for damages, by any of the persons
injured by its malfeasance.
He is of opinion that, whatever latent liability of this kind
may exist in our law, explicit legislation is required. If loss
of life or health be clearly proved, there can be no reason why
claims for compensation should not be made upon a company
of water purveyors, or upon a board of health (acting either as
water providers or sewage carriers), as well as upon a railway
company.
A most instructive discussion followed upon Dr. Macadam’s
interesting paper on river pollution, in this department at
Manchester, where we had the advantage of hearing Lord
Robert Montagu’s clear summary of the question, and Mr.
Rawlinson’s able comments on the practical working of various
experiments. The River Commission has to some extent en¬
dorsed the principle of the resolution carried on that occasion,
recommending prohibitory legislation against the pollution of
rivers. Should the legislature proceed in the course it has
wisely commenced, and determine eventually that no natural
stream of water shall be defiled by the refuse of towns, mines,
or manufactories, we need not doubt that adequate and remu¬
nerative methods will be discovered for safely disposing of
them all, and thus maintaining our rivers as distributors of
life, health, and pleasure to an increasing and prosperous popu¬
lation. In the discussion .just referred to, it was conclusively
•hewn that prohibition of this kind had fully answered with
i sintfcjtepwtK. a y. 4,r- wi.
respect to gas works, and that the principle had been, and
might further be, advantageously applied to lead, copper, and
tin mines, as also to the principal manufactures.
Now, it has been clearly established, that the particular de¬
filement of water, which is most dangerous to public health,
is that caused by putrescent animal matter, which has either
passed through town sewers, or percolated the soil, and in
both cases has led to contamination of drinking water.
Sanitary reformers have, therefore, to consider, in the first
place, the case of towns which are committed to the modern
sewerage system, of which the metropolis is the grand exem¬
plar, and which, in the aggregate, have spent many millions
sterling upon their Cyclopean constructions.
The only practical question here, is—what is to be done with
the results ? It is almost childish to propose to abolish that
system, and to commence de novo .
From analyses made of the earlier results of filtration, we
might conclude that not less than six-sevenths of the really
fertilizing elements of town sewage remain in the fluid which
has passed through the strainers and tanks of outfall works.
So that, besides the injury to health and life caused by
allowing this foul water to escape into rivers, the means of
augmenting and cheapening the food supply of a teeming and
needy population, have been wantonly wasted.
With regard to the sanitary injury, it is true that, given a
sufficient time, sufficient length of current, and sufficient
aeration of river water, the greater portion—and how much
is not exactly known—of the dissolved and suspended poison
is consumed by the oxygen naturally existing in the water
and constantly renewed from the air. This is another of
those beautiful provisions of nature which one cannot pass by
without thankful acknowledgment.
The burning power of oxygen, so wonderfully active in the
air, is almost as surely, though far less quickly, efficient in
running water, provided the quantity of refuse thrown into
the stream be not enough to extinguish the combustion. It is
therefore a matter of the utmost importance not to tax the
oxygen of water unduly. Oxygen being far more soluble than
nitrogen in water, it is well for mankind that the air contained
in running water should consist of nearly double the propor¬
tion of oxygen which the atmosphere holds. This bountiful
provision of oxygen seems as though it were intended to com¬
pensate in part for the slower combustion of dead and decom¬
posing organic matter in water.
A remarkable proof of the gradual extinction of the burn¬
ing, by the corrupting, principle, was furnished in the Thames
at the height of its pollution by London sewage. Professor
Miller tells us that in 1858, the river water at Kingston
showed oxygen in normal proportion ; at Hammersmith the
ratio had sunk to half ; at Somerset House to one-fifth ; and
at Greenwich and Woolwich the oxygen was almost annihi¬
lated. The friendly elemental fire was quenched ! Corrup¬
tion had triumphed ! The naturally purifying action of
aerated water has thug its limits and its fatal counteractions.
Neither can it be trusted when the contamination is of a
peculiarly fatal character. It is the quality rather than the
quantity of organic matter which determines its danger. We
are, as vet, quite ignorant of the degree of tenacity of life
possessed by the germs of specific diseases. The proportion of
nitrogenous matter, as determined by the chemist, does not
even mark clearly the distinction between what is putrescent
and what is not at the time decomposing. Still less does it
tell of more recondite organic constituents.
“ To look for a specific test for miasma in water is absurd,"
said Mr. Tichbome, in a recent remarkable physiological •
paper ; 1 “ there are certain subtle substances of intense power
which are physically unrecognisable—substances that, so far
as we have gone, no balance can weigh, no microscope can
enable us to see."
That pretty and popular test, the permanganate of potass,
though useful enough for demonstrating the loss of oxygen in
water, and indicating roughly, though serviceably, the un-
wholesomeness of water, has been shown to be untrustworthy
for determining the proportion of the worst forms of organic
matter. Nor does the apparent completeness of the burning work
of oxygen in water, as shown by the presence of nitrates
or nitrites in the clear, cool, sparkling, yet treacherous, water
of certain town wells, prove that the most dangerous ingre¬
dients have been destroyed. Well-known facts of disease and
mortality among the drinkers have prove d that it still exists.
1 Rsfcd in the Physiological Section of the Medial Association at
Dublin.
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400 The Medical Press and Circular.
GLEANINGS.
November 4,1848.
We come then to the only known and reliable method of
dealing with thU hideous creation, Town Sewage, which we
have formed, as Frankenstein did his Fiend, by dabbling with
decomposition,—a monster which, like his, may shorten our
miserable days, unless we bury it in the earth—our fourth
element.
Metaphor apart, the distribution of this pernicious yet pre¬
cious sewer water, over the land by irrigation, within safe and
accessible distances from our large towns, appears to be plainly
indicated as the best cure for the evil, and it has now been
proved to be both practicable and remunerative ; at least, in
all those places where irrigation can be accomplished by
gravitation.
(To ba continued.)
-4-
TOOR-LAW MEDICAL OFFICERS’ ASSOCIATION
(OF ENGLAND).
Tub fir>t quarterly mooting of this Association was held on
Tuesday, 27th ult., at the Freemasons’ Tavern, London ; Dr.
Rogers in the chair.
Our last number contained the chief portion of the Report
of the Council, which was circulated beforehand. Wo need
not therefore repeat its contents.
That Report having been adopted by the meeting,
Dr. Thomas moved, “That in the opiuion of this mooting
the salaries of Poor-law Medical Officers are totally inadequate
to the onerous and very responsible duties they are required
to perform, and the meeting recommends that the Council of
tho Association be authorised to memorialise Parliament on
the subject, and to take such other steps as they may deem
requisite to ensure to tho medical officers a system of fair and
equitable remuneration for their professional services.”
This resolution was seconded by Mr. B. Baker, and carried
unanimously.
Dr. Fowler proposed, and Mr. Bruce seconded, the next
resolution—“That thus mcetiug is of opinion that all Poor-
law Medical Officers should be appointed for lift*, as recom¬
mended by tho Select Committee of tho House of Commons
in 1854.”
This resolution was adopted, and tho usual vote of thanks
to the President and Council was given.
THE DINNER.
The annual dinner was held at the Freemasons’ Tavern in
the evening of the same day. The toast of tho evening was
given by the President, who, in proposing “ Prosperity to the
Association,” traced its origin from July, 1SG(3, when 27
members joined. At the end of tho first year tho number
had increased to 45; at the end of tho second to 80. At¬
tempts were made to crush out the society, which had become
obnoxious to certain parties in power; but it prospered not¬
withstanding, and an amalgamation took place betweeu the
provincial and metropolitan poor-law officers. The Associa¬
tion had now grown to be a fact. The position of the medical
officer had become so bad that it was impossible for him to do
his duty towards the poor placed under his control, unless at
tho loss of his own time and money. A case was mentioned
where a poor-law medical officer, who had to ride over 30,000
acres of district, and find medicines, was paid by the guardians
the sum of .£15 ; and other instances were given of an equally
striking character. In returning thanks for the hearty man¬
ner in which this toast was honoured. Dr. Fowler laid down
the principle that, in parochial matters, as in others, under¬
paid work was under-done work.
\ arious other speeches wero made, the speakers includin''
the Rev. II. Jones, Dr. Dixon, Dr. Brett, Mr. B. Baker, Mr.
Norton, Dr. Stallard, Dr. Anstie, &c.
-♦-
gleanings.
A WORD FOR INTRODUCTORY LECTURERS.
This, gentlemen, is a restless age. There is no quiet
journeying by easy stages, but a scream, a whistle, and
where are you ? You must change at every station. All
things come under review. Reverence is gone, authority i 3
dead. Everything is questioned, and sometimes before
an answer can be given, the fiat goes forth—“ Sweep it
away ! ” There is said to be no harm in all this, ft is
merely the spirit of the age. And as savages kill off their
old relations, so some would consign the innocent introductory
lecture, along with most other institutions with any antiquity
to vouch for their respectability, to the limbo of forgotten
things, as it serves, according to them, merely for the airing
of wise saw3 and empty platitudes. But they forget that
the lecture is a centre around which other attractions cluster.
They forget that men are not made up of lines and angles
only ;—tnat old times and old memories have a charm that
leads the student of years gone by to visit once more his
alma mater , and be reminded of former days, when he sees
them mirrored in the student of to-day. Whatever the
lecture may be, “old students”—proud of a title which
carries them back to the dawn of their professional life, and
tells us that though freed from academic restraints and the
fetters of a curriculum, they are and ever will be students
still — are glad of the opportunity of again recalling the
scenes of former toil and pleasure, and of conjuring back
the time when responsibility was sought for and care sat
lightly.
The occasion, too, is a fitting one for throwing out some
hints and suggestions to those about to leave us, in order to
ascertain the truth of the theory of correlation according to
which the Art of Healing should resolve itself into the
means of living. And it would not be a seemly thing to
we lcome those who have to-day enrolled themselves as Stu¬
dents of Medicine with only a silent greeting. —Dr. H.
Simpson's Address at the Manchester School ,
PARISH NURSERIES.
Some time back the question Was started, whether day
nurseries could not ba organised, at which working women
could leave their younger children while they went out to
work. After a great deal of talk, several nurseries were
organised in the metropolis and some other large towns. We
believe that they have been eminently successful, and that
they are appreciated by those for whom they are intended.
They are, however, very few comparatively. To be of
universal benefit they must be established in every district.
A suggestion now made for the first time deserves attention.
It is proposed that the children of very poor and hard-work¬
ing parents should find a home daring the day, be nursed,
taught, and fed at the cost of the parish. Such a system
would be open to gross abuse if it were not well organised.
The question is, wnether it could not be so organised as to
prevent the children of well-to-do parents being taken care
of, or being “left until called for. ’ —Lincolnshire Chronicle*
THE MEDICAL CALLING.
The study of medicine oommends itself. We are told (by
Mr. Ruskin) that “there are five great intellectual profes¬
sions relating to the daily necessities of life—the soldier's to
defend it; the pastor’s to instruct it; the physician’s to
keep it in health ; the lawyer’s to enforce justice in it, and
the merchant’s to provide for it. ” Of these daily necessities,
by no means the least worthy of consideration, is the duty
of the physician to keep the body in health. That it the
port we have to play.
Our profession is one of great usefulness, and is as free
from allurements to dishonesty as any other calling. No
right-minded man will employ the public for his own in¬
terest ; he will rather make it the interest of the public to
employ him. Again, the very nature of our education
affords the exercise of the highest faculties of the mind.
“ The flower, tho tree, the birds, the running brook.
Are all to us material for thought.”
Tt is impossible to study Anatomy, Physiology, or Che¬
mistry, three of the most comprehensive subjects in science-
forming the solid basis upon which we have to build our
superstructure, without being deeply impressed with the
infinite wisdom of Divine power. In reading the volume of
Nature, we aro animated by a passionate yearning for in¬
creased research in exact proportion as our ideas become
more developed, our tastes more elevated, and our intellects
more refined. If we view the beautiful symmetry and the
variety of Nature’s forms, the grace and regularity of her
designs, our minds must be led to purer notions ana happier
thoughts.
True, indeed, is it that the man who is most to be pitied
under misfortune is he whose happiness depends on outward
circumstances. To be really happy, he should be capable
of finding resources in himself, and what more ennobling or
what more useful employment than thestndy of that science
which relates to the phenomenon of life ?
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MEDICAL NEWS.
November 4, 1868. 401
41 Knowledge,’* says a distinguished writer, 41 is essen¬
tially and directly power: and it is indirectly virtue.
Knowledge is also happiness. There is no other pastime
that can oe compared with it in variety. Even to him who
has been longest conversant with it, it has still as much
novelty to oner as at first. It may be resorted to by all in
all circumstances, by the young and by the old. It converts
solitude into the most delightful society. ” As our reading
comprises an endless variety of subjects, it is no matter of
surprise that, from time immemorial, medicine should have
been studied for its own sake by those possessing the keenest
reasoning powers ; but when it is cultivated for the sake of
aiding others, then it is like the quality of mercy—
:t It is twice bless’d—
It blesseth him that give, and him that takes.”
44 The constant object,” says Brodie, 44 of our profession
is to oonfer benefit on others. The advocate at one time
pleads for the guilty, and at another endeavours to oonvict
the innocent. The soldier engages to go wherever he is sent
that he may destroy the lives of those from whom he never
received an injury ; but the Physician and Surgeon are en¬
gaged only in lessening the affliction and prolonging the
existence of their fellow-creatures.” In the pursuit of a
profession which has for its object such lofty and beneficient
aims —the cure of disease—the relief of suffering, the keep¬
ing the body in health, it is no wonder that the good phy¬
sician should be taken as the highest type of humanity.
Further, if we regard the worldly emolument to be de¬
rived from the practice of our profession, we have, even on
this score, not much reason to complain. Were we all to
attain great wealth, high station, or enormous influence,
our natural emulation would be quickly dispelled, and our
motives for acquiring superior skill speedily crushed. Such
honours are but to the few ; yet the prizes are open to all,
and just as the race is to the swift, and the battle to the
strong, so he who arms himself with perseverance, self-
reliance, and endurance, will be the first to reach the win¬
ning post. We may all, however, expect a modest compe¬
tency ; but we acquire a far richer reward which gold can¬
not purchase—the heartfelt gratitude and thanks of suffer¬
ing humanity—as well as the intense satisfaction we our¬
selves derive from pursuing a vocation whose object is at
once sacred, unselfish and sublime.
It is nothing that science has discovered an agent which
produces complete temporary insensibility, so that the sur¬
geon is enabled to perform tne most trivial as well as the
most formidable operation with absolute painlessness ? Is it
nothing that we have entrusted to our keeping the power of
restoring sight to the blind, and of making the lame walk ?
Is it nothing that when a child is suffering from impending
suffocation—when indeed the last spark ol life has well nigh
fled, we, by our art, can snatch that child as it were from
the very jaws of death ? Is it nothing for us to know that
when a patient is bleeding profusely and dangerously, that
we have committed to our care the means of instantly stem¬
ming that haemorrhage ? Is it nothing that in our daily
practice, our skill, properly applied, often changes the scene
from one of utter gnef and desolation to one of perfect joy
and gladness ? Is all this nothing ? Then science is nothing,
art is nothing, and our profession is nothing! —Mr. F.
Mason'9 Introductory Address at Westminster Hospital.
■ -
Ipfal ftefoss.
The Public Health.— We extract the more in¬
teresting items from the last return of the Registrar-General.
3,169 deaths were registered in London and in thirteen other
large towns of the United Kingdom. The annual rate of
mortality was 26 per 1,000 persons living. The annual rate
was 24 per 1,000 in Loudon, 28 in Edinburgh, and 22 in
Dublin ; 19 in Bristol, 21 in Birmingham, 30 in Liverpool,
32 in Manchester, 38 in Salford, 25 in Sheffield, 28 in Brad¬
ford, 29 in Leeds, 28 in Hall, 25 in Newcastle-on-Tyne, and
31 in Glasgow. The deaths registered in London during the
week were 1,421. It was the forty-third week ot the year ;
and the average number of deaths for that week is, with a
correction for increase of population, 1,340. The deaths in
the present return exceed by 81 the estimated amount. The
deaths from zymotic diseases were 831, the corrected aveiage
number being 352. Four deaths from small-pox, 19 from
measles, 105 from scarlatina, 10 from diphtheria, 21 from
whooping-cough, 67 from fever, and 30 from diarrhoea, were
registered. Of the 67 deaths from fever, 19 are registered as
typhus, 37 as typhoid or gastric fever, and 11 simply as com¬
mon continued fever. One hundred and ninety-two deaths
occurred from phthisis, 120 from bronchitis, and 77 from
pneumonia.
Bristol Board or Guardians. —At the usual weekly
meeting of this Board, held last week, Mr. J. Bartlett (the
Govornor) presided. Mr. H. Naish, in accordance with his
notice of motion, moved that the salaries of the medical
officers of the four districts now coinciding with the relief di¬
stricts (as resolved last week) should be £100 per annum. The
number of paupers under the new arrangement would be as
follow:—In No. 1 district, 918; No. 2, 912; No. 8, 774;
No. 4, 882 paupers. He (Mr. Naish) would have preferred to
propose a salary of £90 for the medical officer of No. 8 dis¬
trict, and that St. Peter’s Hospital should be included in
No. 2 district; but as this would not be in accordance with
the resolution of which he had given notice, he was unable to
move it. He thought his proposition was a liberal one to the
medical officers, and just to the paupers. Mr. Wintle seconded
the resolution. Mr. Pearce (Maiyleport) proposed, as an
amendment, that the salary of the medical officer of No. 3
district should be £90, and the rest £100 each. Mr. Tuckey
seconded the amendment. Mr. Hodgson wished to move
another amendment—that Nos. 1 and 2 districts should bo
amalgamated, and assigned to one medical officer at a salary
of £175 per annum, which would be a saving of £50 on Mr.
Naish’s proposition. He ultimately gave notice of bringing
forward a motion next week, to rescind Mr. Naish’s resolution
that was carried last week. After considerable discussion, a
further amendment was proposed by Mr. Holmes, and seconded
by Mr. Shackell, to the effect that St. Peter’s Hospital should
be included in No. 2 district, and that the salary should be
£100, and the salary for No. 1 district £100, No. 3 district
£90, and No. 4 district £100. It was*contended that notice of
such motions should be given; and the whole question was
being rc-opeued, when Mr. Hodgson suggested that the debate
should bo adjourned for a week, subject to discussion on all
the amendments at present proposed. Mr. Shackell’s amend¬
ment having been lost, Mr. Pearce’s amendment was dismissed
by the casting vote of the chairman ; and Mr. Naish’s reso¬
lution, giving £100 each to the medical officers of the four
districts, was carried, twenty-two gentlemen voting for it.
The questiou relative to St. Peter’s Hospital was understood
to stand over till next week. The other busiuess was of a
routine character.
- + -
INEBRIATE ASYLUMS.
In the October number of the Atlantic Monthly is a narra¬
tive by Mr. Parton of a visit to the largest of the inebriate
asylum 8 in America, one of which is situated at Binghamton
New York. This institution is under the care of Dr. Albert
Day, who formerly filled a similar position in the Washing¬
ton Home at Boston. The treatment consists in rest from
the ordinary vocations of the patient, pleasant occupation,
a wholesome diet, croquet, billiards, and bowling, a library,
reading-room, music and flowers, gardening, and 4 good
company.’ These are some of the influences used to prevent
the recurrence of’ the desire fbr alcohol The system is
voluntary, but patients are not allowed to visit the village
without permission, and on a violation of this rule they are
placed in confinement We read 4 It occasionally happens
that a patient, conscious of the coming on of a paroxysm of
desire, asks to have the key of his room turned upon him
till it is over. It is desired that this turning of the key,
and those few barred rooms in one of the wards, shall
be regarded as mero remedial appliances, as much so as the
bottles of medicine in the medicine chest. It is, however,
understood that no one is to be released from confinement
who does not manifest a renewed purpose to refrain.’
It is stated that a great many patients come to the asylum
intoxicated, being only able by such means to screw up their
courage. Once entered within the walls the use of liauor is
absolutely prohibited. No gradual 4 tapering off ’ is allowed,
and this is found not only to be safe, bat gives the patient
less intense suffering, and suffering of briefer duration. No
medicine is used to cure drunkards of their taste for liquor.
It is believed to be impossible to effect anything by suoh
e
402 The Medical Press and Circular.
ADVERTISEMENTS,
November 4,186$.
NOTICES TO CORRESPONDENTS.
On account of the unusual pressure upon our advertising eolumns, we
are compelled to postpone much valuable matter, Notices to Corre¬
spondents, Ac., to our next.
Disinfectants.
To the Editor of the Medical Press and Circular.
Sir,— In your excellent remarks on Scarlatina, you enumerate as good
disinfectants to be employed carbolic and chloride of lime, and Condy*s
Fluid. Why is Burnett’s Disinfecting Fluid left out ? It is one of the
best disinfectants, according to -the experiments of Mr. Chat men, of
Merton College, Oxford, recorded in the “ Journal of Science,” for Jan ,
1867, page 138, and my own experience confirms this view Mr. Chapman
classes it, in point of efficacy, as equil to the now fashionable carbolie
acid, and to sulphate of iron, and as rather superior to Condos Fluid,
though the latter is very good. We must, not lend ourselves to fashions
in such matters, but use the best. In the sanitary department of the
Brighton Museum, all good sorts are exhibited without favour or
omission. But I have not got Dr. Pairman’s sulphur pastilles, and should
be glad of a sample.
I am. Sir,
Tour obedient servant,
W. E. C. Nourbb, F.R.C.S.
Brighton.
Communications with enclosures have been received from Mr. Barker,
London; Dr. Davis, Swords; Dr. Armstrong, Cork; Mr. RAwdon Mac-
namara, Dublin; Dr. Crofton, Tuam ; Dr. Rumsey, Cheltenham ; Mr.
McCulloch, Birmingham; Dr. Craig, Sc irborough; Mr. J. Lawrence,
Birmingham; Dr. Phehm, Dr. J. G. Beatty, Dublin; Mr. J. Warnock,
Birmingham; Mr. Savory, Hastings ; Dr. Ashe, Warrenpoint; Dr. F.
Clarke, Luton ; Dr. E. Smith, Londonderry; Dr. R. H. Newett, Siiank-
hill; Mr. Freeman, LewUh m; Dr. G. H. Porter, Dublin; Dr. J. As¬
ton, Wadingham(new subscriber;) Mr. R. W. Swtn, Dublin ; Dr. Pierson,
Scarborough ; Mr. Morgan, Dublin; Mr. Nourae, Brighton ; Dr. Green-
way, Wellington; Mr. Wilson, London; Mr. Bentley, I.ondon; Dr.
Jackman, Bwymbridge; Mr. F. W. B«own, Uppingham; the Secretary
of the Harveian Society; Di*. F. Pratt, Cardiff; Dr. Dobbs, Newport;
Dr. Kirby, London ; Professor Humphrey, Cambridge ; J. Baker Bmwu,
Ksq.. London; Mr. Huntley, Reading; Dr. Murphey,' Mil town, Kerry ;
Dr.Peppard, Pilt wn, Kilkeriy; Dr. 8criven. St Stephen’s green, Dublin;
Dr. M>s»y, Ravens dale, Louth; I)r. McBride, Newiy; Dr. Saunderson,
Edenderry; Dr. tV.lson, Kead’ie, Roscommon; Dr. Nicolls, Navan ; Dr.
O’Sullivan, Limerick; Dr. Murray, Delvin ; Dr. Welsh, Ballyshannon ;
Dr. Stafford, Newcastle, Clonmel; Dr. Smart, Ballymahon ; Dr. Reidy,
Tralee ; Dr. D. Tayes Shanagolden ; Dr. Mulville, Gonr; Dr. M cEvoy,
Balhriggaa ; Dr. Leeper, Ready; Dr. Quinlan, Lismore; Dr. Ringland,
Lisbane; Dr. McMurtry, Birmingham; Dr. Wade, Kilcoch ; Dr. Charles
Coukstown, Ac., Ac.
-♦-
BOOKS, PAMPHLETS, Ac., RECEIVED.
The Liverpool Medical and Surgical Reports. Vol II. London : John
Churchill and Sons.
The World of Wonders. Part I. London ; Cassell. Petter, A Co.
Dr. lligley’s Obstetric Memoranda Fou:th Edition. By Alfred
Meadows, M.D. London: HenryRenshrw.
Cases of Di ease in the Subjects of Inherited Syphilis. By J. Hugh-
ling Jackson, M.D. London: John Churchill aud Son*.
Bible Animals. Part XI. Longmans A Co.
The Pharmaceutical Journal.
Edinburgh Medical Journal.
Canada Medical Journal.
-♦-
APPOINTMENTS.
Aitken, J. M., ’M.D.—Consulting Surgeon to the Kilmarnock Fever
Hospital and Dispensary.
Barclay, J., M.D. —Visitor of Houses licensed for the Reception of
Lunatics wLhin the County of Leicester.
Borland, J., M.D.—Medical Officer to the Kilmarnock Fever Hospital
and Infirmary.
Cajlxv, F. E.. M.D.—Medical Officer to the Lunatic Asylum, Guernsey,
vice De Beauvoir de Li le, M.R.C.P.L.. deceased.
Cooks, J., M.B.—Medical Officer to the Hastings Dispensary.
He.nbxak, Mr., M.R.C.8 .E.—Assistant Medical Officer to the Devon
County Lunatic Asylum, Exminster, vice Joseph P. Richard,
M.R.C 8.E., appointed Medical Officer to the Middlesex County
Lunatic Asylum, Hanwell.
Matthews, J., M.R.C.S., Ac.—Certifying Surgeon, under the pro¬
visions of the Factory Act, for the Camforth and Holme Districts.
Paxton, J., M.D.—Consulting Physician to the Kilmarnock Fever Hos¬
pital and Disnensary.
Tfiuksfield, T. G., M.D.—Certifying Factory Surgeon for the District
of Broseley, Salop, vice Richard Thursfleld, M.R.C.8.E., deceased.
Wilson, T., L R.C.P,iSd.—Certifying Facto: y S:ngeon for the Alton Dis¬
trict. Hants.
- + -
§irijr uuir
BIRTH.
Brown.— On the 21st n'f.. at Uppingham, the wife or Frederick Warren
Brown, Esq , M.R.O.S., of a son.
DEATHS.
Clark. —On the 23rd ult., H. Clark, Af.R.C.S.E., of Leamington, late
Senior Surgeon H.E.I.Co.’s Bengal Service, age l 7‘k
Diver.—O n lie 27th Sept, rt Rampart row, Bombay, the wifeo: Thomas
Liv.r, M.D.
Eves.—O n tiie 22nd ult., Augustus Eves. M.D., of Cheltenham,
aged 60.
Forte.—O n the 6th ult, of phthisis, at George town, Dem ram, A. C.
Forte, M. D., M. R. C.8. E.
Knavp.—O n the 24th ult.. J. M. Knapp of Bath, Surgeon-Major, late
Bombay Army, aged 64.
URGENT APPEAL.
T HE Members of the Medical Profession and the bene¬
volent public are earnestly requested to contribute to the
relief of Dr. Aldridge and family, who are reduced to a state of desti¬
tution.
It is hoped that a sufficient sum may be collected to enable the fa»ny
to join their relations in Australia.
Contributions in aid of this object, will be thankfully received aad
acknowledged by the following gentlemen:—
Sir W. B. Wilde, Dr. Stokes, Dr. O’Ferrall, Dr. Croker, Dr. Gordon,
Dr. Hudson, Dr. W. O. Barker, and Messrs. Bewley and Hamil¬
ton.
SUMS ALREADY RECEIVED.
Henry Bewley, Esq., £i00.
Dr. J. T. Hamilton
Dr. A. Hudson,
Dr. O’Ferrall, .
E. Long, Esq., .
Dr. Croker,
Dr. Duncan,
Dr. Evory Kennedy,
Dr. M'Donnell,
Sir W. Wilde, .
Dr. Gordon,
Dr. Cruise,
Dr. Mapother, .
Dr. P. Smyly, .
Dr. Nalty,
Dr. Dwyer,
Dr. Doyle,
Dr. Bennett,
Dr. Smailman, .
Dr. West,
Dr. Thornhill, .
Dr. E. Bradshaw,
Dr. Forrest.
Dr. W. Stokes, Jr.
Dr. Churchill, .
Dr. Fitzpatrick,
Dr. Harrison, .
R. J. Swift, Esq.,
Mrs. S. Hinds,
Dr. Bateson,
Dr. Beatty,
Dr. C. H. Leet,.
Amicus,
G. H. Porter, Esq.,
J. Stronge, Esq.,
£15
10
10
10
6
5
5
6
0
0
0
0
0
0
0
0
8
8
2
2
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0 10
0 10
0 10
S. Nalty, Esq., 0 10
Per Dr. Croayn, 0 10
J ames Hough ton. Esq.
Dr. Oldham, .
Dr. Barton,
Dr. Bevan,
Dr. Harvey,
Dr. Banks,
Dr. Hildige,
H. N. Draper, Esq.,
Dr. Lipsett,
Dr. Duigan,
Dr. Cronyn,
Dr. Brunker, .
Dr. Collins,
From a Friend,
Dr. E. Bewley, .
Dr. E. Hamilton,
Dr. Barker,
Dr. Denham, .
Dr. Hardy,
Andrew Armstrong, Esq., 2
Dr. F Kirkpatrick,
Dr. Kidd, . /
Dr. James Armstrong
Ben Thos. Patterson, Esq
Dr. Chaplin,
Dr. Mollan,
Dr. Stewart,
Dr. M. Burke,
Dr. Elliott,
The Editor Medical Press
and Circular, 1 1
Dr. J hnA. Fergusson 1 0
0
2
1
2
0 0
0 0
6 0
0 0
1 0
1 0 0
1 0 ©
10 0
0
0
1
0
0
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0
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CITY OF DUBLIN ELECTION, 1868.
EDICAL SUBSCRIPTION towards a GUARANTEE
FUND, for Expenses of Sir D. J. CORRIGAN, Btrt,
M ]
M.D.
The Treasurers, Drs. Lyons, R. M'Donnell, ami Mapother, beg to
acknowledge the following subscriptions received since last publication:
1 1 0
Dr. W. 8tokes, Jon. - £10 0
Dr. P. W. Long - 6 0
Dr. Steven Longford 2 0
Dr. G. M. M‘Coral ck - 10 0
Dr. G. Oldham - 10 10
Dr. Tucker, Sligo - - 1 0
Dr. Fitzsiuions, Bother-
gan ....
Dr. Lao i gan, Ballyma-
hon
Dr. G. Atkinson
Dr. Kennedy, Tipperary
Dr. C ean, Wexford
Dr. Goodall, ,,
Dr. Boxwell, „
Dr. furlong, „
Dr. Hadden „
A. B., per Dr. Lyons
Dr. Nedley -
Dr. R. O’Kelly
Dr. Pope, Donegal -
An Army Medical Officer
Mr. Powers, student
Dr. Scully, jun., Clor
mel
Dr. Anderson, Newtown
hamiiton
G. H., per Dr. Mapother
Dr. Bennett Bruff
Dr. J. 8 Hughes
Dr. Walshe
Dr. Ilyl.ind
Dr. J, A. Byrne
Dr. Eustace -
Dr. M’Cormac
Dr. Cuming -
Dr. 8hauno i -
Dr P. W. Long
Dr. D. F. Biv.ny
Dr. Fitzpatrick
D . A’tuu
Dr. Honrahan
Dr. < ahill
Dr. Dieigan •
Dr. Thorpe
1 0 0
and
Dr. Doyle
Dr. Adrien
Dr. M'Cabe •
Dr. Zanphton
Dr. 8. Nichol s
Dr. Atkins
Dr. Martin Portion
Dr. O’Rorke -
Dr. Drennan -
Dr. Laffan
Dr. M'Drrmott
Dr. Leeper
Dr. Phelan
Dr. Foley
Dr. Cahill
Dr. 8almon -
Dr. M-William, Howes
Dr. O’Donoglius
Dr. T. Furlong
Dm. E O'Kelly, sen.
jun.
Dr. M'Neagh -
Dr. P. O’Brien
Dr. Quic'c
Dr. Kisby
Dr. Doran
Dr. Doherty -
Dr. Baxter
Dr. H. H. Stewart
Dr. Hayes
Dr. J. Rt an -
Dr. Ooke
Dr. White
Dr. Ivors
Dr. Kearney -
Dr. O'Kancl! -
Dr. Browae -
Dr. Heiiernan
Dr. Fennell, C.U.
Dr. E. I ong -
Dr. J. Murray
Dr. O’Donnell
Dr. J. Pa ten
Dr. M*Ghoin -
E. F. - -
N. J. Butler -
£ 2
2
2
2
2
t
2
2
2
5
1
1
1
1
1
1
1
1
10
6
6
1
1
0 10
5 0
Po9t-offlce Orders or Cheques to be made payable to —
E. l).^LYO>S, 8 Meriion square West, Dublin.
B. MoDOlVNELL, 14 Lower Pembroke street. Dublin
E. 1>. MAPOTHER, 186 Stephen*! Green, Dobite.
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©for fgWial & (ftirndM.
“SALUS POPIJLI SUPREMA LEX.”
WEDNESDAY, NOVEMBER 1 1, 1 868.
CONTENTS.
PAQE
LECTURE.
Introductory Address delivered at the
City of Dublin Hospital, by Dr. J. II.
Benson, Physic an to the HnHpit d _ 403
ORIGINAL COMMUNICATIONS.
Fncture of both Bones of the Le^ in
Two Flaces, and the Leg Re-fra< tured
after Eleven Weeks at the Lower Break
—Recovery. By Francis Mt Ev»y,
L. K.Q.C.r. I.. L M., M. R.C.S. E., Med!cal
Officer, Balbriggan Dispensary; Surg on
and Agent to the Coastguard, Balbriggau,
and Nanny Water, Surgeon Factories,
Balbriggan, Arc., Ac-.
HOSPITAL REPORTS.
King's Collf.oe Hospital—
Cases under the care of Dr. Beale, F.R.S.
(From No*es by Dr. Tonge).
Wkst-uoreland Lock Hospital—
Suppuration of the IngmnalGlnnds Simu¬
lating the “ Bubon D’Emblre.” with
Uterine Primary Sore. Under the
care of Mr. Morgan. Professor of Ana¬
tomy, R.C.S I. ; Surgeon to the Hos¬
pital, and to the Mercer’s Hospital ..
•108
400
410
PACK
Medical Board. 410
LEADING ARTICLES.
I REFORM OF the Mkdical CoUNtJU. 411
Certificate Signatures. 411
NOTES ON CURRENT TOPICS.
Royal College of Physicians of London .. 412
I Royal College of Surgeons of England .... 412
( Nurses for the Sick Poor. 412
Charing Cross Hospital. 412
Ovariotomy . 412
Death from Chlorofo m . 413
Th* late Mr, Partridge, of Colchester_ 413
The late Professor Griesinger. 413
Dr. Wolfe . 418
The Mastership of the Rotundo Lying-in
Hospital, Dublin. 413
Sir Dominic Corrigan. 413
Gresham Lectures. By E. Syraes Thomp-
fon, M D , F.R.C.P., Graham Professor
of Medicine . 413
Colonial Benefit Societies. . 414
SCOTLAND.
The Chancellorship. 414
The Parliamentary Election. 415
4 he Hoot >r*hip . 415
he Tr >vost. 415
PAQE
Museum tf Science and Art. 415
Moral Philosophy . 15
The Principalship . 415
St Andrew’s United College . 415
Retirement of Dr. M. Prpsser James fruin
his Candidature for the Representation
of the Universities of Edinburgh and 8‘.
Andrew’s . 415
Social Science Association—
Health 8e. tion.—Address by H. W. Rum-
sey, Esq.. M. D., President of the Section 416
FOREIGN MEDICAL LITERA¬
TURE.
Case of Hemiopia. Communicated by Dr.
M. K. Loewegren. Translated by W.
D. Moore, M.D., Dub. et Cantab.,
L.K.Q.C.P.I, M.R.I.A. 420
CORRESPONDENCE.
The Contest for the Universities of Edin¬
burgh and St. Andrews. 421
Last Summer’s Cholera and Diarrhoea.... 421
Medical News, Notices to Correspondents,
&C . 422
Introductory Address
DELIVERED AT
THE CITY OF DUBLIN HOSPITAL,
By Du. J. H. Benson,
Physician to tho Hospital.
Gentlemen, —We are assembled to-day to inaugurate the
work of another medical session. Deeply sensible as I am of the
high compliment conferred on me by my colleagues in deputing
me to deliver the introductory address, I yet stand before
you with mingled feelings of diffidence and of hope. Of diffi¬
dence, when I contemplate my own imperfect qualifications
for the undertaking ; and when I remember the names of the
illustrious men who have preceded me on similar occasions,
and who, by their eloquent addresses, have bequeathed to
their successors a task from which any man may reasonably
shrink. I am here with feelings of hope, almost of confidence,
too, from the grateful recollection of the indulgence which I
have invariably experienced both at the hands of my re¬
spected colleagues, and from you, my student friends, during
my clinical teaching and clinical investigations. I now crave
a renewal of my lease of indulgence, and must ask you to bear
with me a little, while I say a few words about your future
prospects and pursuits.
Advice or suggestion on matters of importance is seldom
valued or even listened to, except when it comes from one
whose hoary head entitles him to be heard with the attention
due to his years, or whose long experience and success in life
are not matters of question. But, as I cannot boast of these
S ualifications, I must plead that the recollections of all ypur
ifficulties, doubts, and temptations are still green in my
memory, as having been but so lately one of yourselves ; and
what I want in the multitude of years I must endeavour to
make up by the freshness with which the picture stands be¬
fore me.
On behalf of my colleagues then, Gentlemen, and from
myself, T bid you a hearty welcome at the threshold of the
profession you have chosen. I assume that both you and your
parents have already well considered the question of your
choice of a profession in all its bearings ; but if not, I ask
yon to pause ere you enter the porch, and to count the costs.
To give you a sketch of the work before you I will begin
by quoting a passage from an introductory address delivered
here a few years ago by him who is at once my colleague and
my nearest of kin. “You are choosing, then,” he says, “a
! very arduous profession,—I might almost say a life of toil
\ and anxiety, mingled, however, with many exquisite enjoy¬
ments. Other professions lead to higher rank, and frequently
to greater riches. There are no grand prizes to be drawn in
this ; no peerages in prospect ; no seats on woolsacks ; no
ermine or lawn sleeves, or large pensions. Our profession, there¬
fore, does not attract the aristocracy of birth, nor the worship¬
pers of wealth ; but it does attract and develop much of the
aristocracy of intellect. The lovers of science find its studies
congenial to their taBtes ; and the benevolent can here find
ample opportunities for the exercise of their best aspirations.
Its pursuits are ennobling and elevating to the mind ; the
most fascinating studies form a part of the preparation for it ;
while its object, end, and aim are to take from the misery and
add to the happiness of mankind. I am content to place one
study before it in dignity and importance, and only one—
namely, divinity. The subjects which engage the attention in
divinity are higher, the interests involved are more momen¬
tous. But next to that, I would place the study of medicine.
Other professions have, indeed, their charms and their useful¬
ness, and I have already allowed that they more frequently
lead to riches and honours ; but are the objects which engage
the attention in them of such paramount importance ? They
have to do with property ; our profession with life. They with
the outworks ; ours with the citadel. What is that which
confessedly, even to a proverb, is the greatest of earthly bless¬
ings ? What is that without which all others are valueless ?
Is it not health—a sound mind in a sound body ? . . . .
How gladly would we give all that we possess for life and
health, if these cannot be obtained on any other terms. Your
business will be to preserve that life, and to restore that in¬
valuable health. The lawyer’s profession is a noble one ; but
it is in many respects less so than ours. He has to deal
chiefly with property ; we with the more important concern
—life. He may establish the right, protect the weak, and
defend the innocent; but how often is he engaged in establish¬
ing the wrong, or screening the guilty ? %
“ Not so with you, Gentlemen. Your business will be at all
times and in all places to do good,—to protect the sick and
weak, to restore every man to his property, health. Your
client is always the oppressed; his adversaries are pain, disease,
and death. To combat with these is your vocation, and to
triumph over them can do no wrong to other men. You have
the privilege of humbly imitating your Divine Master, who,
while on earth, went about doing good, and healing all manner
of sickness and all ipanner of disease among the people. The
soldier’s profession is esteemed a noble one, and so it is when
exercised in a just cause —in defence of home and country,
in defending the weak, and protecting the innocent. But,
alas ! unjust wars are sometimes carried on, and the brave
soldier must bear a part in scenes of violence and slaughter at
Digitized by
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404 The Medical Press and Circular.
INTRODUCTORY ADDRESS.
November 11,1863
whioh his soul, in cooler moments, would shudder. He must
fight and kill according to orders. Your task, my friends,
will be a better one. Not only in civil life, but even in the
Army and Navy, your grateful duty will be to heal the wounds
that others have inflicted ; to bind up the broken heart ; to
soothe the pangs of suffering humanity. Friend and foe you
treat with kindness, and save to the uttermost of your power.
The laws of war allow this. At home or abroad, in civilised
or in savage life, you are always to be the benefactor and the
friend—the good Samaritan—often the confidential adviser,
ministering to minds diseased as well as to their suffering
bodies. This is your acknowledged mission, so that you are
spared and welcomed wherever you go, even amongst the
bitterest enemies of your country or race.
“ Contrast a great physician with a great warrior—with an
Alexander or a Napoleon. The conqueror is called ‘ great,’
estimating him, as we do the whirlwind, by the devastation he
has wrought. The greatness of the physician is measured by
the benefits he has conferred on his fellow-man, by the num¬
ber of lives he has saved ; and whether is it nobler to save
life or to destroy ? ”
The benefits conferred on mankind by medical men—by such
men as Jenner, Harvey, Sydenham, Hunter, Simpson, and a
host of others, are almost inestimable. Napoleon has slain
his thousands, but these have saved their ten thousands ; and
the last named of these has robbed the surgeon’s knife of half
its terror. Nor is it only in matters strictly medical that men
of our calling are foremost in usefulness. The justice of the
great Samuel Johnson’s remark on this subject will be acknow¬
ledged by everyone. He says :—** Wherever there has been
any association of good men for laudable ends—wherever a:iy
institution has sprung up, having science or literature for its
object, or any great scheme of benevolence been designed or
perfected, medical men have always been found amongst their
first—their most zealous and useful supporters.”
But not even a tithe of the medical man’s benevolent labours
is known to the world. A soldier in his campaign endures
many hardships, privations, and dangers. His brilliant victories
he achieves for the most part in the ardour and heat of battle,
with his comrades around him ; each ready to conquer or die.
Then the most timid women could entertain no fear. His acts
of daring are told abroad, and their story brings upon the
cheeks of friends at home the flush of rapturous enthusiasm,
and the heart of the patriot throbs in fervid sympathy with
his. Perhaps he falls gloriously in battle, and a tablet is
erected to his memory, or else he returns home laden with
medals and crosses ; and in either case is called, and rightly
called, a hero. But what is his to the unwritten heroism (un¬
written. except in the eternal pages above) of the man who, not
on occasions only, and when the world stares, but habitually—
daily for a lifetime—enters unseen, in cold blood, into the
dark chamber of loathsome disease, often joined with squalid
poverty and crime, and there stands face to face with death,
and wrestles long and hard with the great enemy; and but too
often, in his zeal to rescue the life of his fellow man, becomes
himself a silent victim to the destroyer. Yet who calls him a
hero ?
But in saying so much as I have in praise of our profession,
I do not mean to exalt it by enviously lowering others—far from
it; but I wish to put prominently before you its true dignity
and importance.
Let us now glance at the nature of your future studies, and
the means at your disposal for acquiring the necessary informa¬
tion. Medical science embraces, more or less directly, almost
every branch of human knowledge. There is scarcely any de¬
partment of science or of art which does not contribute its
stream to the great gulf of medicine, while several are entirely
merged in its depths. You cannot, therefore, expect to master
all the subjects thus connected with it; but you can master
the most important, and gain a familiar acquaintance with the
elements of most, if not of all the rest.
Among these I include the various subjects which form parts
of what is called a liberal education, and though their study
bring not in itself professional knowledge, it is that which, in
the words of John Stuart Mill, one of our greatest thinkers,
will “ direct the use of your professional knowledge, and bring
the light of general culture to illuminate the technicalities of
a special pursuit.” But the subjects which are intimately
amalgamated with therapeutics (or the healing art), and witn
which you will be required to prove your acquaintance by ex¬
amination, are sufficiently numerous by themselves. So many
and so complicated are they, indeed, that you will not be ex¬
pected to master all of them thoroughly in the short period of
your pupilage ; but while you pay special attention to some,
you may and ought to obtain a comprehensive insight into the
rest. Without this you will be unable to appreciate their im¬
portant bearings upon practice—there will be many an unseen
weight clogging your professional career ; and, looking back at
the close of any stage of your race you will have reason to
know why your chariots “ draw heavily,” and to regret it be¬
cause it will have been your own fault.
At the College of Surgeons you will learn many of the ne¬
cessary collateral subjects ; but surgery, practice of physic,
midwifery, and partly path^ jgy can be successfully studied on/y
in hospital, and at the bedside. During your first and second
years, attend particularly to anatomy. It is the first and
grand foundation-stone of your professional studies. Without
a thorough knowledge of the various parts of a complicated
machine, you could never attempt to repair it, and would you
feel yourself justified in undertaking the repair of the most
complicated, most universal in all action, of all machines—the
human body—with a scanty knowledge of its mechanism ? I
hope most of you heard, and profited by, the valuable advice
on this subject given by my respected and experienced col¬
league, Dr. Hargreave, in his late able and eloquent address at
the College of Surgeons. Remember the important distinctioa
he drew between the qualifications of the lingual anatomist'’
and the “ scalpellary anatomist.”
The age has passed when our forefathers supposed that the
arteries contained air, that the pineal gland was the seat of the
soul, and that the use of the brain was (after their own ex¬
pression) “ to act as a sponge in soaking up the pituita which
distilled from the nostrils in chilly weather.” Since then, ana¬
tomy has made gigantic strides, and with the aid of her twin-
sister physiology, many of the inscrutable mysteries of former
days have been revealed, and many secret chambers have been
discovered, and, one by one, unlocked. We now can dearly
see the speaking evidences of omniscient design in planning
our frame, and of consummate skill and stupendous power in
the ease with which every difficulty is overcome, and in the
perfection and harmony of the whole.
Chemistry, another important collateral, treats of the pro¬
perties of those secondary agents of the Creator, by whose
mutual reactions all physical operations take place on the sur¬
face of our globe from the least to the greatest. In certain
questions purely medical, the aid of chemistry is indispensible.
As a means of diagnosis and prognosis we employ it directly in
some cases, such as in morbus brightii and diabetes, and with¬
out a familiar acquaintance with the subject we should be con¬
tinually at fault in endeavouring to understand the local info
ence of medicinal agents, and their reciprocal reactions in the
treatment of disease. Of all the collateral subjects you will
have to deal with, chemistry is the one whose study will be
attended with, perhaps, the largest mental training. It will
cultivate not only the memory, but all the intellectual faculties;
and it has many of the advantages of mathematics in tending
to produce a close and accurate habit of thought and reasoning.
Up to a comparatively recent period its study was carried on
in secret, I may say, until the genius of such men as Davy and
his pupil Faraday, Berthollet, Liebig, and others, brought light
out of darkness, and raised the subject to its present high posi¬
tion among the sciences. By their invaluable labours we ha«
now, laid up, a large fund of interesting and important infor¬
mation ; and we can dimly descry stretched before us a vast,
untravelled plain, whose doubtless fertile soil is rich with hidden
treasure. By the aid of chemistry we are made acquainted 1
with some of the grandest, most beautiful, and most harmoni¬
ous of nature’s laws, and in surrounding objects and pheno¬
mena we trace evidence of their operations, from the delicate
perfume of the violet to the vast earthquake of Peru, or the
upheaval of whole continents.
The present is essentially an age of progress and enlighten¬
ment. Daily we see empiricism uprooted, and the mesMi of
old and groundless theories rent into fragments by the spirit of
enquiry and criticism. Science is rapidly outgrowing bar
weaker sisters, Literature and Art. Every year it is becoming
less true that, “ Science moves but slowly, slowly, creeping oa
from point to point; ” for her strides are npvf gigantic, sad by
no conjunction can we set bounds to her possible conquest*.
How lately in the world’s history was it that Galvani, n
Italian physician, observed that the contact of certain dis¬
similar metals with certain parts of a frog’s leg, produce move¬
ments in the latter ; or that the genius of the immortal New
ton unfolded the compound nature of light— yet what art the
results even now ? Though the fruit of these seeds may
yet be fully ripe, so rapid a growth has taken place that we
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can now transmit our thoughts with unerring truth, and with
the rapidity of lightning, through thousands of miles of ocean,
along the awful solitudes of Atlantic’s bed ; or, leaving earth
and all its mimic storms behind, we take our flight into the
regions of immensity, and from the nature of the spectrum of
their light calculate the rapidity of motion of what have been
hitherto called the fixed stars, and analyse the very ingredients
of their atmosphere, or determine the physical constitution of
the nebulae, more leagues away, ten thousand times, than there
were seconds since tho creation of roan. In the domain of medi¬
cine too, Science has shown herself able and willing to work with
no sluggard's hand. By pressing the physical sciences into our
service, we are now supplied with such all-important instru¬
ments as the stethoscope, laryngoscope, ophthalmoscope, endo¬
scope, microscope, sphygmograph, clinical thermometer, gal¬
vanic machine, Ac. ; and the late introduction of most of these
clearly indicates the rapid and welcome advance of the corre¬
sponding sciences into the domain of medicine.
Modern investigation is fast leading us to a belief in the
cryptogiuuic origin of mauy diseases. The opinion is uow
gaining ground tnat tho cause of the malarious fevers of hot
climates, of dysentery, yellow fever, ami cholera, may be
traced to the introduction into tho system of different species
of fungus, or of infusoria. Tho time is, perhaps, not very
remote when further investigations may show that typhus and
enteric fevers, as well as stnall-pox, measles, and scarlatina,
have a similar origin. In support of this view I may men¬
tion that Professors Hallier, Docent, A. Zuerne, and Keber,
of Dantzic, have all observed peculiar organic bodies, en¬
dowed with powers of active movement, in the lymph'of
certain forms of variola. During the late fatal epidemic of fever
in the Mauritius, tho researches of Dr. Schmidt demonstrated
the prepuce of minute plants of a fungus along the whole of
the intestinal canal of patients who died of the disease ; and
these fungoid growths were found by the aid of the micro-
scoj»e, to be the conutertypes of similar organisms discovered
in the Grand River, which ran through the infected district.
The treatment of so-called zymotic diseases by the use of anti¬
septic or sej>ticidnl agents, indicates another important
advancement in therapeutics, and one which may prove of ex¬
tensive application. The medicinal agents of this class, such
as the sulphites, advocated by Poli, of Milan, carbolic ncid,
etc., are thought to act either by destroying the so-called
catalytic germs of the organic poisons of certain diseases, or,
by reacting on the material components of our own organism,
to render them incapable of being acted on by these catalytic
germs. In surgery, carbolic acid, as recommended especially
by Lister, has already proved of great servico. When used as
an external application in any of its various forms, it destroys
the minute vegetable and infusorial spores which we know
from the researches of Pasteur are continually floating in the
atmosphere, particularly where animal and vegetable life
abounds, and which, by being admitted into wounds ami to
raw surfaces, is the chief cause of suppuration. These septic
organisms being destroyed, then, and the entrance of others
being guarded against, rapid cicatrization takes place. As I
have referred to the researches of Pasteur, I may mention that
in a late communication to the French Academy of Sciences
M. Poulet stated that he had collected the breatli of a number
of patients suffering from whooping-cough during an epidemic
of that disease, ami that on examining the vapour microscopi¬
cally he found a large number of minute infusoria, which were
in all cases identical, though differing from any found in the
atmosphere at the same time.
The incalculable amount of human suffering which has been
spared by the introduction of chloroform seems likely to be
still further increased by another agont, tho bichloride of
methylene, whose properties have been investigated by
Richardson. This fluid is possessed of anaesthetic properties
somewhat similar to those of chloroform and other agents of
the sameclass, but has a fow minor advantages. It n ncot zes
more rapidly iu an open chamber than either the chloride of
methyl, chloroform, or tetrachloride of carbon.” B sides, it is
found to be more gentle and quite as snfo in it administration
as chloroform, producing less struggling, less vascular ex¬
citement, and interfering less witu muscular irritability.
Other general anaesthetics used of late are nitrous oxide, whose
effect is vciy transient, and pure nitrogen, which has not yet
had much trial. The effect of the colouring matter of the
blood on the solar spectrum, aud the remarkable modifications
of this effect observed in disease, promises to add another to
the list of important alls which we derive directly from the
physical sciences. By means of an instrument consisting of a
combination of the microscope and spectroscope, called the
micro-spectroscope, the presence of so small a quantity of
blood as tho one-thousandth of a grain of the dried fluid can
now be detected. In hot water and ice we possess agents
which, being applied to certain regions of the spine, and
thereby modifying, it is supposed, tho functional activity of
the nervous centres, gives us considerable control over various
diseases. This is a subject replete with physiological and
therapeutical interest, hinging as it does upon the beautiful
results obtained by Claude Bernard, Waller, and Brown-
Sequard, as to tho vaso motor functions of the sympathetic, and
upon the influence of the spinal and cranial nervous centres upon
nutrition, glandular secretion, and the other functions of the
bo ly. In a memoir lately presented to tho Academy of
Sciences, M. Bucliut shows that the ophthalmoscope will often
enable us to ascertain the existence of remote disease of the
nervous system by detecting certain dependent lesions of
circulation, secretion, and nutrition in the eye itself.
But time would fail me were I to attempt to refer now to
the various advances of knowledge made lately in the profes¬
sion. And when we glance at the recent explorations into
the secrets ol the nervous sys mu by electrical agencies through
the labours of Duchenne, Lockhart Clarke, and others ; and
when we consider the late researches into the origiu of tuberclo
by Sanderson, Villimin, and Wilson Fox ; and the enquiries
into the physiological action of medicinal and poisonous sub¬
stances ; and into the nature of infection amt its relation to
zymotic diseases ; we can see that there is still a large field of
enquiry open to us and, as some new discovery or inven¬
tion daily rolls away the cloud that hung about the foreground,
we see the landscape gradually opening upon us, and exposing
to our view the vast extent of the uutraveiled plain that lies
before u-. Each of us may contribute our mite to the fund of
discovery and improvement which has for its glorious object
the alleviation of human suffering. Eich of us may yet per¬
form “ some work of noble note, ” and leave our “ footprints
on the sands of time.”
But let ns now glance at our hospital work. It is true that
a great part of your medical education must be conducted at
the college ; but that i 3 merely to fit you for the most important
of all your studies—the study of disease. It is impossible
that mere reading, 1-ctures, or catechetical teaching could
ever make you so acquainted with disease as to render you
competent to undertake its treatment. By such means you
merely obtain an indistinct outline of its general aspects;
imagination and memory are almost the only faculties exer¬
cised, while the vastly more important ones—observation and
reflection, and the culture of tho senses—are all but totally
neglected. Believe mo I ain not speaking my own experience
merely, but also that of all the modern masters, as well as the
grand old Fathers of Medicine, when I assure you tint it is
only at the bed-side you can gain th»t familiar acquaintance
with the protean forms of those ills to which flesh is heir,
which will render you competent to undertake their treatment,
and will supply you with confidence and with the enviable
companion of a self-approving conscience. Attend to your
hospital, therefore, with scrupulous regularity; and while
you listen to the observations of the physicians or surgeons at
the bed-side, remember that their remarks are intended merely
to direct >our attention to the most important features of the
case before you, but can never supply that experience which
is gained only by a certain mental training, ami by the intel¬
ligent exercise of your own faculties and senses. Experience
has been said by an eminent writer to be merely “ a collection
off'Cts” stored lip in the mind. N"W. it seems to mo to be that,
and much more. It implies as well, I think, a certain increase
of our naturalfacility of association—an acquired susceptibility,
as it were, of receiving impressions of a particular kind, and of
selecting from them those which should chiefly influence the
judgment, aud ofgiving to each its due weight, so that correct
promises may be laid down, and that, from them, conclusions
may be correctly drawn. But this facility is not to be
gaitiod in haste. Its acquisition is a long and painful pro¬
cess, by which the mind must bo rendered susceptible, and
yet so tempered that the graving-tool employed may leave a
clear and permriheut impression on it. If you wish, then, to
gain exierietice early (fur it can be gained early) lose no
opportunity of collecting fact-, and, at the same time, by
observation and reflection chiefly, endeavour to establish this
mental constitution. Experience is not a synonymous terra
with age, as the public are sometimes wont to think. Its
amount is in the proportion compounded of the number and
importance of the facts collected, and of the success which has
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marked your efforts to acquire the mental constitution I refer
to ; but these are so often proportional to the time through
which the operations have proceeded, that the mistake has
arisen, and is almost a general one. From books, lectures,
and catechetical teachers (irreverently called grinders), you
will gain most of the necessary facts, but the mental training,
to be successfully engrafted on a good preliminary education,
must be conducted at the bed-side.
This hospital. Gentlemen, will afford you ample opportu¬
nities for studying disease in all its forms. It is not as large
as some others in town, but it is very questionable if that is
any disadvantage. The way to gain knowledge and experience
in disease is not by seeing a great number of patients every
day, for by so doing, the mind, whether of student or practi¬
tioner, wearies, attention becomes weakened, and the habit
of observation becomes slovenly. It is far more effectually
done by watching a few chosen cases carefully and attentively,
and by recording in the note-book and in the tables of the me*
Thory, all the circumstances and features of each, with their
varying aspects from day to day, and their corresponding
variations of treatment ; and, at the same time, by reflecting
upon them—digesting, as it were, and assimilating the store
thus laid up. Knowledge, like food, if not digested sickens
the economy, producing harm and not good. Surely eighty
or ninety beds filled with a succession of all the severer forms
of medical and surgical diseases, with nearly an equal number
of extern patients attending every day (about 17,000 in the
year) labouring under less urgent maladies, must afford ample
employment and intellectual food for the most eager and
healthy appetite. Then, our staff of medical officers may
boldly challenge comparison with that of any other hospital.
Four of them have been Presidents of the College of Surgeons;
two of them Presidents of the College of Physicians ; and, of
these, one had the singular honour of being President of both
Colleges—a distinction never before conferred on any member
of the profession. Most of them are, or have been, Professors
in the College of Surgeons ; Professors of Practice of Surgery,
of Practice of Medicine, of Military Surgery, of Medical Juris¬
prudence, and of Midwifery. Two are Demonstrators of Ana¬
tomy, and one of our consultants is the distinguished Professor
of Chemistry in Trinity College ; so that they have all the
branches of the healing art and the collateral sciences familiar
to them as household words. All of them are well practised
in clinical teaching; some as long as thirty-six years, during
which time they have been accumulating experience and
acquiring a facility iu communicating their knowledge.
It is in hospitals that you must learn the effects of re¬
medies. In the laboratory and in the class-room you study their
physical properties, their chemical relations, and perhaps their
principal therapeutic effects; but if you endeavour to investi¬
gate their intimate remedial value there, you will be labouring,
so to speak, at arm’s length, and could never learn to prescribe
with advantage to your patients. It is here, also, that you
must learn to prescribe, not according to the name of the dis¬
ease, but for the individual who is suffering from the disease,
taking into consideration its probable cause and as many of
the attending circumstances as you can. You should always
endeavour to ascertain the cause of disease, for it is manifest
that if we could ascertain tho preseuce of some condition
without which the disease would cease to exist, and if we
addressed ourselves to remove this, and afterwards to help the
vis uiedicatrix naturce, wo should be proceeding in the path
indicated by reason, and the only one by which we could ex¬
pect success in dealing with a given combination of circum¬
stances. This is called the rational method, as opposed to
the empirical, which seeks for no cause ; but, trusting to pro¬
bability, proceeds on the results of former experiment or
accident.
For the very junior student, I mean the one in his first few
months, it is better, I think, that ho should not undertake
what is called taking cases, that is, recording for himself the
features and treatment of individual examples of diseases.
At that period it is impossible that he could recognise the
facts and features of disease with sufficient clearness to enable
him to express in words the ideas conveyed by them. From
the very commencement, however, he might with advantage
apply himself to the medical education, so to speak, of his special
senses. Let him endeavour to make himself familiar with the
general aspect of disease, and with the peculiar appearance
which almost every malady stamps, more or less clearly, on
its victim, that which is called the physiognomy of disease.
Let him also educate [the sense of touch by manipulating
whenever it is'possible^and by all means let him take every
opportunity of using the stethoscope, or applying the ear
directly to the parts where sounds may be heard. And let me
warn all of youjagainstthe too common mistake among students
of using the senses only when you are told that some abnor¬
mal condition is present. You must be familiar with the
normal state of parts before you can rccoguise any departure
from that state. Endeavour to understand and appreciate, as
far as possible, every thing you hear, or see, or feel. “ A mere
passive reception,” writes my friend and respected colleague,
Dr. Geoghcgan, “of the teaching of others, however gifted,
cannot for a moment supply the place of that personal obser¬
vation—that habit of thinkiug and reading for yourselves,
which is iu no profession more important thart in our own.
Depend upon it the best part of everyone’s knowledge is that
which he has acquired for himself, and which he can but in a
limited degree communicate to others. Labour, therefore, to
make knowledge your own , by your own txertiom. Whilst,
therefore it shall be our earnest efforts to afford you practical
information by brief disquisitions on tho cases, we are far in¬
deed from desiring to place your minds in that neutral and
inactive state, in which your memory is almost the only
faculty exercised. We wish, in our teachings, to lead you by
vigorous mental efforts to teach yourselves. We want to in¬
struct you ; but not as a late eminent hospital surgeon of our
city used quaintly to express it—to spoonfeed you.”
In your records and notes cultivate clearness, terseness, and
defiuitiveness of language. Take every opportunity to ascer¬
tain the exact meaning of terms, and endeavour to annex
precise and steady ideas to your words. Till this object be
accomplished you will always have before you one of the great
difficulties which retards all metaphysical and moral enquiries.
You must be careful also not to allow your mind to receive a
bias from preconceived notions as to the nature of the case
before you. Take no one’s word for anything as long as you
can examine for yourself. Use all your senses and faculties to
verify or to correct tho conclusions of others; and take
nothing lor granted. This is essential if you wish to secure
success. What was it that iu a great measure added such
lustre to the philosophy of Newton, and helped to raise him
to such pre-eminence among the great men of the earth, but
the simple fact that ho took nothing for granted when en¬
deavouring to establish a conclusion—ho accepted uothiug
without evidence, though it had the authority of antiquity,
and the patronage of philosophy ; while at the same time he
admitted everything that had demonstration on its side,
though fashion scowled uponit, mid though it threatened to
cruelly break up the beauteous speculations of former days.
Be careful also not to confound collateral phenomena with
the disease itself. By nnsoundness in this respect typhoid
fever was once supposed, by the French physicians, to be caused
by ulceration of tho lower part of the ileum—a mistake which
led to a sad failure in their treatment of the disease ; ami
inflammation of the membranes of the brain and spinal chord
was so generally thought to be the essence of that terrible
epidemic, which was so lately amongst us, sometimes called
the Black Death, that the disease took a variety of names from
the circumstance.
We must over be watchful to avoid warping or colouring
facts. If ever we suspect ourselves to bo aoiug so it behoves
us to bend downward the cold eye of reason, aud dispas¬
sionately examine our frame of mind at the time, aud take
asunder each step of tho process by which wc arrived at the
conclusion. Our judgment is frequently led astray by some
time-honoured prejudice, or some seductive theory of our own
formation, till the mind, by constantly dwelling on its own
desire to preserve the prejudice or theory, unconsciously
creates a chimerical fact to satisfy its craving—“quodvolu-
mus id lacile. credimus.” To be aware of our proneuess to
yield to this subtle temptation is the first step to be gained
in combating its inroads ; and this we must do with a strong
hand. Let the knowledge of this frailty of our nature also
induce us to listen to the opinion of other men with more for¬
bearance than we are wont to do, aud to view them with the
clear, calm eye of toleration, and to weigh them well in the
balance of reason; ever remembering that we are just as
fallible as they, and that if we have reason and experieuce on
our side, so perhaps have they. Another pit-fall into which
we must throw the clear light of reason, in order that we may
avoid it, is the fact, too often lost sight of, that ours is not one
of the exact sciences ; and that in nearly all our clinical in¬
vestigations our deductions must be drawn from evidence
which consists of probabilities. That though such evidence
admits of degrees, ranging from the lowest presumption up
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INTRODUCTORY ADDRESS.
November 11,1868. 407
to the very highest moral certainty, still, it is merely
probable evidence, and as such prove* nothing. Demonstrative
evidence, which of course is conclusive, comes comparatively
seldom to our aid, in elucidating questions in the purely
medical wards. Its assistance is more frequently experienced,
however, in the surgical wards, and in the mortuary, but even
in these departments it is very often withheld. Let us
always keep these considerations beforo us, and, though an
accumulation of stroug probabilities may amount to a proof,
we must be cautious how we set down as demonstrated those
conclusions which are only drawn from probable evidence.
Let us, on the same grounds also, endeavour to avoid that
dogmatism and confident assertion which is so often the supple¬
ment of ignorance, and which is so much at variance with the
very conception of enlightened philosophy. Apropos to this
subject I will quote a passage from an introductory address
delivered here three years ago by my esteemed friend and
colleague Dr. Beatty. After referring to the instability of the
materials with which we have to deal, he says :—“ This want
of exactuess in medicine is a chief reason why wo sometimes
find men of highly educated minds prone to run after and
adopt the vilest quackery. They have been accustomed to
deal with, and exercise their minds upon, the exact sciences.
They are accustomed to look for and to find accuracy as the
result of their investigations ; and they expect that the pro¬
fessor of medicine shall predict every change in the course of a
disease, and its final termination, with the accuracy with which
an astronomer foretells an eclipse of the sun ; and that lie shall
adopt means to carry them over their difficulties with the
same certainty as an engineer lays a lattice bridge to carry a
railway-train over a raviue. Now the true physical! or surgeon
promises nothing positively. He says, 1 know what I have
to deal with ; I have spent my life in the investigation of man,
in health and in disease ; I have assisted my powers of obser¬
vation by studying the works of the masters that have
gone before me, or aro my contemporaries; 1 have derived
the benefit of their experience, and compared it with my
own ; and as far as the accumulated knowledge of years,
sifted and purified by passing through the filter of
modern experience, can make me competent, I am willing
to do my best to relievo you. Anyone who goes beyond that
in promising to cure disease is nothing but a charlatan. We
do not profess unerring success ; and hence the class of per¬
sons to whom I have alluded, unable to comprehend the
reasons for such caution, fly in disgust, and throw thpmselves
into the arms and into the power of some of tho numerous
impostors, whose chief bait, to catch the learned as well as
the unlearned, consists in the falsehood and effrontery with
which they promise a certain cure. But, although the true
disciple of medicine abstains from tho dishonest boasting of
the unblushing quack, he kuows that tho resources of his
art are almost boundless, and that when used with skill and
ability, they are most frequently successful.’*
One of our most important, but most difficult objects in our
profession, as well as through life, is to seek truth , and to steer
clear of the sunken rocks of fallacy, while tracing its winding
and foggy channel. To do this with success, we must put
forth aJl our seamanship, and proceed cautiously. We must
take our soundings at every turn, and not be too hasty in con-
clnding that some tall outline, dimly seen through the mist,
is our haven, lest we presently strike it, and find ourselves
shipwrecked on the cliff of error. Wo must also keep before
ns the mutual relations and the comparative value of practico
and theory, lest we should fall into tho mistake of neglecting
or of giving undue importance to cither.
While never losing sight of the all-important fact which I
wish to impress, that the end of all our studies—the goal to
which all our efforts should tend, is to arrest or cure disease,
or to repair tho damages of accident, and to prolong life, we
roust acknowledge that theory is often subservient to this end,
and that it should not bo wholly disregarded even by the most
practical mau. A theory obtained by induction is especially
useful, for, by putting ns in possession of a few general facts,
it enables us to determine, by reasoning, what will be the re¬
sult of any supposed combination of them, and thus to com¬
prehend an infinite variety of particulars, which no memory,
However vigorous, would have been able to retain.”
But it is otherwise with tho class of theories called hypo¬
thetical. These arc numerous, and ever changing, in the ad¬
vancing sciences. They may be necessary agents to our
investigating questions in the mathematical or the physical
sciences, as they assist progress, among other ways, by sug¬
gesting experiment, and thus leading on to inductivo conclu¬
sions. And, as many of these physical sciences form parts of
the foundations of therapeutics, many of the corresponding
hypothetical theories find their way into the latter. We may
indulge in them with safety if wo regard them merely as helps
to tho memory, and as interesting speculations, and even hail
them as indicating the vitality and progress of science, and as
being the foreshadows of coming discoveries ; but in actual
practice we must be cautious how wo allow these hypotheses
to influence our conduct, since from their very nature they
are too apt to lead us into error in judging of cases which
have not previously come within our own experience, and to
distract the attention from the one grand object—viz., to cure
our patient. The theorist lm3 an advantage over the purely
practical man in difficult ami uncommon situations—in deal¬
ing with new and untried combinations- of circumstances, and
is far more likely to enrich our art by new inventions, and 'to
elevate it by substituting rationalism for empiricism. But
there his superiority ceases. In matters of detail he is quite
at a loss, for as “all the elements of practical skill are to be
acquired only by habits of active exertion, and by familiar ac¬
quaintance with real occurrences,” so it is in the actual scenes
of the sick-room alone, and amidst the details of bed-side
management, that wo can learn to treat disease. “ Expert
men,” says Lord Bacon, “ can execute and judge of parti¬
culars one by one ; but the general counsels, the plots, and
the marshalling of affairs, come best from those that are
learned.”
In laying before you, Gentlemen, these few observations,
no one is more painfully aware of their many imperfections
than myself; yet do I incur, without hesitation, the risk of
adverse criticism, since, in common with my colleagues, I
have your best interests at heart. I have coupled myself with
you, for wo are all, from tho youngest to the oldest, fellow-
students, aud fellow-labourers in the same vinoyard. Somn
have laboured longer than others, and have borne the burden
and heat of the day, but all are far from the goal of perfec¬
tion. Let each of us work with a concentration of energy—
with a steadiness aud earnestness of purpose, that we may daily
attain a nearer approach to that goal. At a time like the pre¬
sent, when the glories of England’s might are still ringing in
the ears of the nations, let us prove that “peace hath her
victories, no less renowned than war.” To do this, wo must
ever recognise the modesty of true science, aud, while “the
flippancy of a few superficial acquirements is enough to place
a philosopher of tho day on tho pedestal of his fancied eleva¬
tion, and to vest him with an assumed lordship over the whole
domain of natural and revealed knowledge,” let ours rather be
the philosophy of Newton, that prince of philosophers. Calm
in his high position among the great men of tho earth, and
unmoved amid the intoxicating draughts of his immortal dis¬
coveries, he was yet ever mindful of the margin which sepa¬
rates the region of evidence from the region of conjecture,
whiltj he sat at the book of nature in the humble attitude of
its pupil and its interpreter. He it was who said on his death¬
bed, with characteristic and sublime simplicity, “I do not
know what 1 may appear to the world ; but to myself I seem
to have been ouly like a child playing on the sea-shore, and
diverting myself in now and then finding a smoother pebble
or a prettier shell than ordinary, whilst tho great ocean of
truth lay all undiscovered before me.” Lot us, however, take
courage, Gentlemen, and venture boldly, but with caution, be¬
yond the shore, into this undiscovered ocean of truth, armed
with the weapons of integrity, and guided by the compass of
experience and philosophy, linked with revelation. Let not
the drowsy wavo of ajmthy creep through our sluggish veins,
but, in the words ascribed to the wily King of Ithaca of old,
let us “ push off, and sitting well in order, smite the sound¬
ing furrows.”
Let it never be said of us—
“ Our sails flap idly when our busy prow
Should grate the golden isles ; ”
but let our pass-word ever be, onward , and our motto Haud
ignara i umli , miser is succurrere disco. We must ever bo mind¬
ful of the true dignity and high elevation of our mission. It
is one of toil anil weary anxiety, yet it will cultivate to the
highest pitch some of the noblest principles of our nature. It
will be necessary that a high moral tone be thrown over uu-
daunted courage, indomitable perseverance, a patient temper,
a feeling heart, and a never-tiring benevolence. “Picture to
yourselves the medical practitioner in the full tide of his pro¬
fessional career—what a stormy, anxious, unrest it is ; what
exorbitant exactions are made upon his resources ; what exag-
e
408 The Medical Press and Circular.
ORIGINAL COMMUNICATIONS.
November 11,18».
gerated expectations are formed of his powers ; what unthink¬
ing demands are made upon his time, and upon his vital
energies. By day and by night, for rich and for poor, with or
without recompense, he must obey the summons of suffering
humanity. He must be ever ready to encounter accidents,
diseases, and death in all their most appalling forms. When
friends are paralysed with fear, and when contagion carries
panic to the stoutest heart, he must be there, calm and un¬
moved. Life ninv be ebbing fast through the bleeding artery ;
the bl inched mother may be fluttering out her own life at the
moment when she has given birth to another ; the victim of
cholera may present all the most hideous features of death,
whilst yet writhing in vital agouy; delirium, tetanus, or hy¬
drophobia, may compress the energies of a whole life into a
few brief racking hours, and still he must be there to gaze on
sufferings which he cannot always relieve, and to feel that
science is often impotent, and humbled in the presence of
busy death. Yet, amid all this, he has occasional gleams of
sunshine; he knows that his welcome footstep and his kind
voice bring comfort to many an anxious sufferer ; a smile
awaits him in the hall of the wealthy, and in the lowly cottage
of the poor; and the story of his disinterested, self-deny¬
ing life and labours is written on many a grateful heart.”
Comparing our profession with others, few will dispute the
pre-eminence of divinity—its intcresls are eternal, and its
source is God ; but after that I yield the palm to none. Other
professions and callings are honourable and indispensable,
forming necessary limbs and features in the colossal statue of
life ; but what so elevating—so ennobling to man ns that
which has to deal with the image of his Maker?
“ Glorious is our aim—to case the labouring heart,
To war with death, and stop the flying dart,
To trace the source whence the fierce contest grow,
And life’s short lease on easier terms renew :
To calm the frenzy of the burning brain,
To heal the tortures of imploring pain ;
Or, when more powerful ills all efforts bravo,
To ease the victim no device can save,
And smooth the stormy passage to the grave.”
-♦- -
drighial CummurirHtitfiTS.
FRACTURE OF BOTH BONES OF
tHE LEG IN TWO PLACES, AND THE LEG RE¬
FRACTURED AFTER ELEVEN WEEKS AT
THE LOWER BREAK-RECOVERY.
Bt FRANCIS McEVOY, L.K.Q.C.P.I., L.M., M.It.C.S.E.
Medica Officer, Balbriggan Dispensary ; burgeon an 1 Agent
to th * Co istgna.d. li.albri.rgan, and N’a my Water,
Surgeon Factories, B.ilbrigg in, &c.,
Monsieur B., a young French gentleman, 22 years
of age, somewhat lymphatic, and remarkably handsome,
with all the animation and gaiety of his nation, was paying a
visit at G-Castle, when he was induced to mount a
pony which he was to have ridden next day at the meet of
that celebrated pack, “The South Fox Hounds,” was
thrown off, and fractured his leg in two places. How it
occurred never could be satisfactorily accounted for.
When I saw him, about two hours afterwards, he was
lying on a door upstairs in G-Castle, as Lord and Lady
G-, with their usual kindness and hospitality, would
not hear of his removal thence. At the first glance it was
easy to see that the leg was fractured, both bones in two
places—first, three inches above the ankle, and again, at
the junction of the upper and middle third—enormously
swollen, and having a livid mark where the tibia was
within an ace of prbtruding through the skin, which it
would have done were it not for the presence of mind of
a lady who was present when the accident occurred, ran
up and put the leg straight, which before was bent at right
angles, and, in fact, set it. I merely put it up in a modi¬
fication of the Liston and Houston splint, as I term them,
with a bandage rour d the in tap and ankle, and a large
silk handkerchief at the groin, to make counter extension,
without either bandaging the leg or the splints to the leg
but merely securing them witli three straps and buckles.
Applied cold lotion until the inflammation and swelling
had partly subsided, which they did in two or three days.
I then applied a many-tailed bandage to the leg and splint*
as before, again making gentle counter extension.
He suffered much the night of the accident, and, indeed,
for the three or four succeeding ones, more from restless¬
ness and nervousness than from twitchings, starting, and
cramps. The former gradually subsided, and in fifty-six
days he was up on crutches.
He left G-Castle on the 7th of March, and went to
Stedalt, where he had been staying previous to the acci¬
dent. In from ten to fifteen days he had thrown by bis
crutches, and was able to walk with a stick and drive in &
phaeton.
The same hounds again met at G-Castle. He drove
out to see them, taking one of the farm horses, on account
of its steadiness. The horse shied, and he pulled pretty
strongly in the opposite direction, when he became aware
that his leg was again fractured. He and his friend, Mr.
Walsh, who was with him at the time, both assert that hi*
foot never touched the bottom of the carriage, so that it
must have been broken by muscular contraction.
Fortunately my friend, Dr. John Adrien, was out that
day, w'ho had him conveyed home, and immediately set the
leg; and, its he had no pads, improvised two very good
ones until I came with others. We thought it a pity to
disturb the leg to put them on, it was so very well set, and
looked and felt so comfortable. Still, at Monsieur B/s
express wish, we did so, as he thought they looked better.
A Frenchman never forgets to look his best, under the
most trying circumstances.
He progressed favourably from this time forward, with¬
out any untoward event to retard his recovery, nor did hi*
general health suffer in the least by the long confinement
and annoyance consequent on the second break.
lbmarks. —I prefer, and now always use, a modification
of that accomplished surgeon, the late Mr. Houston’s
splints, which, in my mind, have one fault, and that is,
that the external splint is too short for the purpose of
making sufficient counter extension. I therefore hare
adopted Liston’s long splint with Houston’s short one, con¬
nect ing the two splints at bottom with calico to support
the limb, and straps and buckles to confine it. (
Houston’s fracture apparatus.)
My friend, Mr. Porter, in a very able paper which he
has written lately on Colliss fracture, has adopted strap*
and buckles in place of bandages.
In fractures of tibia and fibula, as well as femur, I would
recommend this apparatus, especially in country practice,
where the surgeon lives at a distance from his patient, who
may be of a nervous, irritable temperament, that nothing
will keep quiet or prevent from throwing himself about.
I have frequently been sent for at night to re-arrange
short splints and double inclined plains, which I had left
quite nicely two or three hours previously, until I adopted
the (if I may so call them) Liston and Houston splints,
minus the mummy-like bandages, more particularly of
Liston.
I never use one (at all events, as long as there is the
least tendency to inflammation or swelling), as I do not
see the utility of bandaging a fractured limb; on the con¬
trary, consider it useless, injurious, and filthy.
Firstly. Because a bandage cannot (in ray mind) by pos¬
sibility tend to support a fractured limb; and, I opine,
that in surgery' any appliance that is doubtful, and not *
positive benefit, becomes useless, may be injurious, and had
better be done without.
Secondly. Does it rot appear absurdly ridiculous to
apply damp, cold cloths to keep a limb cool, and, at the
same time, to envelope it in a bandage and do quite the
reverse?
Thirdly. If you make allowance for inflammation, swell¬
ing of the limb, shrinking of the bandage, and afterwards
shrinking of the limb from decrease of inflammation and
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hospital reports.
November 11, 1£C8. 409
swelling, of what possible use can it be? At your next
visit you will find it tossed, ropy, awry, and uncomfortable,
from the cold damp cloths which you were obliged to
apply to reduce the excessive inflammation to that healthy
standard that nature requires, and you will have to re¬
arrange it to the great annoyance and discomfort of the
patient.
Fourthly. No matter how long the bandage may be
applied, or how experienced the surgeon, remove it after
a period of twenty-four hours, and jou can trace each fold
of the bandage on the skin.
Fifthly. It also often retards the circulation, and pre¬
vents the consequent reparative inflammation that nature
sets up to mend the injury done.
Sixthly. What surgeon has not seen (at some time of
life) the most direful consequences resulting from bandag¬
ing? I myself have seen the loss of two extremities, an
upper and a lower.
Seventhly. Do yon not also find that they often produce
intolerable itching from crumbs, dust, and more frequently
from insects? If there is one about the bed or room, it
most assuredly will get inside the bandage, and cause great
annoyance. Have you not often been entreated by the
patient to allow him to scratch or mb the limb with a
coarse towel ? Ay, and he rubs it with a will when he
gets permission.
Thus I have endeavoured to shew that bandaging a frac¬
tured limb is objectionable. Nor do I lay any claim to
originality, as the same idea has struck many surgeons to
whom I have spoken on the subject. The late Sir Philip
Crampton, one day shortly before his death, speaking of
bandaging, agreed that it was very little use, if any, in
fractures; but said he was too old to become a reformer,
and if he did not see any real good, he did not see much
harm in it, if properly applied.
If I can induce any hospital surgeon to try it, and give
the result of his experience, I shall have attained the ob¬
ject I had view.
HwsjjiM gUprfs.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. Beale, F.R.S.
(From notes by Dr. Tonge.)
ovaritis.
M. H., set. twenty-nine, needlewoman ; admitted
Januaiy 4 ; transferred to K.C. ward on January 21 ; in
hospital seventeen days ; much relieved. Married six
years. Catamenia every three weeks. Leucorrhoea five
months. Had scarlet fever seven months ago. Profuse
flooding at end of catamenial period six days ago. Since
then pain in lower part of abdomen, especially in region of
left ovary, beariug down pains, slight vaginal discharge,
painful and difficult micturition, vomiting, headache, con¬
stipation, tongue furred. Pulse 92.
Concium squills and ether ; calomel and opium ; on
January 9, sulphate of iron and sulphate of magnesia.
LEUCORRHCEA—TiENIA.
E. G., set. twenty-three, nursemaid ; admitted Feb¬
ruary 2.9 ; discharged March 19 ; in hospital nineteen
days ; recovery. Ulceration of os and ccroi uteri, yellow
leucorrhoeal discharge, and dysuria eighteen months.
Typhoid fever four months ago. Catamenia frequent and
profuse four months. Backache. Has had tapeworm
twelve months.
Chloric ether and sesquichloride of iron ; tepid hip
bath ; inj. communis.
AllENORRHCEA.
Mary G., set. twenty-eight, cook ; admitted June 10 ;
discharged June 25 ; in hospital fifteen days ; recovery.
Menorrhagia twelve months ago. Catamenia absent two
months. Anaemic. Bowels confined. Some pain in hy-
j pogastric and right iliac regions. Much phosphate in
urine.
DE1TTLITT.
Rebecca D., £f*t. twenty-one, servant ; admitted Oc¬
tober 27 ; discharged November 2 ; in hospital six days ;
recovery. Weakness, following an attack of sore throat
fourteen days ago.
Quinine and dilute sulphuric acid.
A. G., set. forty, laundress ; admitted October 27 ; dis¬
charged November 12 ; in hospital sixteen days ; relieved.
Weakness following an attack of purging and vomiting,
with slight fever on day before admission. Diarrhoea
stopped next day.
Carbonate of ammonia, chloric ether, and liq. ammon.
acetatis (six days). Then quinine and dilute sulphuric
acid. Aperients.
Jane G., a?t. seventeen, servant; admitted April 29 ;
discharged May 4 ; in hospital five days; recovery. Previous
illness one week, with pain in limbs, nausea, constipation,
and headache.
James D., set. forty, cabman; admitted January 16;
discharged February 6; in hospital twenty-one days ;
much improved. Five years ago gradually lost power in
limbs after a catarrh. Well in five months. Six weeks
ago got wet. Then shivering and shooting pains and
gradual loss of power in limbs. On admission general
weakness, staggers when walking, muscles small and flabby,
dimness of sight, and buzzing in ears. Pulse 60.
Sesquichloride of iron and dilute muriatic acid (nine
days). Then same with quinine.
H. S., set. forty-seven, labourer; admitted February 4 ;
discharged March 5 ; in hospital thirty days ; relieved.
Very frequent micturition six years. Subject to asthma
two years. Appetite bad one year. A few small waxy
and granular casts in urine, which is otherwise healthy.
Bicarbonate of potass and henbane. Afterwards
assnfeetida, ammon io-citrate of iron and tincture of valerian.
Cold shower baths.
Sarah P., set. fifty, married ; admitted August 13 ; dis¬
charged August 31 ; in hospital eighteen days ; relieved.
Loss of power in left leg fourteen years. Pain in left side.
Headache. Sleeps badly.
Quinine and dilate sulphuric acid.
W. J., ict. eighteen, mathematical instrument maker;
admitted March 1 ; discharged March 5 ; in hospital four
days ; relieved. More cough and weakness since dis¬
charge, on February 24. Inspiratory click over right
scapular and supra-clavicular regions.
Quinine and dilute sulphuric acid.
D. C., ret. 27, housemaid ; admitted April 7 ; discharged
April 23 ; in hospital sixteen days ; much relieved. Pro¬
bably phthisical.
Aromatic spirits of ammonia, chloric ether, and decoction
of bark (eight days). Tiien dilute muriatic acid and
quassia.
DROWNING.
Ellen B., net. 17, married; admitted November 15; dis
charged November 15 ; in hospital 1 day; recovery. Fell
into Thames—did not lose consciousness completely.
POISONING BY OPIUM.—DELIRIUM TREMENS.
P. I)e C., cet. 38, discharged soldier ; admitted August
12; discharged August 17 ; in hospital five days ; recovery.
Delirium tremens nine years ago. During last week has
drunk freely, has taken fl\xl of laudanum every night,
and has smoked opium occasionally ; took three-quarters
of an ounce of laudanum in some gin half-an-hour before
admission. Had had an emetic and vomited freely before
admission. When brought in usual symptoms of slight
poisoning by opium and alcohol. Spectra during night,
rational next day.
Stomach pump, emetics, cold effusion, &c.; then aromatic
spirits of ammonia and chloric ether.
OPIUM EATING.—DELIRIUM TREMENS.
P. De C., set. 39, discharged soldier; admitted November
18; discharged November 23 ; in hospital five days ; re¬
covery. Very drunk all last week, and has swallowed and
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410 The Medical Press and Circular.
HOSPITAL REPORTS.
November ll, 180;
smoked u good deal of opium. On admission excited and
tremulous, tongue furred, skin moist, pupils slightly con¬
tracted, sees “a lot of little fellows” around him ; pulse
90. Next morning lost his voice suddenly, but recovered
it in a few days.
Aromatic spirits of ammonia and chloric ether ; brandy
four ounces, stout three pints. On November 20, tr. opii,
n\xxx; on November 22 quinine, dilute muriatic acid,and
brandy.
POISONING BY PARAFFIN OIL.
Mary B., tet. 48 ; admitted May 8; discharged May 9;
in hospital one day ; recovery.
IRRITANT POISONING.
H. T., *t. 23, militiaman; admitted May 4; discharged
May 5 ; in hospital one day ; recovery. On evening of
admission while tipsy took by mistake about £ij. of a
liquid used for cleaning brass buttons ; immediately felt a
burning taste in mouth and throat, and then had much
retching; had milk and chalk before admission. Next day
well with the exception of slight pain in throat.
Stomach washed out with lime water ; ipecac, emetic ;
castor oil.
WESTMORELAND LOCK HOSPITAL.
Suppuration of the Inguinal Glands Simulating
THE “BUBON D’EmBLEE,” WITH UTERINE PRIMARY
Sore.
Under the care of Mr. Morgan,
Professor of Anatomy, R.C.S.l. ; Surgeon to the Hospital, ami to
Mercer’s Hospital.
The subject of this case was a patient of unusually robust
aspect and apparently in most healthy condition. The
following is her history.
M. R. (ward No. 1, bed No. 9) admitted September 22,
three and a-half years unvirtuous. Was treated three years
ago in hospital for eruption ; since then has had no secon¬
dary affection whatever. On the 3rd of September, 18(38,
she felt pain and swelling of the glands in both groins, but
especially in the right. These became soon more tender,
and one went on to suppuration in ten days, and opened
spontaneously.
The glands on both sides now are enlarged and tolerably
dense, on the right, side, and one situated above Pou-
rt’s ligament had gone on to suppuration, another
low it presents a granulating surface about the size of a
florin.
On speculum examination, a well marked defined ulcer,
the size of a split pea, with reddish surface and indented
edge was found close to the os uteri ; there was very slight
vaginal discharge, no other ulceration or abrasion of the
mucous tract, but the ulcer presented all the appearances of
that in the previous case.
The bubo was opened, and after a few days both dressed
with equal parts of ung. iodidi plumbi, and ung. resinae,
ten grains of iodide of potassium in bitter infusion, given
every six hours. The uterine ulcer was freely cauterized
with nitrate of silver, and again at four successive periods,
when it healed by gradual closing in from the edge.
No secondary or other signs of contamination are pre¬
sent, and the patient is now apparently in perfect health
and discharged November 2nd, 1868.
These cases, if not examined by the speculum, might
have been assumed to be instances of the “bubon
d’embl£e, the bubo forming as the primary lesion without
any local ulceration or sign whatever externally, and froiQ
the insensibility of the internal parts, the patients them¬
selves were of course wholly ignorant of the existence of
any sore; they illustrate well the remark of Ricord—“ Que
d'erreurs commettent encore ceux qui Different baser leur
science sur des histoirts racont4es par les malades, plutot
que d’aller chercher la v4rit4 un peu plus profond4ment.”
Since the occurrence of these cases, I have examined
one with my colleague, Dr. McDowell, of a young married
woman, apparently in perfect health and condition, who
was admitted under his care, suffering from an enlarged
and tender group of glands in the right groin, threatening
to run into suppuration, and a few enlarged on the left
side. On speculum examination, a well-marked ulcer was
found situated close to the os uteri, red in colour, furnished
with slight secretion, and representing all the characters
seen in the preceding instances.
-♦-
MEDICAL BOARD.
With a view to the removal of misapprehension in regard
to the signification of the term “ Medical Board," which is at
present understood in a different sense by military and medi¬
cal authorities, the following rules, which have received the
sanction of Government, art published for general information
and guidance :—Indian medical officers are not in future to be
nominated members of any boards, except such as are purely
professional or departmental. Professional boards to be con¬
sidered all “ medical boards on officers or soldiers.” Sanitary
hoards, when matters influencing, or likely to influence, the
health of tho troops or community arc concerned, aud on
which a medical opinion only is required. Boards for exami¬
nation of candidates for admission into the subordinate
medical department Departmental boards mean boards on
medicines and surgical equipment.
Such boards to be composed of medical officers exclusively,
and to consist of a president and two members, under all cir¬
cumstances.
Boards of survey on hospital bedding, clothing, and uten¬
sils, on hospital diets and wines, although considered depart¬
mental, may, however, bo composed of medical aud military
officers indifferently.
Boards to examine as to the fitness or otherwise of soldiers
for rc-engagement are purely ** professional.” At stations
where there are two or more regiments, these boards should
be presided over by a medical officer of a regiment other than
that to which the soldier belongs. If, however, there be only
one regiment at tho station, tho medical officers of tho regi¬
ment should of themselves constitute a board, sign the re-en-
gngement certificate, and should, besides, furnish to the
commanding officer a written statement detailing their opinion
as to the man’s health, muscular development, age, Ac., and,
in case of rejection, a full explanation of their reasons; aud
this statement they should all sign, and attach to the rc en¬
gagement form.
Boards of survey on barrack funiiture, soldiers’ ration*, and
canteen supplies, should be composed of military officers ex¬
clusively ; $nd, if tho opinion of a medical officer be required,
one should be detailed to attend the board (regimentally or
from the brigade office, who will give his opinion either nVd
vocc or in writing); this opinion, if in writing, to be attached
to the proceedings of tho board.
The only exception to these rules to be in the case of can¬
tonment committees, at which the principal medical officers
of the British and Indian forces will attend as members.
These rules will not affect tho composition of special saui-
tary committees appointed by Government or the Commander-
in-Chief.— Army and Navy Gazette.
-♦-
Drainage in the Metropolis. —It is important to pro¬
perty owners to know that counsel’s opinion has been given
this week to the effect that the Board of Works is not em¬
powered to drain streets, and charge the property owners with
the costs, but tho owners arc bound to construct the necessary
drains in accordance with the requirements of the board.—
South London Press.
Tiie Sick Poor of East London. —The Poplar and
Stepney Sick Asylum Board, appointed under the recent Act
of Parliament, are about to erect a hospital at Bromlet,
Middlesex, for the accommodation of about 600 of the si«,
bodridden, and infirm of the Poplar and Stepucy Unions. The
whole of the poor-law institutions of the East cf London arc
undergoing complete revision, and the workhouses of the t*o
unions just mentioned will in future bo used only for the
reception of able-bodied paupers. The cost of the erection is
estimated at £58,000. It is satisfactory to fiud that the
recent legislative enactments are being so promptly and
efficiently acted upon by the Poor-law Board, and the boards
acting under them,
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November 11,1888. 411
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Annual Subscription, post free f Ten Dollars.
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“SALUS POPULI SUPBEMA LEX.”
WEDNESDAY, NOVEMBER 11 ? 1863.
-*-
REFORM OF THE MEDICAL COUNCIL.
This question is undoubtedly advancing, and difficult
as every change must be, wc may fairly congratulate
the profession on tlie prospect before it. We have
given so much attention to the schemes of reform
that have been proposed, that our readers must be well
acquainted with them. What has been inaptly termed
the indirect method is the simplest plan, and the one
that will be first carried, inasmuch as it needs no Act of
Parliament, and can only excite opposition on the part of
interested corporations, and these bodies must themselves
consent to be reformers of their own constitution, or they
will inevitably perish from want of harmony with the
age. We are able to state, further, that several candidates
for Parliamentary seats, including some of the leaders of
the Liberal party, have accepted that plan as by far the
best, while, if carried out, it by no means precludes
further modifications.
A manifesto to the members of the British Medical 1
Association and profession, with the signatures of Dr.
Sibson, Dr. Wat el's, and Dr. Watkin Williams, has been
sent to us for notice since our last, urging the direct re¬
presentation of the profession in the Council. The gen¬
tlemen named think that representatives selected by the
immediate suffrages of the registered members of the pro¬
fession should be added to the extent of one-fourth of the
total members.
We have on several occasions criticised this proposal,
and pointed out the difficulties of effecting it. It is near
akin to that so ably advocated by Dr. Andrew Wood last
session, and the still larger measure proposed since then
by Mr. Walter Rivington. We are by no means squeamish
as to the increase in the number of the Council. For real
work it has been found small enough, and the question of j
expense is, perhaps, not incapable of solution. The corpo¬
rations might fairly be asked to pay their own members;
whether the Crown would consent to do so is extremely
doubtful, but the Government members are not numerous.
If the profession is to be saddled with the whole cost, Dr.
Andrew Wood’s magnanimous solution would have to be
| candidly considered, though it would fall heaviest on
members from a distance, who must even now be heavy
! losers so far as mere money is concerned. The great ob¬
jection to the plan, and one which in the present aspect
of public affairs is insurmountable, is, that an Act of
| Parliament is required. Public men know well enough
that there is no chance of such an Act being shortly ob¬
tained, especially as the Council would oppose rather
i than aid it. True, the Council is not very powerful, but
j it may be far more easy to obstruct than to promote a
I change. The Council has tried to get an amendment of
the Medical Act, and has egregiously failed again and
again. Load such an Act with additional impediments
like these, in a time of political excitement such as all
are looking forward to, and who can hope for a hearing i
We say advisedly no sane person conversant with these
things can expect it. The one sufficient reply will be—
“ You have it in your power to effect a reform; let your
corporations extend their franchises, so that you may re¬
present truly your profession, and then if a real repre¬
sentative Council wants more come and say so.”
We say that such a reply as this would he just, and we
therefore urge once more, in the face of this new circular,
that the gentlemen who signed it have not done justice to
the counter-plan, which commended itself to many, and
would very possibly lead in the end to the solution at
which they aim. Wc state, without fear of contradiction,
that they advance no argument that does not equally
apply to the more simple plan, and that lias not been
used to support it. They tell us nothing that has not
been repeatedly stated by various medical journalists.
The one point of the circular is that it asks for what is
confessedly difficult to obtain, while it forgets the substi¬
tute which would be very easy if the present Councillors
! are worthy individually of the credit it give*. We believe
they are thus worthy, and therefore we ask them once
more to try what they are competent to inaugurate.
Let the Council pass a resolution that the corporations
ought to extend their franchises, and these bodies would
find it impossible to hold out for any length of time. By
doing so they will give an earnest of their good intentions,
aud lay a claim to the respect of the profession.
It should be clearly understood that the retirement of
Dr. Prosser James from the coutest for a seat in Parlia¬
ment in no way affects his proposal, except that it secures
the return of a member who approves the scheme. At
least half a dozen who thoroughly endorse it are, we be¬
lieve, safe for a seat. Besides, this plan was not started
during the contest. It is older than the Council itself,
and wc know that many politicians, on the passing of the
Act, thought it would necessarily be adopted. Some
bodies have to some extent acted in accordance with it.
Thus it is partially accomplished. Let the profession
but be united and the recalcitrant, selfish corporations
will find longer resistance useless, and so consent to en¬
large their boundaries.
CERTIFICATE SIGNATURES.
The Royal College of Surgeons of London have or¬
ganised and brought into operation the plan for simpli¬
fying the signature of certificates, which we informed our
readers was in contemplation this time last year. The
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NOTES ON CURRENT TOPICS.
November 11, 1868.
following letter has been forwarded to all recognised
medical schools and hospitals :—
u Royal College of Surgeons of England,
London, W.C., 19th October, 1868.
u Sir^—I am desired by the President to acquaint you,
that tho question adverted to in my letter of the 20th of
December last—viz., the desirability of simplifying, if
possible, the certificates produced by candidates for the
diplomas of this college without in any way vitiating their
authenticity and reliable character—has been brought
under the consideration of the Court of Examiners of this
college; and X am directed to inform you that tho Court,
having considered the several replies to my letter of the
20th of December last, and finding that a large majority
of the authorities of the recognised medical schools and
hospitals are of opinion that the number of signatures
might be reduced, and that the duty of signing certifi¬
cates might he very properly confided to one, or m some
cases to two trustworthy officers appointed for the pur¬
pose, resolved in future to receive certificates so signed
from those medical schools who have appointed the neces¬
sary officer or officers.
‘‘I am therefore to enclose an amended form of schedule
which has been approved by the Court, and which, while
it is adapted for the individual signatures of the surgical
teachers of the medical schools and hospitals, has been
framed with a view to carry out the desired simplification
of certificates, and thus to obviate the inconvenience
hitherto occasioned both to teachers and students by the
multiplicity of signatures.
“ I am, at the same time, to request that you will fur¬
nish me with the names of the officer or officers to whom
the duty of signing certificates shall have been delegated
by the authorities of your school.
“ I am, Sir, your obedient servant,
u Edward Trimmer, Secretary.
w To the Dean or Secretary of the
Medical School of City of
Dublin Hospital) Dublin,”
This communication is accompanied by an amended
schedule, in which the dates of study of each subject and
of the passing of all examinations is Bet forth, with a
signature column for the attestation either of individual
professors or of oue person appointed for the purpose, in
accordance with the suggestion of the college.
When this proposal was first noticed in our columns,
we commented on it, and pointed out its obvious ten¬
dency to make certificates of attendance even less reliable
or truthful than they are at present. Although every one
admit* and deplores the existing abuses of the certificate
system, still we think that if their falsification has be¬
come so universal as to make the individual written testi¬
mony of teacliers as to the diligence of students totally
valueless, it is time that licensing bodies, instead of
offering facilities for perpetuating the system, should
sweep it away altogether. We do not believe that mat¬
ters have yet arrived at the point when teachers are
wholly careless as to whether they attach their signature
to a falsehood or the truth.
If, however, one person is to be permitted to testify
in globo to diligent attendance of which he has no per¬
sonal knowledge whatever—if teachers are allowed to
salve their consciences by transferring the responsibility
of untruthful testimony from themselves—it appears to us
that the system may more honestly, and with more ad¬
vantage, be simplified by drawing the pen through all
regulations which require “ attendance,” and demanding
.nothing but a receipt for the payment of the fee. We
should be very sorry that this principle should be offici¬
ally countenanced by any licensing body.
We believe that lecturing is a most valuable means of
instruction, and we think it would be a more dignified
course for colleges to take in hand the greatly-needed
reform of professorial lecturing than to abandon the
system altogether, and degrade it to the level of a mere
farce.
-♦-
look's 0ii €mxm\ topics.
Royal College of Physicians of London.
We have already noticed the little measure of reform
that has been carried by Dr. C. J. B. William?. We do
not use the term “ little ” to detract from the credit of
Dr. Williams in accomplishing it. That gentleman him¬
self, by proposing larger measures, justifies o«r thu*
describing this. We are glad to get in the thin end of
the wedge, but only for the sake of driving it further;
and we hope all will support Dr. Williams and all others
who are willing to do justice. We are surprised at the
" much ado ” tliat has been made by what wc fear may
turn out to be next to nothing. We have heard Fdlom
remark that this measure will change nothing, that the
Council will always vote together, and that the majority
of Fellows will support the list of the Council. We hope
the majority may do no such thing, but we cannot but
feel that such a course is possible. We almost fear it is
probable.
Royal College of Surgeons of England.
Our readers must remember that at the last election
of councillors the right of Fellows to discuss in their
own hall was denied by the President and supported
by the college solicitor. We do not intend to describe
again the scene. Our present purpose is to inform oar
readers that the question is not likely to be suffered to
rest. The discontented Fellows talk of united action, and
we have been made confidants of a proposal to make
some effort to secure to the whole body of Fellows the
privilege which common sense points out they ought to
possess. We are glad to hear it, and we hope those who
mean to move will have the support of all their
brethren. Such a reform would double the value of
the Fellowship at once.
Nurses for the Sick Poor.
Wb were glad to see Dr. Sieveking’s letter in the
Times, but we cannot admire the fawning of the La***!
upon the Court physician. Had anyone who bad not
been a favourite with the clique that rules that weekly
repertory ventured to write to the Tim**, he might haw
been as feebly snubbed as some other worthy men have
been for the same act.
Charing Cross Hospital
Dr. Chowns is said by the periodical that has lately
impertinently offered him uncalled-for advice to have
resigned his chair in midwifery. “ It is true that he
followed an old custom n in continuing to hold the chair,
says the Lcmcet. Why then complain ? Who is to be
benefited by hurrying on his retirement ?
His testimonial is the efficient answer to all calumni*
Ovariotomy.
An Italian correspondent writes to us about the twelfth
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The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
November 11,1868.413
case performed in his country as a successful one at Pisa,
and asks us whether all English surgeons’are satisfied that
the operation is justifiable. Certainly ovariotomy is now
recognised in Great Britain. Some months ago we pub¬
lished the statistics of some our of first surgeons. Our cor¬
respondent is desirous of knowing Mr. Baker Brown’s
latest results. On enquiry, we have been informed that
out of his last fifty-eight completed cases he has only had
seven deaths. This success will surely settle the doubts of
any who still question the propriety of this operation.
Death from Chloroform.
At Wrexham a coroner’s inquest has shown that death
occurred from this agent, properly administered by a quali¬
fied man for an operation for fistula.
At Leicester, Mrs. Adams, thirty-three years of age, died
from the effects of chloroform given for the operation of ex¬
tracting the stumps of several teeth. The evidence at the
inquest showed that every precaution was used, her own
attendant and another medical man being present. The
jury found that deceased died from chloroform, “ in re¬
ference to which more than usual precaution had been
taken.” These cases show the dangers that exist even in
the hands of skilled persons. A forcible example of the
folly of those who are not qualified being entrusted with
such an agent is seen in the sad case of the Hon. and Rev.
Arthur Sugden, who died from taking chloroform by the
stomach in mistake. The deceased gentleman kept the
drug by him, and was in the habit of inhaling it sometimes
to relieve neuralgia, from which he suffered. On one
occasion he seems to have swallowed a large dose in mis¬
take for something more innocent. Tt appeared the late
gentleman had also “ a diseased heart ”—a fiict that would
render his inhaling chloroform more than usually hazardous,
and be an additional reason why he ought not to have been
entrusted with the drug.
The late Mr. Partridge, of Oolohester.
This gentleman was well known throughout Essex,
where he enjoyed the confidence of many of his profes¬
sional brethren, who frequently sought his opinion. He
served many years os Surgeon to the Colchester Hospital,
and was, a few years ago, made Consulting Surgeon. He
was a most successful operator, the capacity in which we
personally knew most of him. He became a Member of
the College of Surgeons in 1813, and an Honorary Fellow
in 1843. He died on the 24th nit.
The late Professor Qriesinger.
It seems but yesterday that we had to welcome the
English translation of this great physician’s work on
mental diseases, and we have now the melancholy duty of
recording his demise. He had achieved for himself a
reputation more than European, and in him Germany
loses one of her brightest examples of medical genius.
Dr. Wolfe.
Dr. J. R. Wolfe has had a great compliment paid to
him. His admirers in Aberdeen, where he has practised
as Ophthalmic Surgeon to the Infirmary for the last six
years, have presented him with a valuable time-piece and
elegant silver salver, “ in token of esteem on the occasion
of his leaving for Glasgow.” We ean only wish him an
equally prosperous and happy career in his new sphere.
The Mastership of the Rotundo Lying-in
Hospital, Dublin.
The Governors of this justly celebrated institution met
on Friday last, for the purpose of electing a master in the
room of Dr. Denham, whose term of occupancy has
just expired. The office is recognised as being the
highest obstetric appointment in Ireland. It is tenable
for seven years, and its average emoluments may be set
down at about <£1000 a-year, exclusive of the claim to the
public confidence which its occupancy confers. The master
is elected from amongst those who have, in years passed,
acted as assistant physician in the hospital. Dr. Denham
is succeeded in the office by Dr. George Johnston, a Fellow
of the King’s mid Queen’s College of Physicians, and joint
author, with Dr. Sinclair, of the well-known work on
Practical Midwifery.
Already the claims of candidates for succession to the
office seven years hence are actively canvassed, and we
understand that Dr. Lombe Atthill and Dr. Rutherford
Kirkpatrick will probably offer themselves to the governors
at the proper time. Dr. Atthill is a Fellow and Censor
of the King’s and Queen’s College of Physicians, and was
last year examiner in Midwifery in the Queen’s University.
Dr. Kirkpatrick is an M.B. of the University of Dublin,
and Fellow of the Royal College of Surgeons, and Medical
Officer to the North Dublin Union.
Sir Dominic Corrigan:
The learned medical baronet is certainly pressing his
qualifications upon the electors of the city of Dublin with
very commendable energy, and it is believed that, if not
certain of success, he may hope to ran a very close race
for the envied seat.
He has met his constituents several times since our
last, and has taken ground on the strongest Radical poli¬
tical programme.
We believe that Sir Dominic Corrigan has not received
from bis professional brethren in Dublin the support
which he anticipated. In the first place the omission of
any mention of his profession from his address, albeit the
omission was immediately made good by the special
address to liis brethren which appears in our advertising
columns, still was considered by many in the light of a
slight. Moreover, many of those who would most gladly
have thrown their whole vigour into the scale in support
of Sir Dominic Corrigan, could not, under the critical
political circumstances of the coming Parliamentary
session, feel it their duty to do so.
The efforts of those of his professional brethren who
agree with the learned baronet in his political views have,
however, been very hearty and vigorous, and he has
obtained the political and monetary support of many
influential Liberals in the profession. On Thursday last
the subscription list had reached £1,070, and further con¬
tributions were coming in.
Gresham Lectures.
By E. Symes Thompson, M.D., F.R.C.P.,
Gresham Professor of Medicine.
The lectures delivered in Gresham College this term
were upon Training the Body and the Mind, The Pro¬
fessor showed that for the preservation of health not only
were pure air and water, gi>od food, and sufficient sleep
needed (subjects to which previous lectures have been
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►SCOTLAND,
November 11, ises..
devoted), but that due exercise of body and mind is
essential likewise. The gradations of health short of
actual disease are great. Health being such a state of
system as will permit a man to do his appointed work
without impediment, a condition of health adequate of
success as a clerk or shopman is miserably insufficient for
a sailor or a colonist.
The appointed work of a man backed to fight or about to
run a race is very severe; and if his body is not to hinder
his task or his task injure his body, his standard of health
or “ condition’ must be very high. A1 though we may never
be called upon for such feats of strength, it is very desir¬
able that our condition should be such as to enable us to
perform exceptionable efforts without injury.
After alluding to the systems of training adopted by
the Greeks, Romans, and moderns, the superiority of
athletic exercises as a pastime and recreation over smoking
and dawdling—especially for those engaged in sedentary
occupations—was insisted on. It was shewn that great
mistakes were made by those who regarded rowing and
other exercises of the kind as detrimental to health.* In
University life the struggles on the Isis and the Cam play
their part, as well as those in the Senate House, in de¬
veloping the mau and preparing him for the struggles of
life. Physical education need not interfere, but ought to
aid in the moral and intellectual well being. All the
faculties of mind and body need cultivation. We must
aim at the “mens sana in cor pore sa no. n In this practical
age people want to see an object in everything, and care
only for that kind of knowledge or acquirement which
will pay in the battle of life. But it must not be for¬
gotten that technical, professional, or what the Germans
call brodwissenschaften (bread knowing or bread and butter
sciences), are not alone the object of education-
Obedience, industry, application, are at least as im¬
portant as an acquaintance with reading, writing, and
arithmetic. The cultivation of method, thoroughness^
the habit of sustained thought, to say nothing of the willy
formation of character and of conscience ,—these all need
care, and must not be left to chance influences. We are
too ready to look at the “ appeal to results/ as it is
termed, to examinations , as the one test of ability.
It is not well that subjects of study should be too
limited. Classics and mathematics are invaluable in
training to accurate observation and discrimination, but
so are the natural sciences. In a scientific age studies
should not be solely literary. Thinking, like rowing, can
only be learnt by practice, and that subject is best which
most stimulates thoughts. Contrast the avidity with
which boys throw their whole minds into physical science
with their languishing inefficiency at Greek and Latin,
and it is clear in which study perception, penetration,
grasp, and power are best drawn out. Growth is rapid
as well as sound ; accuracy, exactness, and acuteness the
very qualities most useful in the business of life, are thus
developed with far greater certainty than in literary work.
Botany, natural philosophy, and chemistry, may be
taken as the best subjeets for this scientific discipline.
The lecture concluded with a series of investigations—
analytical, synthetical, chemical, and electrical—into the
composition of water as illustrative of the value of ex¬
periment and observation in mental education.
Ooloniai Benefit Societies.
Onn Australian brethren appear to be agitating for an
increase of their fees for attending members of the
Foresters and other benefit societies. The members of
the Medico-Ethical Society having resolved not to attend
in cases of fracture, operations, &c., without extra charge,
a lengthy correspondence appears in the columns of the
Melbourne Arfjvj, from which it would seem there are
upwards of 30,000 adult male members of the several
benefit societies in the colonies.
Dr. Thorne Thorne has been w seut to Luton and
Dunstable to investigate their sanitary state.
We know a good deal of the straw-plait districts, and
we venture to predict that Dr. Thorne’s visit will he of
service.
Mr. A. Wall, lately pupil at the Royal Medical
College at Epsom, has won the Jeaffreson scholarship at
St. Bartholomew’s Hospital. It is worth £20 per annum,
and he can hold it for two years.
The President of the Poor-law Board has appointed
two barristers to be additional Poor-law inspectors. After
the proved necessity of appointing medical men to such
offices bow can this be accoimted for ? Is it the spas¬
modic act of a power that feels doomed ?
It lnts been suggested that as the names ot the barris¬
ters correspond so nearly with those of the President and
the permanent secretary, the event is only a gross piece
of nepotism. If so, we hope the attention of Parliament
will be called to the job.
The Dublin University Medico-Chirurgical Society will
hold the opening meeting of the session 1868-9 on Friday
evening, the 13th instant, in the dining-hall, Trinity
College. The chair will be taken at eight o’clock (college
time) by the President, the Regius Professor of Smgen*.
The opening address will be delivered by the Auditor,
W. E. Battersbv, B.A., Med. Sell,
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SCOTLAND.
Edinburgh, Wednesday, November 11th, 186S.
Tiie last number of the Scotch edition of the Medical
Press and Circular contained full information as to
the various movements that are interesting the profession
so much just now. This article need, therefore, only re¬
peat a portion of that information, and complete it by adding
later items. The meeting of the University Council was a
great success from many points of view, though some few
have complained to us of some incidents. Of course
the vote on the late Lord Brougham was carried with
proper deference, after which the great business of tbe
council was commenced by the election to
THE CHANCELLORSHIP.
P ROFE8SOR Douglas Maclagan made a first-rate speech
in proposing the Lord Justice General, and touched most
questions with unusual skill. He desired to divest the
election of politics. He was ably seconded by Mr. Phin.
Sir J. Y, Simpson proposed Mr. Gladstone in a speech
in which he set forth that right honourable gentleman’s
claims as greater than those of any local celebrity, and
thought it desirable to elect one who would honour the Uni¬
versity. Mr. Gladstone was seconded by Rev. Dr. Guthrie, in
one of his eloquent speeches. On a show of hands, the chair¬
man (Professor Chnstison) said he dare bet, if anything,
the majority was for the Lord Justice. This curious mode
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November 11, 1868. 415
of declaring having been smiled at and accepted, a poll was
demanded by Sir J. Y. Simpson, and at once granted. The
papers must be returned, as we stated hist week, by the
20th instant.
THE PARLIAMENTARY ELECTION.
Peopessou Playfair’s committee have circulated a
correspondence, which we print in another column, in
which Dr. Prosser James, finding that he can secure the
advocacy of the principles he sought to enforce, in order
not to divide his party, retires from the contest for this
and the sister University of St. Andrew’s. This step had
become necessary on the part of one of the Liberal candi¬
dates, for since Dr. Richardson withdrew the Conser¬
vatives had spared no effort, and it was common
talk in some of the clubs that if three went to the poll
Mr. fewinton would succeed. Negotiations were accordingly
opened, and were received by the medical candidate in the
most considerate spirit. His committee admitted the
statement made to be important, acknowledged they had
not so many written pledges as their opponents, and con¬
fessed extreme reluctance to risk the seat. Some of his
medical supporters were, however, anxious to contest the
election solely on medical grounds, and there was for
a time some danger. Eventually they left the whole
matter in the hands of their candidate, who, having con¬
sulted some eminent members of the Liberal partv, con¬
sented to waive his claims on condition that his medical
programme were accepted, and the rights of his professional
brethren received the support of his competitor. There¬
upon the formal correspondence published was commenced.
It is believed that he was much stronger than was supposed
by some, and that on a future occasion his committee will
again bring him forward. This time it is evident he was
too late in the field, as many of his most likely supporters
were previously pledged. Some of his committee express
themselves as gratified that his candidature has produced
more unequivocally liberal professions than would have
otherwise been made by Dr. Lyon Playfair. It is now
desirable that medical voters should throw their weight on
the Liberal side.
THE RECTORSHIP.
This contest has much interest. The students throw
their own life and energy into it. Some of the scenes and
sayings are willed ungentlemanly, but were not older and
more staid professors once excitable and ardent students ?
The telegram announcing that the Poet Laureate declined
to be nominated, was much regretted. Sir William Fer-
gusson’s name, as a representative of surgery, was popular
with a large number. Others protested against it, as they
thought Professor Syme sufficiently represented that art in
the University. It seems politics will not be excluded
from the contest.
LORD PROVOST.
Last week Sir J. Simpson headed a deputation, in
which Drs. Moir, Alex. Wood, Murray, Smith, Miller,
Husband, Burns, Grove, Place, and others took part, to ask
the Lord Provost to consent to be again nominated, so
that he might be in office to see the sanitary measures, in
which his lordship takes so much interest, completed. The
Lord Provost, in his reply, spoke in most flattering terms
of the intercourse he had had with the members of the
profession on various occasions.
MUSEUM OF SCIENCE AND ART.
This day week the introductory lecture of the second
session of the evening lectures to the industrial classes was
delivered in this Museum by Professor Allman. He was
warmly greeted on rising, and proceeded to say that he
was not about to instruct them in the practice of any of
those occupations to which, as working men, their iives
were devoted ; but to enlarge their minds by introducing
them into new departments of knowledge. The object of
his lecture was to describe the conditions of life of the
earths organized inhabitants—the distribution over the
earth’s surface of heat, light, and moisture—their influence
on the physiological actions of living beings—the laws of
geographical distribution of plants and animals, which he
illustrated in various ways. He was listened to with great
attention, and met with frequent applause by the large
audience.
MORAL PHILOSOPHY.
The newly appointed professor, Dr. Calderwood, de¬
livered his first lecture last Wednesday, in the chemistry
class-room. He was accompanied on entering by the new
Principal, Sir A. Grant, and many professors. It was
a most powerful address, in which the professor con¬
sidered moral philosophy as a science and a discipline.
THE PRINCIPALSHIP.
The above paragraph reminds us that on the 2nd
instant, at a crowded meeting of the Senatus Academicus,
Dr. Christison, senior professor, in the chair, Sir Alexander
Grant, Bart., D.C.L., was formally installed Principal of
the L T niversity of Edinburgh. Sir Alexander was intro¬
duced to the Senatus by the Deans of the Faculties ot
Divinity, Law, Medicine, and Arts. After the oaths of
office had been taken, the new Principal occupied the
chair, and was installed by the Rev. Dr. Crawford, Dean
of the Faculty of Theology. The Senatus then adjourned
to hear the introductory address of the new Profeasor of
Engineering, Mr. Fleeming Jenkin, who was recently
elected to the newly-instituted Chair of Engineering,
established by the patriotic liberality of Sir David
Baxter.
ST. ANDREW’S UNITED COLLEGE.
This College was opened at two o’clock on Tuesday, the
3rd instant, for the session of 1868-6$. The large hall was
filled to overflowing with the students and others. Pro¬
fessor Fischer presided, and Professor Campbell delivered
the inaugural address, the students welcoming him by
singing “ The Campbells are coming.” In the preface of
his address he referred very feelingly to the present state
of Principal Forbes’ health. The subject of the address
was “ University Education.” The names of the students
who had gained the vacant competition bursaries were
given at the close of the proceedings.
-♦-
RETIREMENT OF DR. M. PROSSER JAMES FROM
HIS CANDIDATURE FOR THE REPRESENTA¬
TION OF THE UNIVERSITIES OF EDINBURGH
AND ST. ANDREW’S.
Copy of Correspondence between Dr. W. S. Playfair , Dr.
Prosser James , and Dr. Lyon Playfair , as to the Jiepre-
senlation in Parliament of the Universities of Edinburgh
and St. A ndrew's.
I.—Dn. W. S. Playfair to Dr. Prosser James.
5 Curzon street, Mayfair, London, W.,
23rd October, 1808.
My dear Sir, —I trust you will excuse me addressing you
on the subject of the ensuing election for the representation
of the Universities of St. Andrew’s and Edinburg]). You have
conducted your canvass in so courteous and gentlemanly a
manner, that I am quito certain you will not feel annoyed
if l point out to you the exact position my brother has
gained in the contest.
Both he and you have the interests of the Liberal party at
heart ; and I feel convinced that neither of you will willingly
run the risk of dividing your party, and thus increasing the
chances of the opposing candidate. On Dr. Playfair’s part, l
can venture to say that he would withdraw his candidature,
were he convinced that his chance of success was less than
yours.
I think, however, I can shew you that his promises of sup¬
port are so large that no other Liberal candidate has the
smallest prospect of being returned.
Within the last few days, Dr. Richardson has definitely
withdrawn ; and one of his honorary secretaries has joined my
brother’s committee. There can be no reasonable doubt that
a largo proportion of his supporters, if not an actual majority,
will pass over to my brother, and thus considerably increase
the votes in his favour. Jinking these facts into consideration,
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l would beg you to reflect, in the interests of our Profession,
which we both have at heart, whether it is worth your while
to continue a hopeless contest.
Had you been earlier in the field, I doubt not that you would
have secured a much larger following ; but ray brother was at
work months before you started, ana thus naturally secured a
large number of pledges which might otherwise have been
given to you. I would wish to say a word on a point on
which there has been much misrepresentation : My brother’s
opponents have made considerable capital out of the fact that
he has no Medical Degree. This is true ; but it is equally
true that his whole life has been spent in the study of the
very questions on which our Profession most requires repre¬
sentation, such as hygiene, the healtli of towns, nnl the like ;
and on which he can claim to apeak with some authority. As
he has had a complete medical curriculum, and has been for
years a teacher of medical men, he naturally feels himself
identified with their interests, which he stands pledged to
advance'to the best of his ability.
Those parts of your address which refer to the representation
of the Profession in the Medical Council receive my brother’s
hearty concurrence. I hope you will take these facts into
your kind consideration, and lay them before your committee.
If a conference of the two committees, or of delegates from
them, could be arranged, I am sure some amicable under¬
standing could be made.
I am, yours sincerely,
W. S. Playfair,
Hon. Sec. to Dr. Lyon Playfair’s Committee.
cere wishes for his success aa the only Liberal candidate left
in the field.
I remaiu, yours faithfully,
Prosser James.
III.— Dr. Lyon Playfair to Dr. Prosser James.
5 St. Andrew Square, Edinburgh, 81st October, 1888.
My dear Sir, —1 am much obliged by the receipt of a copy
of your letter to my brother announcing your intention to
retire from the contest. His letter has my full sanction, and
especially that part of it which alludes to the courteous and
gentlemanly spirit with which you have conducted the coutest
I share with you the desire to see the Medical Practitioners
more fully represented in the Medical Council, and thiuk that
the plan proposed by you is the most practical one which has
been suggested. You already know that I am much interested
in the removal of the injustices which have rendered the
public medical services of this country so unpopular with the
members of the Medical Profession.
I am, yours sincerely,
Lyon Playfair
-♦-
$0cid
HEALTH SECTION.
II.— Dr. Prosser James to Dr. W. S. Playfair.
18 Dover street, Piccadilly,
30 th October, 1863.
My dear Sir,—H aving, as you judiciously suggested, laid
your letter of the 23rd before my committee, I am now pre¬
pared to reply.
In the first place I assume, from your near relationship to Pro¬
fessor Lyon Playfair, and as honorary secretary to his London
Committee, that you have his authority, as well as theirs, for
ail you promise.
You do me simple justice when stating your conviction that
I would not willingly incur the risk of dividing the Liberal
party, to which I belong. That I would make any honourable
sacrifice to avoid such a result is well known to those who
lead us. In return, I accept the assurance that your brother
would give way to me if he thought his chances of success
fewer than mine. This, however, is a comparison into which
it were futile to enter by any other than the ordinary and only
decisive wav.
Should Dr. Richardson’s friends, as you anticipate, cast
their weight into your brother’s scale, that would give him a
quantum valcat advantage over me, who, being avowedly ail
advanced Liberal, might easily lose some of even his medical
supporters of Conservative views.
Nevertheless, while I would be the last to incur the odious
responsibility of dividing the Liberals, the occasion involves
interests which I might be justified, perhaps in regarding as
paramount to those of mere party. I allude to the principles
and schemes of Medical Reform, on behalf of which 1 was
brought forward as a candidate.
Did your brother put himself in my place respecting these,
I should not be one to make an obstacle of his not beiug a
graduate in medicine.
His eminence as a man of science ail acknowledge, while liis
attainments and his experience are near akin to those of our
own Faculty—much nearer, lo say the least, than those to
which a member of the l?gal profession can pretend.
You speak of those parts of my address which refer to the
representation of the Profession in the Medical Council as
having your brother’s “hearty concurrence.” I am happy to
hear it. The determination of my course, allow me to say,
depends upon the construction I am to put upon this assurance.
Unless in giving way I have the perfect guarantee that I am
yielding to a candidate who will undertake to do that, for the
opportunity of doing which I principally sought a seat in Par¬
liament, I shall expose myself to the merited reproaches of
my professional brethren, particularly such ns have given me
their support and promised me their votes. My address is in
your hands, and to it I recpectfully refer you. On receiving
from your brother satisfactory intimation as to this great
matter, 1 shall be ready to retire from the contest, with sin-
***
by
H. W. RUMSEY, ESQ., M.D.,
President of the Section.
(Continued from page 400.)
III. Thus we arrive at Earth, the matrix and birthplace of
elementary forms and germs of living beings, where they lie
dormant and apparently dead, until roused into action by water
or air or both ; action which may be either beneficial or per
nicious to man, according to the origin of those seminal prin¬
ciples.
The marvellous properties of earth, especially of the alu¬
minous soils, in arresting, fixing, and assimilating, the nitro¬
genous and aramoniacal constituents of dead animal matter,
point out earth as the proper destination of sewage, wherever
it can be so used. For this conclusion we are mainly indebted
to the researches and experiments of Professor Way, eighteen
years ago. Even the poorer soils, consisting chiefly or wholly
of gravel, sand, silica, or shale, may be converted from
barren wastes into productive farms. This kind of land seem*
capable of absorbing almost any amount of sewage. The well-
known case of the Craigentinny Meadows, near Edinburgh, a
sea-beach in pre-historic times, and worthless in a commercial
sense until treated with the sewage of the town, has settled
that question ; although the rough and very disgusting
methods, adopted at Edinburgh, have tended to bring sewage
irrigation into disfavour. And now, the Maplin sands on the
Essex coast, are performing the same duty for the filthy flood
of London ; and seem likely, pace Baron Leibig, to receive
the like benefit.
But it would be wrong to rely on the disinfecting pnpertias
of sandy and gravelly soils. They have not proved their capa¬
bility of decomposing nitrogenous organic matter, or of fixing
its elements in vegetable growth. They cannot, therefore, he
depended on for the completion of that marvellous cycle of life,
that adjustment of the balance of organic nature, which Dam**
and Boussingault long ago demonstrated as essential to the
existence of plants and animals—that “eternal round in which
death is quickened and life appears, but in which matter merely
changes its place and form.”i
I would gladly avoid the details of utilization of sewage, a
subject which involves both water and earth, and which hss
now a voluminous literature of its own. But tome further
notice of the question seems almost inevitable.
Recent disposals of town sewage by irrigation at Banbury,
Warwick, and elsewhere, seem to promise grand success, after
the failure of all chemical nostrums ; success, both in arresting
1 Dumas, p. 48.
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the reflux of impurity into the river, and in producing rich
crops of various kinds.
But I beg to offer a few words of caution with respect to the
multitude of schemes, now pretentiously advertised, for treating
town sewage with chemicals, for the purpose of precipitating
and solidifying its organic constituents for agricultural use, as
dry manure, lam not aware that, hitherto, any of the projects
have succeeded financially. The undissolved matter of town
sewage contains, we are assured, only about one-sixth or one-
seventh of its fertilising elements. And all plans of this kind
involve this enormous disadvantage, that the more perfect the
separation and precipitation of the suspended (or, perhaps,
dissolved) matters may be, the less available does the fluid
become for any useful purpose, and therefore the greater
temptation is there to allow of its escape into watercourses,
which ought never to be permitted, until we have obtained
satisfactory guarantees for its thorough disinfection.
There is, indeed, one tried process—and others may yet be
discovered—which are not equally open to these objections.
Dr. Bird’s plan of precipitation, submitted to the York meet¬
ing of this Association in 1864, and for three years past in
partial operation at Stroud, deserves a more extensive and
thorough trial. It consists in the application of what he calls
Sulphated Ferruginous Clay, both to the solid and fluid portions
of the sewage. It is said, on good authority, to furnish a com¬
post which does pay the manufacturers and does succeed in
procuring a marked increase of agricultural produce. But, to
sanitarians, the main recommendation is, that it is based on
the scientific truth, already noticed, that water charged with
organic matter is chemically purified by filtration through alu¬
minous soil. If, by the advancing perfection of this process,
(of which a scientific writer! has just informed us,) the effluent
water should become so nearly pure, as not to be worth
the cost of distributing by irrigate n on land ; yet, if it cannot
be proved that this water has been freed from noxious germs
so as to be safely used for domestic purposes ; the town au¬
thorities, or the contractors, or both, may still find themselves
in an awkward dilemma.
A less favourable criticism may apply to a more recent
scheme, the ABC process, as it is called, which professes to
be based on the Chinese principle of applying an aluminous
compound to excreta. It has already been tested, with some
promise of success, at Leicester; but even the last and most
favourable statements 1 2 shew that more than ten grains of or¬
ganic matter remain in each gallon of water after the ABC
process, while in the last report of Dr. Bird’s aluminous treat¬
ment, the volatile and combustible matter seems to have been
reduced to less than two grains.
Now, should none of these ambitious processes succeed in
absolutely clearing sewer water of deleterious principles, even
if proved to be financially profitable, should the nymph of the
sewer, like other chronic invalids who have been dosed with a
variety of drugs, find that treatment by quacks and patentees
does not restore her to health and purity, she must still carry
her foul stream, rich in its nitrogenous, and not wanting in its
phosphoric, elements, to the broad acres of the landowner, there
to augment the food supply of the people. The problem will
then be solved, at least for those places which are irreversibly
pledged to the common-sewer system.
From the evidence already in our possession, and on review¬
ing many conflicting statements, it may, I think, be fairly
inferred, that, in the use of fluid 6ewage for land irrigation, the
following sanitary conditions should be observed.
An extent of land surface should be obtained, which shall
be sufficient, under engineering direction and proper precau¬
tions, to absorb the whole of the fluid in dry weather; sufficient
to decompose and fix its organic constituents ; sufficient,
again, to prevent atmospheric pollution ; sufficient, also, to
admit of long intervals between the periodical applications of
the fluid to each portion of the surface ; and, therefore, suffi¬
cient to promote a succession of crops, roots and cereals, so
that we may hear of something better, on good soils, than
Italian rye-gra83.
To secure the fulfilment of these conditions, and on physio¬
logical grounds generally, though perhaps not in accordance
with eminent engineering authority, I suggest that not less
than an acre of clay or loam be secured for every thirty or forty
of town population.
If sand, gravel, or silica constitute the bulk of the soil—
these admitting of a far larger proportion of sewage on the
1 Lancet , September 26, 1868.
2 Times, August 25.
same area—the effluent water should not be allowed to enter
any stream which may be needed for domestic use until it hp >d
been disinfected by scientific and approved methods.
Before dismissing the question of removing town-refuse, by
means of water, I would say that the system so well planned
and ably described by Mr. Menzies, deserves a complete and
careful trial. It seems to be the first reasonable and practic¬
able proposal for carrying into effect the famous alliterative
dogma of Mr. F. 0. Ward— 4i The Rainfall to the Kiver, the
Sewage to the Soil.” It accordingly promotes economy in
the use of water. It also embodies the principle of upward
filtration, first suggested by the wise and good Prince Consort.
By substituting Dr. Bird’s aluminous compound for the disin¬
fectants suggested by Mr. Menzies, his plan of filtration would
probably be much improved, I believe that, in a large pro¬
portion of the yet unsewered towns, a skilful combination of
the measures proposed by Dr. Bird and Mr. Menzies, might be
very advantageously adopted.l
At all events, in those towns and villages which are not yet
hopelessly involved in the difficulties of the water-carriage
arrangement, the local authorities would be fully justified in
pausing until repeated scientific experiments (which I agree
with Dr. Child, of Oxford, ought to be aided by Government)
shall have determined, as far a3 possible, the comparative
merits of the several rival systems.
But, if threatening dangers demand immediate action, these
places had better adopt that most ancient principle recently
revived, in which earth is brought to the matter to be dis¬
infected in its primitive condition, instead of carrying that
matter, in solution and suspension, to the earth.
The fact that certain Boils possess the power, to which I have
already referred, not only to deodorize, but also to abstract from
decomposing animal matter those elements which may be assi¬
milated by the roots of plants, leads to the conclusion that the
Jewish Legislator of old proclaimed a most philosophical, as
well as a very practical and profitable, expedient. Had the
principle of that sanitary regulation been discreetly observed
by the inhabitants of Jerusalem, under the monarchy, they
might have preserved the valley of Hinnom from pollution, as
the lay-stall and common cesspool of the city, and thus per¬
haps have prevented that strange use of the perpetual fires of
Hinnom, in which, as some learned commentators say, abomi¬
nations of all sorts were burnt and reduced to ashes. This
cinereal method of dealing with animal remains is not likely to
find favour in England, unless, which God forbid, another
cattle-plague should break out.
It is, then, an ascertained fact, that by covering the matters
in question with dried clay, marl, or peaty loam, their volatile
and nitrogenous constituents are at once fixed, and with their
phosphates are slowly assimilated with the earth. The deodo-
rization is perfect, because it is the result of complete chemical
change. The compound resulting from this mixture becomes
in a few weeks a uniform inodorous earth, again capable of
performing the same digestive function ; and this process may
be repeated several times by the same mass of earth. The
success of the experiment appears to depend on the dryness
and separateness of the particles of soil, allowing the air, with
its oxygen, to penetrate them freely.
The disinfecting quality of ordinary humus, is, I need hardly
say, quite distinct from the power possessed by sand and gravel
of promoting the oxidation of nitrogenous matters in solution.
The latter is, indeed, a good instance of mechanical agency. But
the former is a more remarkable proof of the provisions made
by nature for the chemical arrest of putrefaction, and so for
our safety and preservation, if we did but reasonably follow
her indications, as the dog and fox do, when they bury their
dead prey for future food. The water, therefore, would be the
first carrier, the air the second, while the earth would be
merely the intermediate resting-place.
The practical lesson to be learnt from the researches of that
celebrated Professor, consists mainly, I think, in the impor¬
tance, (1) of securing, as far as possible, dryness of soil; (2)
of preventing contamination of earth in the immediate neigh¬
bourhood of dwelling houses; and (3) of proriding, in the par¬
ticular process under consideration, a supply of really dry earth.
1 Another very clever invention by a gentleman of this town, Mr.
Edwin Chcsshbe, claims oir notico. Its principle is lom.ike, by me ms
of intercepting house-t mks, such sepaaion of the fluid and s-lid
mn ter t • be icmoved, a- would greatly ditniu sh the subsequent dim-
cultie - of disp»sa: and utilization. It appears also to be * sure pr-veu-
tiv-t f the sanitarv fin u-es in hnnsc drainage s<» ca'efu’ly 1 vo tigited
i by Dr. Carpenter, of Cr y on. The same principle, though »>> a «tif-
leront method, lits boon advocated by Mr. Bnnnehr, C.E., of Exeter.
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It is with much satisfaction that I can now refer to the full
recognition of this method by the Legislature, in the amended
Sanitary Act of last session.
I am also glad to call attention to an excellent address, just
printed by Dr. Newman, of Stamford, in which he has had the
courage and good sense, while urging the immediate abolition
of the abominable cesspools in that town, to warn its inhabit
tants against the fashionable water method, and to recommend
them at once to adopt the dry-earth system.
One caution given by the River Commission! appears to be
of extreme importance, viz., that the general use of Mr.
Houle’s contrivances should be placed by the local authorities
under vigilant inspection ; and this of course implies a much
more efficient staff of nuisance inspectors than at present, and
more frequent domiciliary visits in poor and crowded localities.
IV. In the preceding observations on air, water, and earth—
as modified by the all-pervading principle of oxygen, repre¬
senting the old elemental fire—in their various relations to
public health and to some recent measures for its improve¬
ment, I am well aware that I have already exceeded the ordi¬
nary limits of a departmental address.
Continual reference to well-known facts in physiology and
natural science, may have appeared tedious and unnecessary
to one portion of my audience, while certain disagreeable de¬
tails may have been as distasteful to others. Yet while con¬
fessing to have dwelt perhaps too long upon principles which
seem to me to lie at the root of all sound sanitary legislation,
I cannot satisfy my sense of what is due to you on this occa¬
sion, without making, in conclusion, some reference to the
practical question of administrative machinery.
From a remote period of English history, there have been
laws and constituted authorities which took cognizance of
matters injurious to the health of communities.
Actionable nuisances were condemned in courts of law, and
certain public as well as individual wrong3 were vigorously
redressed. On such points, the old common law of England
was very explicit and not a little severe, recognising the right
of every man to “ fresh and pure air,” and to the removal of
whatever was deemed unwholesome or even offensive. The
common law has often, to the present day, provided a more
certain sanitary remedy, in some such cases, than proceedings
under modem Acts.
But there were also ancient statutes concerning health. So
long ago as the reign of Richard II. a curious law for the pre¬
vention and removal of nuisances in “ divers cities, boroughs,
anti towns of the realm and the suburbs of them,” declared
the condition of ditches, rivers, and other waters to be so bad,
“ that the air is greatly corrupt and infect, and many maladies
and other intolerable diseases do daily happen.” This Act is
said to be only declaratory of yet older common law.2 The
mayor and bailiffs were authorised to administer the Act and
to enforce penalties on those who transgressed it.
In the times of the Plantagenets, if not earlier, there were
Crown Commissioners of Sewers (Ste-wcvrs in Saxon, sea-weirs
or sea-fences), which were then merely wide and deep trenches,
with embankments to protect the land against inundations,
whether from the sea or from navigable rivers. Statutes fol¬
lowed under the Tudors and Stuarts respecting the drainage
of land. All this shows the care bestowed by government
upon matters affecting the safety of the people in the middle
ages.
Then there were Courts Leet, relics of Saxon local govern¬
ment, modified by feudal tenure and service, at which any
common nuisance might be presented. Both these have fallen
into disuse, and are now practically obsolete. Local boards
of health are their modern representatives. Justices of the
peace in counties, and the chief officers of cities and boroughs,
were occupied, centuries ago, during periods of pestilence, in
what we should now deem unskilful efforts to protect the
health of the people ; and those officials have succeeded in
maintaining and even strengthening their position as modem
sanitary authorities.
Together with the reform and the growth of municipalities,
a distinct order of local administrative bodies in sanitary
matters, is now established.
I need only mention that the Privy Council has been autho¬
rized to interpose on behalf of the public health in emergencies
of extreme danger.
But it was not until the old Poor Laws were amended, and
parishes were grouped into unions, nor yet until these union
1 Second Report, p. 14.
2 Tou 1 2 min Smith, P H. Law-?, j. 22, ISIS.
districts were made the chief areas for a general system of
registration, in which the main facts of mortality and repro¬
duction, and (to a considerable extent) the causes of deaths,
were recorded for the whole country,—that the relations of
pauperism and destitution, with the sickness and mortality of
the suffering masses, were fully brought to light. Not until
the new administrative bodies, with their medical and registra¬
tion staffs, were in full action in these districts, was it clearly
shewn, by Mr. Chadwick, in his famous “ Report on the Sani¬
tary Condition of the Labouring Population,” that the causes
of disease and premature death, and the social miseries thereon
dependent, might be removed or remedied by a systematic
application of sanitary measures. For that full exposition of
the principles of an economical and efficient sanitary organisa¬
tion, based on the poor-law and registration divisions, the
country is greatly indebted to Mr. Chadwick. It is, in my
humble opinion, much to be regretted that the frame-work of
local administration then recommended, was not employed for
almost all purposes of preventive medicine, as a similar organ¬
isation in Ireland has since been utilized.
Whatever might have been the original defects of the area*
of registration, when viewed in their relations to physical
science, or to vital statistics, or to ancient usages and divisions,
they are unquestionably, of all existing districts, the best fitted
for sanitary administration; and their boundaries are capable of
rectification, a process which, in fact, is always at work. The
municipal governments, however, have proved to be too strong
a power to admit of a rival organization of that kind. The
towns claimed independent action, and after a few years’
struggle between the boroughs and the State, the Local
Government Act was passed, which threw overboard the prin¬
ciple of governmental or national supervision. No one can
doubt that the Act of 1858 has been of great benefit to many
towns and populous places, but I fear that it has sometimes
helped to strengthen the obstructives, and it has certainly
raised up a host of present difficulties and perplexities in
sanitary administration.
Again, during the last thirty years, our sanitary enactments
of various kinds have multiplied until they form a libraiy, not
very easy of reference, and requiring both abridgment and
codification.
Notwithstanding the greater degree of precision and effec¬
tiveness which marks the Sanitary Act of 1866 and its
supplements,—the continuance, in the same districts, of con¬
flicting jurisdictions, regulations and customs, and the exis¬
tence of many remaining defects and obscurities in the law*
themselves, have given a fresh impulse to the sanitary move¬
ment, the result of which, I am happy to say, is that a Royal
Commission is about to issue for full inquiry into these matters.
Under circumstances so propitious, it might be premature
to enter into a number of particulars which I doubt not will
be thoroughly and impartially investigated by that commission.
Something, however, I have to say. The chiefs of several
departments to which various matters affecting the health and
safety of the community and of the working classes are now
referred, are undoubtedly alive to the importance of some
greater simplicity and unity in central action. And I believe
there is a hearty desire on the part of Government to consider
favourably the now general demand for the establishment of a
single Department of Public Health.
We may hope that in any reconstruction of existing ma¬
chinery—supposing such to be sanctioned by Parliament—
the future central department may include and empower all
those distinguished men who have for years rendered
able services to the public, under the present fragmentary and
inharmonious system. ..
Of authorised local administration I wish to speak with ail
due respect. And I would preface a few remarks on the dis¬
trict question, by explaining that they are not intended to
apply to the districts either of the Metropolis or of the larges*
cities and towns of the kingdom, such as this, the Metropolis
>f the Midland Counties.
In these vast centres of population, probably, the more
>ressing necessities of the case might be met by increa.
acilities of administrative co-operation between the urban and
he suburban and the surrounding rural districts.
It is very satisfactory to perceive that, of late years, I
governing bodies throughout the country have become more
iealous and more efficient, and have creditably accomp
orae really great undertakings. But it is impossible to shu*
me’s eyes to certain serious defects of local organisation
lefects which hamper and obstruct the most willing effort*-
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The main difficulty which almost everywhere meets the
sanitary reformer is the existence of so many different kinds
of local authority, in all manner of districts, for the execution
of a variety of measures, which, if distinct from each other,
are nevertheless cognate and often strictly correlative.
The Sanitary Act of 1866 itself recognises two orders of
local authorities, each containing several genera and species—
one order dignified by the name of “ Sewer Authorities,” the
other by that of “ Nuisance Authorities.”
And here I would observe that from this distinction we are
by no means to infer that a setrer authority may not prove a
grievous nuisance. As sewers, in the modem acceptation of the
term, are deservedly losing favour, and as it may be undesirable
to extend the formation of such sewers to districts hitherto
without them, one may reasonably regret that it has been
thought necessary to stamp their name upon respectable local
authorities. So far as sewers may be concerned with what
engineers call the “ arterial ” drainage of land, they would
come under the management of authorities of wider jurisdiction.
Now, there are some singularities, I may say oddities, about
these sewer and nuisance authorities, which deserve notice.
The Act of 1866, in agreement with former enactments,
empowers, as Sewer Authorities, the old city and borough coun¬
cils, other local boards of health, boards of town trustees and
commissioners, parish vestries and vestries of new districts to
be cut out of old parishes and called “special drainage districts”
—while the Nuisance Authorities are not only the said councils
or local boards, but also justices in petty session, and boards
of guardians instead of parish vestries.
Great must be the confusion, if not conflict, arising out of
efforts to carry out sanitary measures at all systematically, by
bodies having jurisdictions differing in kind and extent;—the
larger generally including several of the smaller, although the
smaller may be empowered to execute more important func¬
tions than the larger. The diminutiveness of a sphere of
action obviously tends to impair its efficiency.
No general method of co-operation between the various
authorities contained in areas of wide extent (as, for instance,
divisions of counties) now exists.
It is true that some remedies for this admitted defect have
l>een attempted by very recent amendments of the Sanitary
Act. The Act of 1867 enables sewer authorities to purchase
or rent land for the purpose of sewage utilization ; and, while
the creation of “special drainage districts” is encouraged,
power is given to promote the combination of those districts
and thus to extend areas of drainage—a principle of the
utmost importance as regards the physical topography and
geology of a district. But all this is permissive—all depends
on the view taken, by any local board or vestry, of the pro¬
priety of such extension.
Again, by the Act of the last session, the sewer authority is
to supersede the nuisance authority, where they are different
bodies, in certain matters of disease-prevention. In fact, it is
manifest that sewer authorities are getting the upper hand,
and are likely to have the best of it. On the Darwinian theory,
the weaker, though wider, race of nuisance authorities is in
process of extinction, unless, in good time, we may shew cause
for their preservation.
To any sewer authority, out of London, may now be com¬
mitted, with the sanction of the Privy Council, the power of
providing for a temporary supply of medical aid for the poor,
as in 1866 the same boards were empowered to supply hospital
accommodation for the sick,—yet the public provision of me¬
dical relief to the poor throughout England has long been
committed to Boards of Guardians, which are now held, by
the Sanitary Acts, to be only nuisance authorities. In this
matter, then* as in others, two kinds of authority, in the same
area, are empowered to execute the same description of mea¬
sures !
A large party of sanitary reformers are calling for compul¬
sory measures. They desire local bodies to be compelled to
l>erform certain acts, without reference to their fitness or
qualification for such duties.
Will not the imposition of stringent obligations of this kind,
upon incompetent bodies, lead to continual central interference,
and to frequent appeals to courts of law ?
Let me ask you to consider whether it might not be a wiser
course to amend the constitution and composition of local
bodies, so as to secure a more willing execution and a superior
direction of preventive and remedial measures, and thus
really to strengthen the great national principle of local
government.
Again, as a general rule, I would suggest that prohibition
is a safer principle than compulsion. “ Shall not ” is generally
a better legislative formula than “ shall.” For example, it
would be safer to say that local boards shall not empty their
sewers into rivers, than to enact that they shall sewer their
towns ; — better to enact that they shall not permit the
erection of dwellings in already over-crowded localities or on
unhealthy sites, than to compel them to evict a badly-lodged
population better at once absolutely to prohibit (after a
stated period) the slaughtering of animals for human food, and
the keeping of cows for milk-supply, within the boundaries of
towns containing more than (say) ten thousand inhabitants,
than to enforce by inspection a variety of minute and vexatious
regulations for the mere palliation of evils, which slaughter¬
houses and cattle-pens and cow-cellars in populous places must
more or less perpetuate ;—wiser, I repeat, to decide that the
local authorities shall not appoint official engineers or sur¬
veyors or medical officers of health, without ample guarantees
for their superior qualification, freedom of opinion, and devo¬
tion of their whole time to their public duties, than to compel
local boards to make such appointments without the necessary
conditions.
Local authorities—I beg their pardon—sewer authorities,
as we are to call them, are now really in a pitiable plight.
They are, of course, expected to do all that Banitary laws
empower them to do ; they are threatened by advanced
sanitarians with compulsory enactments in case of torpor or
recusancy ; they are warned that coroners’ inquests will be
held upon those who die from preventible causes, which they
ought to have abolished ; they are officially informed of their
liability to ruinous actions for damages, if they poison their
own people with a supply of bad water ; yet they incur the
greatest risk of Chancery Injunctions, on behalf of land-owners
and adjacent districts, if they contaminate the water-courses
by obeying the law.
Now, under these embarrassing circumstances, might it not
be advisable for these local bodies, in smaller districts espe¬
cially, to seek, and for the Legislature to grant, an improved
constitution of the administrative machinery adapted to the
necessities of the public health ?
Very desirable does it appear that town and country and
union authorities should be enabled to unite in the execution
of certain comprehensive measures, and especially in the
appointment of superior officers. The administrative economy
of large areas has been conclusively proved. A still more
extensive combination of existing sanitary authorities seems to
be required for the constitution of river conservancies.
But, before resorting empirically to any schemes, however
promising, it would surely be right to consider what might, in
the abstract, be the most desirable extent of area and popula¬
tion for local sanitary jurisdictions—for those, I mean, in which
the more common hygienic functions are to be advised and
executed ; what, again, should be their relations to larger
areas, as counties and river conservancies, in which more
extensive measures arc to be directed,—as well as to smaller
areas, namely, parishes, townships, and portions of such, for
which only special and limited works are required. Then
would reasonably follow the more practical question—how best
to reconcile the ideal with the actual, how to rectify, with
proper regard to existing interests, the present areas and
limits of administration.
The natural features and boundaries of any region, as in¬
fluencing soil, water, and climate, are very important guides
to the formation of districts for local management. And this
principle may be advantageously borne in mind, in any future
correction of existing boundaries.
The statistical divisions of the kingdom should, I repeat,
be the principal factors in the process. They are the true
bases of public sanitary action.
A rational reform of local divisions and a wise extension of
administrative areas, are quite compatible with respectful
consideration for the ancient limits of parishes, towns, and
counties. By judicious improvements and reinforcements of
County Authority, especially, a very noble and excellent
characteristic of English society may be preserved in the
advance of civilization.
If I have not dwelt with all the enthusiasm of a reformer
ou the progress aud attainments of the last quarter-century,
it is not, I hope, that I undervalue great results; but that I
consider certain defects and sources of failure to be matters
more deserving our immediate attention.
It is well, moreover, to speak with modesty and caution ox
what has hitherto been accomplished. Aud, before con¬
cluding, I venture to protest against the inconsiderate use
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FOREIGN MEDICAL LITERATURE.
November U, 1868.
—I might almost say the audacious misuse—of local rates
of mortality in support of some favourite sanitary mea¬
sure, or in opposition to some dreaded reform, by those
who may not yet have proved the fallacies of sanitary sta¬
tistics ; or who do not perceive how small may be the bear¬
ing of any particular act or neglect upon the variations of a
general death-rate ; or, again, who forget that the same figures
in different places and in populations differing as to age, class,
and occupation, may represent totally differeut standards of
health, vigour, and longevity.
- » -
Jm'eip Iptal literature.
CASE OF HEMIOPIA.
Communicated by Dr. M. K. Loewegren.
Translated from the Hygiea for May, 1868, by
W.D. MOORE,M.D.,Dub.etCantab.,L.K.Q.C.P.I,M.R.I.A.,
HONORARY FELLOW OF THE SWEDISH SOCIETY OF PHYSICIANS J OF
TUB NORWEGIAN MEDICAL SOCIETY; AND OF THE ROYAL MEDICAL
SOCIETY OF COPENHAGEN; SECRETARY FOR SWEDEN, NORWAY AND
DENMARK, TO THE EPIDEMIOLOGICAL SOCIETY OF LONDON.
(Continued from page 390.)
We have thus before us a case belonging to the group of
amauroses which have been named hemiopia, or visus dimidi-
atus, and which are characterised by a defect definite in form
and extent in the eccentric vision, comprising exactly half of
the field of vision of each eye.
Although hemiopia cannot be reckoned precisely among the
rarest forms of disease, the variety of that disease presented
in the foregoing case is sufficiently unusual to call for a few
moments’ attention. Besides, the entire of this group of dis¬
eases affords so many interesting standpoints for the study of
the physiology of the optic nerves, and for establishing the
possibility of an exact diagnosis of the seat and nature of the
foci of the intra-cranial disease, that I may be allowed to ana¬
lyse somewhat more minutely the phenomena exhibited by the
investigation of the case in question.
First, as to the cause of the defect in the field of vision, the
negative result of the ophthalmoscopical examination shows
that its seat is not to be sought within the bulb. The slightly
marked changes observed in the right eye are secondary, and
point to an atrophic condition of the nasal part of the optic
nerve, an atrophy which always occurs sooner or later when the
conduction in the nerve is at any point impeded. The similar
nature of the affection of the field of vision in both eyes proves
that the cause cannot be found within the orbits. It is there¬
fore in the cranium we must seek the latter ; and the first thing
to be decided is whether it is of a central or peripheral nature ;
whether the conduction is disturbed at the origin of the nerve,
that is within the brain itself, or interrupted somewhere in the
course of the tractus optici. The total absence of all signs of
any cerebral affection, the undisturbed integrity of the mental
functions, as well as of the other cerebral nerves, are uncondi
tionally in favour of the latter alternative. In order to
answer the question : In what part of the tractus opticus is
the conduction in the nerve interrupted? we must call to
remembrance the anatomical arrangement of the nerve-fila¬
ments in the chiasma nervorum opticorum. I
In the chiasma, as is well known, the nerve filaments met
with in the two tractus optici behind the chiasma divide in
such a manner that each nerve trunk gives off the inner half
of its filaments to the other nerve trunk, so that on emerging
from the chiasma each optic nerve is connected by one-half of
its nerve filaments (fasciculus lateralis) with the cerebral
hemisphere of the same side, but by the other half (fasciculus
cruciatus) with the other hemisphere. Now, within the eye
these nerve filaments divide in such a manner that the outer
part of the retina is connected through tho lateral fasciculus
with the cerebral hemisphere of the same side, but the inner
part of the retina through the fasciculus cruciatus with that
of the other. This division of the nerve filaments, which has
long since been demonstrated by the dissecting knife, is most
distinctly confirmed by the various forms of hemiopia. It is
in fact granted that, if the conduction in one of the optic
trunks be in any point interrupted, the limitations of the
hemiopic field of vision must, in consequence of this division
of the fibres in the chiasma, be formed in a manner varying
essentially according to the point where the nerve trunk is
affected by the causes of the injury. If, for example, the con¬
duction in the optic trunk proceeding from the right cerebral
hemisphere be completely interrupted in consequence of pres¬
sure from a tumour affecting the nerve trunk behind the
chiasma, complete anaesthesia must of course occur in the two
right retinal halves, which are supplied with nerves precisely
by that trunk, and consequently a corresponding defect in the
field of vision must be met with, in this case occupying the
left half of the field of vision of each eye. In the same manner
we arc justified in referring the seat of the morbid cause to
the left hemisphere (the optic trunk behind the chiasma) in a
case of lateral hemiopia, occupying the two dextral halves of
the fields of vision.
This form of hemiopia, the same-sided , where the defect
occupies symmetrically the two right or the two left halves in
both fields of vision, is that which most commonly occurs, and
dissection has in numerous instances confirmed, even in the
most minute details, the diagnosis made during life, as to the
seat of the cause of the disease. Most frequently the cause is
in these cases to be found within the brain, ana contempora¬
neously with the hemiopia other consequences of the cerebral
lesion are met with, as hemiplegia, facial paralysis, &c., which
then occupy the same side of the body as the limitation of the
field of vision. On the contrary, the form of hemiopia occur¬
ring in the case now under consideration is very rare. The
limitation of the field of vision here affects the onter half of
the field of vision of each eye, consequently the right half of
the right eye, and the left half of the left. The parts of the
retina c< Hresponding to these defects of the field of vision con¬
sisted, therefore, of the nasal halves of the retina, that is the
parts which are supplied with optic filaments from the fasciculi
cruciati. Hence, it is evident that the morbid cause which
gives rise to the interruption in the conduction from these two
retinal parts must have such a position, that both fasciculi cni-
ciati can be acted on by the same influence, that is to sav,
that it must be situated in the middle between the two optic
nerves, either in front of or behind the chiasma. Against its
being situated behind the other central nerves the complete
integrity of the oculo motor nerve on both sides especially
must be regarded as strong evidence against that assumption.
It may, therefore, be assumed with probability closely border¬
ing upon certainty, that the focus of disease in question, in¬
volving the two fasciculi cruciati has its seat directly in
front of the chiasma.
The slow course of the disease, the progressive diminution
of the power of vision during the lapse of two or three years,
the absence of all signs of previous meningitis (the patient had
never been confined to bed by illness), lead to the assumption
of the existence of a tumour. Of what nature this tumour
may be, it must be extremely difficult, if* it be even possible, to
decide.
It appears to me, therefore, that there ia very good reason to
justify us in assuming, that the hemiopia in the case before us,
is caused by a not very voluminous tumour, situated on the
sella turcica in front of the chiasma, which tumour has by
compression removed the power of conduction in the fasciculi
cruciati corresponding with the nasal parts of the retina. The
circumstance that the ** patient sometimes saw worse, some¬
times better,” as well as the complete blindness which came on
last Christmas, by no means disproves the presence of a tumour,
as such oscillations of the power of vision may easily be sup¬
posed to occur from a state of local irritation, and partial dis¬
turbances in the circulation in and around the tumour, which
disturbances might subsequently partially pass off, leaving,
however, behind them each time a diminution in the power of
vision.
. The line of demarcation so well defined, especially on the
right side, between the defective and the still preserved halves
of the field of vision, is in this case particularly striking. I®
same-sided hemiopia, where the compression of the nerve-
trunk takes place behind the chiasma before the fibres have
crossed, this boundary is always sharply drawn. It is also
clear that the two perfect halves of the retina cannot here be
attacked, so long as only the one nerve-trunk is compressed.
The prognosis quoad ciecitatem is therefore in this instance
very favourable. But the case is quite otherwise with the
nasal hemiopias, to which group the history in question
belongs. It is bard to nnderstand why a tuinbur, situated ia
the middle between the two nerve-trunks, and compresging both,
should exercise this compression only on the part of the nervt;
trunk lying closest to the tumour, namely, the two ftscicnli
cruciati. Yon Graefe remarks also, that in nasal heraiopiis
the bouudary of the defect of the field of vision is not sharp’?
defiued. But that this may be so, is proved by the foregoing
case. There can, however, be no doubt that the Otage in
which the patient was at the time of examination, w*s owy
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CORRESPONDENCE.
November 11, IMS. 421
a transition stage. It is, in fact, evident that if the tumour
continues to be developed, it must extend its compressing
and destructive influence more and more, and soon involve
also the lateral fascicnli. That this has already taken place
to a certain degree, is seen from the considerable depression
of the eccentric vision, even iu the parts of the field, which
are still more or less preserved. The prognosis must therefore
on this point be very unfavourable, aud probably complete
blindness will soon supervene .1
On superficial consideration, it may perhaps excite surprise
that the patient did not himself observe the hemiopia. This
is explained partly by the fact that the power of vision on
the whole was considerably lowered, partly by the form of the
hemiopia. In nasal hemiopias, in fact, the two fields of vision
compensate each other, so that for example an eccentric object
situated to the right, which therefore cannot be perceived on
the anaesthetic nasal side of the retina of the right eye, is ob-
served instead on the temporal side of the left- It therefore
easily happens that the patients do not remark the defect of
the held of vision, unless they accidentally close the one eye.
Jn the same-sided hemionias on the contrary, where suen a
mutual compensation ot the two fields of vision does not take
place, the fact cannot be unobserved by the patient.
A circumstance chiefly of anatomical and physiological in¬
terest still deserves to be noted, namely, that in hemiopia the
boundary of tbe defective portion of the field of vision always
posses through the fixed point, that is the yellow spot on the
retina. If the fasciculus cmciatus exclusively supplied the inner
half of the retina with uerve.s, and the fasciculus latealis exclu¬
sively the outer, the boundary of tlio defect of the field of vision
in hemiopia should of course necessarily pass through the eccen¬
tric Harriot te’s, or blind spot situated externally iu the visual
fi*ld, and which in the latter represents the papilla nervi optici.
Now as this is not the case, the outer ha*f of the retina, which
certainly derives its nerves principally from the lateral
fasciculus, must of necessity also to a certain extent receive
some from the fasciculus cruciatus, although the knife of the
anatomist has not as yet succeeded in demonstrating this fact.
In conclusion, I would remark, that ophthalmological
literature contains only very few accurately described cases
of this form of hemiopic limitation of the field of vision. Only
one such case have I been able to meet with, where a post¬
mortem examination was made ; and this is communicated by
Dr. Samiscb, of Bonn, in the Kliniscke Moiiatsbldtter fUr
Auyenhciltcundc for 1865. The case was that of a man, aged
twenty-three, who exhibited symptoms of nasal hemiopia for
a year, and died suddenly with symptoms of meningitis. Dis¬
section exhibited, in addition to the signs of suppurative
meuingitis, a tumour of the size of a pigeon’s egg, lying in
front of the chiasma, surrounded ns by a fork by the optic
nerves pushed out to the sides. The tumour proved to be a
sarcoma, containing a quantity of haemorrhagic cysts, and pro¬
ceeding from the sub-arachnoid connective tissue.
-♦-
ferrsputoita.
THE CONTEST FOR THE UNIVERSITIES OF
EDINBURGH AND ST. ANDREW S.
TO THE EDITOR OP THE MEDICAL PRESS AND
CIRCULAR.
SlB,—Being deeply interested in this contest, I rejoice that
you have given so much space to it, and regret that no medical
candidate remains iu the field, for the following as well as
other reasons:—
First of all the medical profession is deeply discontented. We
fad, sir, that until we get some representative in the house
who can and will make our affairs his chief occupation, we
shall never be able to redress our grievances, or obtain the
consideration which is our due. Any one who notices how
numerous in both Houses of Parliament are the representatives
of the Church and the Law will understand why medical men
have long groaned under injustice which either of the other
professions would long since have been able to redress.
Secondly,—Medical politics are so complicated and their
relations to general politics so numerous, that it would be
useless to send to parliament any one who had not given them
special attention, while the affairs of the profession would so
The patient wia only for a f-bort tme the subject of clinical obser¬
vation in the hospital, and has not since been beard of.
fully occupy his time that party considerations would be but
secondary.
Thirdly,—The voice of a competent authority on hygiene,
sewage, and many subjects where legislation is needed, is much
wanted in Parliament; and, with all deference to scientific
men, only a medical man can be regarded as such authority.
Fourthly,—To represent us fairly wo require not an experi¬
mentalist, not a mere M.D., however distinguished, but a gen¬
tleman, who while practising his profession, and freely mixing
with his brethren, and so being conversant with their wants is
also sufficiently interested in general politics to have associated
himself with them, and to have formed opinions on all the
social topics of the day.
Now, sir, tried by all these tests, there was only one candi-
didate who could have completely represented the profession
in all its aspects, and this is why many Conservatives would
have voted for him. In ray opinion, although to some extent
connected with our faculty, Professor Playfair has not nearly
so much claim on the support of medical men. It was all along
equally admitted that Dr. Richardson’s claims were rather
scientific then anything else, aud as to both these candidates,
I cannot think the floor of the House of Commons the best
place to ventilate scientific problems, and therefore do not care
for either of the so-called scientific candidates.
Now Dr. Prosser James possesses all the claims I have
named. As a medical politician he has no superior, perhaps
no equal. I believe that he possesses the confidence not only
of the great body of his professional brethren in practice
throughout the kingdom, but of the Surgeons of the Army
and Navy, and of the dissatisfied Poor-law medical officers.
Then his proposed reform of the Medical Council is Con¬
servative in the best sense of the word, inasmuch as it preserves
all that is good and useful by removing imperfections and
adapts existing institutions to the wants of the times. Never¬
theless, the changes ho proposes would constitute a veritable
rrfot m.
Again, ho far as authority to speak on certain questions is
concerned I suppose no one will dispute it.
As a teacher of hygiene in one of our metropolitan hospitals
his attention must constantly be occupied with the subjects he
would have to advise upon, while the lengthy period he is
known to have devoted to the Btudy of jurisprudence should
strengthen his authority on points where law and medicine are
both involved. There are other reasons in his favour which I
cannot touch upon. I shall only allude to those which justify
medical men ot both parties in supporting him.
The acceptance of his programme on medical reform by men
of all parties proves that though a liberal he is not so rabid
as has been insinuated. Iconoclasm cannot be charged against
the man who only proposes to adapt our institutions to the
wants of the day, and the chief merit of whose scheme is the
ease with which it may be effected and the little change he
insists on.
On the other hand though medical politics were his greatest
claim, he never set up his class above all others. I see
from the report in your paper that at the meeting of the
St. Andrew’s Medical Association he said, and thereby I
doubt not lost the support of those who can only see their owu
petty interests, that “ medical men should remember that
society did not exist for their sake but that they exist for the
sake of society.” There is, therefore, no fear that his views
are too narrow.
Lastly, on ecclesiastical questions,—Here I admit he is at
issue with a very large party, but Professor Playfair is, as far
ob I can make out, os bad. If a Scotch episcopalian is pre¬
pared to let the Irish branch of the Church of England go,
it is not surprising that an English or Scotch dissenter, which¬
ever he may be, should be equally heretical.
I think that, for the sake of such a medical representative
as Dr. Prosser James, the profession would have acted wisely
to iguore ecclesiastical questions altogether.—I am, Jbc.,
* A Conservative M.D.
-•-
LAST SUMMERS CHOLERA AND DIARRHGSA.
The quarterly returns contain amongst other matter the de¬
tails of the cases of diarrhoea and cholera that occurred last
summer. We extract the following:—
“ Summer cholera prevailed with considerable severity in
London, where 267 deaths were ascribed in thirteen weeks to
this cause. The cases were published in the ( Weekly Tables 1
in the terms employed by the medical attendants; such as
cholera, cholera infantum, choleraic diarrhoea, English cholera,
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422 *The Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
November 11, 1868.
and in a few cases Asiatic cholera. A few individual cases
were of short duration in adults, and were probably undistin-
guishable in their symptoms from many cases in the epidemic
of Asiatic cholera, as it prevailed in the year 1866 ; but the
character of the cases as they generally occurred, the diarrhoea,
the coincidence of an excessively high temperature, and the
general course of the epidemic, left no room to doubt that it
was the common summer cholera of Europe. The late Spanish
Government, however, chose under this pretext to subject ves¬
sels from the United Kingdom to quarantine on and after July
22, and it does not appear that the restrictions were taken olF
before the Spanish Government itself had been removed.
3,145 deaths from diarrhtea occurred this summer in London,
while the deaths from diarrhoea in the two preceding summers
were 2,186 in the year 1867, and 2,298 in the year 1866, when
cholera was epidemic. It is probable, as formerly several types
of disease were confounded under the name of fever, so it may
be now with diarrhoea, some of which may be the result of
cholera matter bearing the same relation to the Asiatic matter
as cowpockbears to varioloid lymph.
“ Fatal as diarrhoea was in London, it was much more fatal
in all the other large towns. Thus, 821 deaths from diarrhoea
were returned in the borough of Birmingham, with a popula¬
tion of 352,296 ; at the high London rate the deaths would not
exceed 350. In Liverpool the deaths from diarrhoea were 859,
Manchester, 869 ; Salford, 279; Sheffield, 407 ; Leeds, 566 ;
Bristol, 157 ; Bradford, 205 ; Hull, 226 ; Newcastle-upon-
Tyne, 122 ; Leicester district, 330 ; Nottingham district, 165.
“ The deaths from diarrhoea in Leicester at the high London
rate would have been about ninety ; so that in that district
there must exist conditions exceptionably favourable to the
diffusion of diarrhoea.
“ Liverpool, Birkenhead, Manchester, Salford, Leeds, and
Bristol have now Health Office re, and they, with the Health
Officers of London, will, we may hope, have all the assistance
they require to enable them to investigate the course, and re¬
move the flagrant causes of a malady which is so fatal to the
population.”
NOTICES TO CORRESPONDENTS.
ccs-sor. Dr. Little, F.K. and Q.C.F, and Physician to the Adelaide
Hospital, who for some voire has been a frequent contributor of review*
as veil as of oririnal communications, t;ikesmy place as editor; audthe
journal will continue to bo published by Fannin and printed by Falconer
as hitherto, and undergo no other change except such improvements as
the great zeal and ability of its new editor may effect.
I am Sir,
Yours very truly,
Georoe H. Kidd.
17 Me-rion square, East; Nov. 7,1808.
Dr. \V Sharp, Rugby, complains that “medical journals are not
to a considerable number of the profession—namely, to all those who
have thought it their duty to investigate homoeopathy ind expresses
a hope that the Correspondence columns of our journal will be opened
to tire views of this class of practitioners. We have always tnkencredit
to ourselves for the broadness and tolerance of our views of medial
practice, and we should be glad at all times to give correspondents of
every opinion the fullest scope in our power. We must, however, inter¬
pose the proviso that homoeopathy or any other peculiar theory shall be
discussed on broad scientific grounds. We i-annot accept exparte state¬
ments without some tangible and substantial principle to confirm them.
If Dr. Sharp has real arguments to adduce in favour of hoimeopatby we
shall be glad to publish them ; and wc afford him the use of our columns
with the greater confidence, from the h’gli scientific position which hr.
Sharp enjoys. Dr. Sharp is a Fellow of the Royal 8ociety, of the Geo¬
graphical Society, and o the Royal Medical aud Chirurgical Society; an
M.D., and an ex-Senior Surgeon of the Bradford Infirmary.
Dr. Lane.— Your letter on “Poor-law Medical Reform" sha’l appear
in our next.
Dr. Maurice.— See previous re pi}’.
Dr. Haslett —Your complaint is n serious one. We will nake en¬
quiries into the character of the person mentioned, and let yo*; know the
result. . „ . ^
Errata.— In the paper of Dr. Sturges. in our issue for Oct. 2 n owing
to the corrected proof not having reached thc olfic *, there arc ionic mi*
prints, in which the movt important are “limb" instead of "that,
“aneurism " for “anasarca.” and “pneumonia" for “ phenomena."
A Smoker says that Condv’s Fluid is the best thins: to remove tb'
odour after smoking. He adds that a few drops of Comly’s Remedial
Fluid will remove the symptoms sometimes brought on by excessive in¬
dulgence in the weed. .
M.A., M.D., Edinburgh.—T he subject was discussed m our last issue
New Subscribers.— The following gentlemen will please receive our
l>est thanks. The journal shall be sent to them forthwith.—Dr.
McOIoviu, Dr. O’Sullivan, Dr. Swanton, Dr Maturin. Dr. Stokes Dr
Wilson, Dr. Massv, Dr. Pcppard, Dr. Kcidy, Dr. Smartt, Dr. Stafford, J.
Aston, Esq , Dr. Dobbs, Dr. Myrtle, H. Waldron, Esq., Dr. Rutland,
Dr. Peirce, Dr. Moyle, Dr. O’Kelly, Dr. O’Couuel, Dr. Patman, Dr.
McDermott, Dr. Nason, Dr. Quinlan, Dr. Robinson, Dr. Walsbe, Dr.
Murray, Dr. Me Milan, Dr. F. Pratt.
--♦-
Inquirer. —In December, 1618, the first edition of the Phannawjxviu
w as published : there had been one piintedsome few months pi eviously,
but owing to the many innceiuacics it contained, the major portion of the
edition was withdrawn.
Dr. J. 8. E.—You will find the information you require in our
“Students’ Number."
A General Practitioner.— I. 8yrop of phosphate of iron and
manganese Ins been found very useful when judiciously administered.—
II. Several eminent nutliorites recommend the inhalation of carbolic
acid in the form of spray, varying from half a grain to one and a half
graius of carbolic acid to < nc ounce of water, in the first and second
stages of phthisis ; but where the case is very acute, and the process of
softening is going on rapidly, Dr. Marcet thinks the inhalation of the
spray might be attended with dangor, from its depressing influence
over the actiou of the heart. The authority we have quoted ad¬
vises a very cautious administration of this spray, and if giddiness,
faintness, trembling, with a permanently weakened pulse, or any in¬
creased irritation in the lungs should result from the treatment, it should
be nt once discontinued.
Entire Wheat Flour. —We have to hand a sample of Chapman and
Co’s Entire Wheat Flour made at their mills, Hatcnam. The use of the
whole of the grain is now pretty generally acknowledged. Besides its
u.'C in the nursery as children’s food, the manufacturer states that it
makes excellent puddings, custards, &c. It contains the earthy salts
aud the other substances which exist in the outer coats of the wheat, and
which are not found in ordinary fine wheat flour.
The following letter addressed to a contemporary has been forwarded
to us, with a request for its publication in our columns
Liebig’s Extract of Meat Company, Limited,
43 Mark lane, London, November, 1868.
Sir,—Y our last number, dated 31st Oototer, refers to assertions of a
Dr. Kemiuerich that Liebig’s Extract of Meat acts, in large doses, as a
poison. You are probably not aware thit extract of meat is. in fact,
nothing but solid beef tea, from which the water has been evaporated,
free of fat and gelatine; and that the extract has been used both for
medical and household purposes for years past, with such increasing
success that the main difficulty of dealers generally has been to find an
adequate supply for the rapidly augmenting demand. The medical pro¬
fession, eminent scientific authorities, and Government commissions have
reported very favourably on extract or meat as an article of food, and
there has nevor been a single instance of its use having produced any
injurious effect. It is nnnifest that the iusinuation that the extract is
IKHsonous in any way is perfectly absurd.
lam,&c.,
Chas. Rotter, Secretary.
Dublin Quarterly Journal.
To the Editor of the Medical Press and Circular.
Dear Sie,—I observe that in the Medical Press and Circular of
the 2Stliult, you announced my retirement from the editorship of the
“ Dublin Quarterly Journal of Medical Science." and take the opportu¬
nity io refer in very complinientery terms to tbemanner in which the
ourn&l fia6 been conducted under my management.
It is quite true that the pressure of other engagements hus obliged me
to resign the editorship, but you have been misinformed as to my sue*
APPOINTMENTS*.
Adrien, J. W., L.K.Q.C.PI.—Medical pfficer for the Workhouse and
Fever Hospital of the Drogheda Union, Co. Louth, vice R. Kelly.
M.B.. deceuscd. ,
Anderson, W., L. K.C.P.L., M.R.C.8.E., L.S. A.—House-Surgeon to Ur
Derbyshire General Infirmary, late House-Surgeon at St. Thomas
Hospital. „
Ash, V., M B., L.R.C.P.L.—Elected Med cal Officer to the RoyaHorn-
wall Infirmary, Truro.
Hallowes, A.H.B., M.R.C.S.E.—House Surgeon to the Kent O’unJT
Ophthalmic Hospital, Maidstone, vies A. H. Morrill, M.B.C.S.K,
Hardy^N., M.R.C.S.E.—Honorary District Surgeon to the Royal .South
London Dispensary.
Hart, W., L.R.C P.E<1., M.R.C.S.E.—Resident Medical Officer to the
Kilburn, Maida-vale, and St. John’s Wood General Dnqrensaiy.
Hensley, H., M.D.—Electtda Physician to the Mineral-WaterHo»pit*J.
Batli, vice J. Tunstall. M.D., resigned from ill health.
Jeafkreson, C., M.R.C.S.E,—Surgical Registrar to the Westminster
Hospital. . .
Jones, J. E., M.D., M.R.C.S.E., L.S.A., T.M.— 8urgeonto the Merioneth
Couuty Gaol at Dolgelly. vice Win. Williams, F. R.C.S., dcceased-
Leonard. W.—Resident Medical Officer to St. Mary’s Hospital. Mancha-
ter, vice F. Orton, M.D.. resigned.
Taylor, J., L.R.C. P.L., M.R.C.S.E.—Honorary’ Surgeon to the Chester
General Infirmary', vice Thomas Britain, F.R.C.S.E., resigned.
Hrllrs ait &
BIRTHS.
Leatham. —On the 2ftli ulf., at Brackaville House, CoulisUnd, the wife
of Dr. Leatham, of a son.
Ashe —On the 3th inst., at Warrcnpoir.t, the wife of Isaac Asha, Esq .
M.B., T.C.D., of a son.
DEATHS.
O'Brien.— On the 18th ult., at Fermoy, Henry O’Brien, M.D, of
Kylebeg. .
Sheppard. —On the 5th ult., at N<»w York, suddenly, while engaged in
professional duty, Dr. J. W. Sheppard, sou of Dr. J. H. Sheppard,
Abbeyleix, Queen’s County. ’ ,
Stewart.— On the 24th ult., at Edinburgh, Archibald Stewart, L.RA.?.
Ed., Inspector-General of Hospitals.
Swaine. —On the 1st inst., at St. Leonard’s place, York, W. E. Swwine,
M.D., F.R.C.8., aged 64.
Wilson —On the 23rd ult., at Cheltenham, Andrew Wilson, late Inspec¬
tor-General of Hospitals, Bengal Service, aged 66.
Young.— On the 23rd or September, Edward Newell Young, of the ship
“ Baringa," eldest son of Dr. Edward Young, of Salisbury, wuu
aged 10.
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424 The u&li'xl 1V*s *nd Circular. ORIGINAL COMMUNICATIONS.
November IB, IMS.
severe cases expire* before there is time to do much, or
anything, for his recover}', death taking place by syncope/
This form i* most frequently seen in men who are
exerting themselves in the heat of the sun while in full
dress and with their accoutrements. Sir R. Martin speak*
of powerful native officer* and trooper* falling from their
horse* during a forced march of forty mile* under a most
fierce *un, vomiting, convulsed, cold, and covered with
with a fit which cannot be accurately described* He fell
down, became unconscious, and waa admitted in a mori¬
bund condition, with a small, very rapid pulse. He died
soon after. Post-mortem 19 hours after death. Body much
decomposed. Brain intensely congested and of a pinkish
hue throughout. The puncta vasculosa were greatly
increased in number, and around the larger ones there
was a distinct halo of discolouration, due to the soaking
profuse clammy sweat, in fact, in a state of more or less of the blood through the walls of the Teasels. The ven-
r _i . _r xi __r __ i • A ... i_x i - __ t j_4.:_ a
complete «yncope. In the cerebro-spinal cases, premoni¬
tory symptom* generally give notice of the coming danger.
These are heat and extreme drynew* of the *kin, giddiness,
congestion of the eyes, extreme debility, nausea, and
frequent desire to micturate. The heat is said to be
remarkably ardent and stinging, and raises the thermo¬
meter sometime* a* high a* 107°. Sometimes delirium is
one of the earlie*t symptoms, the patient* starting up
evidently much alarmed, staggering along, and struggling
tricles contained a quantity of deeply-tinged bloody fluid.
The substance was of firm consistence, and the central
parts were not broken down. The lungs were very much
congested, especially the lower parts, where they had the
appearance ol pulmonary apoplexy, except that the con¬
gestion was not in circumscribed patches, but uniformly
diffused. The heart was uncontracted and empty, its
structure was fatty and rotten, and the valves blood¬
stained. The blood was universally fluid. The liver was
cviuciivij iiiuvit MiuiiitLu. nuig-Li i anu ouuj^juu^ niaiucu. x uc uiuvu ntw uuiwtoiuij * j— *
violently when laid hold of, or uttering wild shouts of natural. The spleen soft and full of blood. The kidneys
i .. i a . _ i__:_ • i . _ i x ii a - _ . . . _ ... i j .i_._i_ r..n / r_i oao T.«1«r
laughter, or becoming incoherent in their talk, threaten¬
ing, and quite maniacal. French soldiers in these circum¬
stance* have often committed suicide. After a longer or
shorter continuance of the above symptoms the patient
becomes insensible *, the heat and dryness of the skin
augment } the respiration become* hurried, noisy,
laboured ; the pupils contract and are quite insensible to
light j the eye* become more congested ; the heart's
action tumultuous ; the pulse, sooner or later, feeble and
irregular ; and death takes place by coma, with or with
out convulsions. When convulsions exist they may occur
at an early or late period.
In the mixed form the symptoms of both varieties are
blended, and death occurs partly by coma, partly by
asthenia. A great majority or the favourable cases, it is
stated by Sir R. Martin, occurring during a march, belong
to this mixed condition.
The heat of the blood is no doubt in all cases increased,
were congested and the tubes full ( Lancet , 1868, July 25).
Congestion of the lungs is one of the most striking and
frequent phenomena revealed by dissection, but it is not
constant. Out of forty-seven cases tabulated by Mr.
Mercus Hill, there are eight in which it is stated that
the thoracic viscera were nealthy, except extensive adhe¬
sions in several. In another there was only partial hepa¬
tization of the left lung, and in some others the conges¬
tion does not seem to have been at all excessive. In
one case the right lung was healthy, but the left was
excessively gorged with blood. In several instances there
was either bloody fluid in the pleural cavity or ecchy-
rnosis, or diffused extravasation beneath the pulmonary
pleura. The right cavities of the heart were not invari¬
ably distended. Most probably in all where the lungs
appeared tolerably healthy there was nothing unusual in
their condition. In some it is said that theheart was empty
The evidence that the brain may be con-
, and natural. -- -
though this point does not seem to have been extensively gested as well as the lungs seems to me decisive ; there
examined as yet. Dr. Baiimler has recently recorded a is the same description of gorged vessels and of blood-
very interesting case of heat-stroke, occurring in London stained effusion in not a few instances.
(luring June, I860, in which the temperature m the axilla Before quitting this part of my subject I will record
was 109°.2 soon after the seizure. Ice w r as applied freely another case which, by its contrast with the preceding,
all over the surface, and the patient placed in a tepid bath may serve to put us on our guard against the error to
at 80° for a short time. The temperature gradually which we are too liable, of laying undue stress on palpable
declined, mid about two hours before death was only
102°.4. In some cases treated by Dr. Levick, at Phila¬
delphia, the temperature was also very high, in two
amounting to 109 w . It is worth remarking that iu Dr.
BaumleFs case there were frequent loose evacuations from
the bowels, consisting of a light yellow fluid with flakes
like coagulated albumen.
The results of host-mortem examination so far os we
are
The blood is invariably fluid, that is to say, has lost its
power of coagulating; and as this depends on the fibrine,
we must regard this constituent as in *ome way deficient
or gravely altered. The lungs are prone to be extremely
congested, sometimes quite black and presenting the
appearance of pulmonary apoplexy; occasionally the con¬
gestion has advanced to actual extravasation, the bronchial
tubes being Ailed with frothy serous blood. The brain
and its membranes are sometimes also extremely com
gested, but less constantly and less intensely than the
lunge, feir R. Martin considers that the more or less
alterations compared with those which are not so evi¬
dent to our senses. A. D., boy, set. 8, was admitted into
St. Mary's Hospital on July 30th of the present year. His
mother states that on the 29th he had been out all day
in the sun without a hat, and without having any food.
In the evening, when he came home, he was convulsed
and fell down insensible. These convulsions occurred
during the night, and when brought in he was quite
acquainted with them seem to be tolerably oonstant. I insensible, with deep stertorous breathing, pulse at 62.
. . ... . The next day (31st), at 11.30 a.m., he lay quite uncon¬
scious ; pulse 78, jerky and thready ; pupils rather
dilated, contracting on application of light; breathing
stertorous ; skin of head hot; respirations 25 per minute.
During the night he had several convulsions, and
about this time (when the notes were taken) he had
another fit lasting two minutes ; the mouth was drawn
to the right side, the right eye turned inwards, the pupils
widely dilated, tne hand and leg drawn upwards. Temp,
iu 100°.
_„ . - - _ ____ _ Post-mortem, one day after death. Body well nourished.
rapid course of each case modifies the jyost-mortem results. Some froth and mucus escaping from the nose. A little
Where death takes place rapidly in the way of syncope, fluid in both pleura. Adhesions, partly of recent forma-
there are found but slight traces of disease within the tion, existed on both sides. Lungs were bright red, a nd
cerebral cavity, but intense pulmonary engorgement is in some parts appeared congested, but were everywhere
present, ending sometimes in pulmonary apoplexy; while crepitant, except a few lobules which were unexpanded.
In cases of slower progress we find the vessels of the dura In the lower lobes of both were many bright red patches,
mater gorged almost ~to bursting, and more or less con¬
gestion of the brain itself, with copious and extensive
serous effUsion on its surface and w itniu its ventricles. I
subjoin the record of a fatal case which occurred at St.
George's Hospital during the present year. A man, set.
60, was seised some time in the afternoon of July 16th
and some quite pale. They were often arranged so that
a red patch of one-eighth or one-fourth of an inch diameter
was surrounded by a pale anaemic zone ; these patches
did not correspond with the lobulea. There were a few
spots of extravasation which appeared to be capillary.
Bronchi filled with purulent mucus, their lining mem-
Digitized by kjOOQle
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SYPHILITIC DEPOSIT OF THE HEART,
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Ky M R. M 0 R G A N, F. R. C. S. I.,
SURGEON TO THE WESTMORELAND LOCK HOSPITAL, ETC.
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The lfediol Proa end Circular.
ORIGINAL COMMUNICATIONS.
November 18, 1898. 425
br&ne highly vascular. Microscopic examination of lungs
showed no inflammatory cells or other products except in
the bronchi Heart contracted ; both sides contained
blood ; the right side was not remarkably fulL The
blood was particularly apt to stain, its coagulation was
very imperfect. There were soft black, but no white
clots ; some bubbles were seen in the right ventricle.
On microscopic examination many small white masses
were seen, just large enough to be visible to the naked
eye ; these appeared to be clots containing a great number
of colourless corpuscles. Liver and kidneys perfectly
healthy. Spleen small and hard, its Malpighian corpus¬
cles were very evident Brain anaemic and dry, its sinuses
very empty, not many puncta vasculosa. The symptoms
during life in this boy, and the mode of his death, were
closely similar to those observed in the case at St George’s,
but the post-mortem phenomena were very different. The
lungs in the former were but slightly congested, the brain
absolutely pale, and the heart well contracted, without
any notable accumulation of blood on either side. In the
elderly man all this was reversed ; the only point of resem¬
blance is the uncoagulated state of the blood, and its ten¬
dency to allow the colouring matter to escape from the
red cells. It seems plain that some less visible alteration
must have existed which was common to the two cases.
It may be mentioned here that meningitis is occa¬
sionally the result of exposure to the sun, even when the
head is covered. I have seen one such case myself, and
another occurred a year or two ago at St. Bartholomew^
(I think).
I proceed to cite some cases of minor severity, which,
nevertheless, appear to me of very great value, and
capable of indicating to us the true pathology of the
malady perhaps even more clearly than those where the
events are more numerous, more complex, and on a larger
scale. A well-known physician related to me once nis
personal experience of sun-stroke. It did not affect him
notably in any other way except that he slept almost con¬
tinuously for forty-eight hours. He suffered, in fact, a
moderate coma. Dr. Strange, in a highly interesting
paper in the British Medical Journal , 1868, August 29th,
relates the following case A stonemason, a strong,
muscular man, working at a short distance from the hos¬
pital one hot day early in the season, was brought in in
a state of partial collapse, the result of sudden sun-stroke
while at work. He stated that he had suffered from the
heat for the previous two or three days. Having recovered
from his collapse, he exhibited the next day the following
symptoms, viz.—considerable dulness of apprehension,
loss of memory, hesitation of speech, with defective sensa¬
tion and motion over the whole of the body. The skin
was cool, and had been so all along ; the pulse slow and
small ; there were sleeplessness and anorexia. With cold
shower-bath, aperients, nourishing diet, and afterwards
quinine, he slowly improved, but was unable to leave the
hospital on account of the defective sensory and motor
power of the limbs. He was Faradised, ana after three
months was discharged pretty well. In a second case
the patient, a slim youth of 18, after exposure to a broiling
sun, suffered collapse. In the evening he had vomiting,
smart fever, rigors, with preceding pain in head and hot
skin. The next aay the vomiting continued, the thirst
was excessive, he had pain down the spine and in all the
muscles, and at night delirium, which continued to recur,
and was exceedingly violent on the fourth night. A ten¬
dency to syncope was occasionally present. With ice to
the head and internally, tepid sponging of the surface,
and beef tea with brandy every three hours, the patient
became rapidly convalescent. In a third case a man,
set. 48, energetic and muscular, after much exposure to
the heat, suffered with weariness, pain in back of head
or down spine, inability to sleep after two a.m., and great
and causeless anxiety. He was speedily cured by bromide
of potassium. Dr. Duller (British Medical Journal } Aug.
22nd, 1868) relates the case of a lady, set. about 30, strong
and unused to illness, who, while walking in the street
on a very hot day, was suddenly seized with pain in the
head, giddiness, faintness, and a sensation as if she should
die. She looked so ill when seen as she was returning
home, that she was with difficulty recognised. For nearly
fourteen days she remained very ill, suffering with sleep¬
lessness, disturbed nights, anxious fearful days, with
occasional aggravated attacks of pain in the top of the
head, which was hot, confused vision, vertigo, sickness,
loss of power in her limbs, palpitation of the heart and
irregular quick pulse, with a sensation of coldness of the
body, and often a distressing anxiety as if she were going
to die. Quiet, cold to the head, aperients, and bromide
of potassium were serviceable ; ana subsequently much
seems to have been effected by a combination of small
doses of calomel, tartar emetic, and muriate of morphia
given repeatedly. In a case at present under my care in
St Marys Hospital, the prominent symptom of the first
seizure which the patient had in England (he had had one
previously in Japan) was loss of sight, which lasted a few
minutes. In a third attack he became unconscious, as he
did in his first
(To be continued.)
-♦-
CASES OF SYPHILITIC DEPOSIT IN THE
HEART.
(See Engraving.)
With Observations thereon
By John Morgan, F.R.C.S.I.,
Professor of Practical Anatomy in the Royal College of Surgeons in
Ireland and Surgeon to Mercer’s Hospital.
The insidious and not infrequent formation of
a gummata ” on late syphilitic deposits in the various
internal organs has always been a point of interest in the
history of the later stages of the disease, their formation
having been observed in the osseous system and viscera,
both thoracic and abdominal; and many anomalous
symptoms have been explained by jmt-mortem detection.
Their occurrence as in the subjoined case on the heart
is remarkable. In this instance death was gradual and
slowly produced, contrary to most of those hitherto
recorded, where death occurred suddenly, and without
warning of any pre-existing cardiac lesion. In this
instance, also, there can be no question as to the satura¬
tion of the system with the syphilitic poison, and its
external evidences at the time of death.
S. B. (Ward No. 1, Bed Q) was admitted June 8, 1868,
suffering from leucorrhceal discharge and general debility.
Has been upwards of twenty years unvirtuous, and
ghteen years ago was treated in hospital for genital
►res. She was then hardly seventeen years of age, and
had ever since led an unvirtuous life, with its concomi¬
tant evils of dissipation, exposure to cold, &c.; having
been five or six times affected by sores, the dates of which
it is not easy to obtain with any reliability, and two or
three times by gonorrhoea, about ten years ago she had
a “ rash,” not to such an extent as, she remarked, to dis¬
figure her, and which was cured out of hospital. She had
never observed any other results of the primary sores,
nor till lately suffered in any way from pains, sore throat,
or other well-marked constitutional affections. She never
took mercury in any form. On admission she presented
the appearance of* one considerably advanced in age,
lookingfully twelve or more years older than she really
was. The limbs were verv thin ; the neck and face
slightly puffed and of a clingy hue ; the lips blueish.
She suffered much from coldness and lassitude. The
breathing was 22 per minute. The pulse was remarkably
feeble, but regular, varying from 56 to 66 according to
position. The area of cardiac dulness was considerably
diminished ; the impulse also was less perceptible both
to the eye and touch. There was no abnormal sound,
but diminis hed intensity of the first. There was no
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426 The Medical Press and Circular.
ORIGINAL COMMUNICATIONS.
Noranber 11, ym.
evidence of disease of the lungs; the other viscera seemed
healthy, and the liver was not enlarged. She was now
suffering from pains in the shoulder and knee joints,
thickening of the periosteum of the left tibia, and the
formation of three gummy tumors on the thigh and one on
the shoulder, the latter having nearly proceeded to ulcera¬
tion. She was ordered generous diet, stimulating mix¬
ture, with cinchona, wine, &c., freely.
June 11, 1868. — She complained a good deal of
palpitation and precordial uneasiness, and of increas¬
ing debility ; could not rest. There was no ortho-
pnoca, but the breathing was at times greatly hur¬
ried. There was some dilatation and slight pul¬
sation of the right external jugular vein, and a faint
bruit over the heart and great vessels. The subse¬
quent history of the case is that of gradually increasing
debility. The pulse became feeble, till for several days
preceding death it was hardly perceptible, feeling as a
mere wave or undulation under the finger. The semi-
congested appearance of the face increased notably, but
not to an inordinate degree. The heart sounds became
more indistinct. There was much irritability of stomach
at times, and notwithstanding an abundant use of stimuli
and nutrition, finally the patient “ died out,” without
suffering from any special or overwhelming symptom, on
July 24, 1868, six and a half weeks after admission. Two
of the gummata had nearly ulcerated, and the pains in
the joints had diminished.
• A post-mortem examination was made 18 hours after death.
The body was emaciated, and rigor mortis well marked.
There was slight puffiness about the neck and face. The
pericardium was healthy, and contained a few drachms of
fluid. The right side of the heart was distended, and the
organ itself was small, weighing but five ounces, indica¬
ting chronic failure of nutrition, as occurs in phthisis,
cancer, and other wasting diseases. On opening the right
ventricle a large clot nearly filling the cavity was to be
seen (as shown in the illustration) entangled in and
forming around the earn® column®, whitish, very firm,
dense, and fleshy-looking. When torn away from the
lining membrane, to which it was adherent but not
covered by, it came in shreds, or lamina, and in section
was solid. Its formation must have been altogether ante¬
mortem , and by its increase and density it encroached on
the cavity to a very great extent. The infundibular por¬
tion of the ventricle was quite free from coagulum and
empty. The right auricle was distended with a soft,
gelatinous, and coloured post-mortem clot, extending into
the superior vena cava. The left ventricle was of small
size and apparently healthy, but towards the apex on the
anterior aspect presented one smaller, and two larger
elevations or nodules, both being raised about half
a line oyer the level of the ventricular wall,
as shewn in the illustration, accurately drawn by Mr.
Grey. To the touch they felt firm, and on section
were found to penetrate one-fourth into the sub¬
stance of the ventricular wall. The colour was not the
yellow tubercular hue depicted by Ricord in his case (plate
29), but was more of a very pale flesh or cream colour.
On making a section the edge of these deposits was toler¬
ably defined, but at the deeper part, where imbedded in
the fleshy substance, not so plainly discernible. On the
posterior aspect of the left ventricle another smaller de¬
posit, but more distinctly marked, was also seen embedded
m like manner. The cavity contained a small, dense, whitish
blood concretion, entangled amongst the earn® column®.
The wall of this ventricle was half-an-inch thick, while
that of the right was thinner and denser than usual, as
shewn in the section. There was no valvular lesion what¬
ever. The lungs were healthy and contained no deposits.
There were a tew old adhesions. The liver was rather
small and pale, not indurated, and presented on the under
part and towards the thin edge three deposits, hardish,
slightly yellow, raised over the surface, and about the
superficies of a sixpence. The other viscera were healthy.
The head was not opened.
The occurrence of syphilitic deposit or gummy tumor
in the heart itself, though recognised by Virchow, Ricord,
Haldane, and others, is rarely demonstrated. The forma¬
tion of these tumors in the tongue as the prelude to tuber¬
cular ulcers, and in the muscles themselves, is undoubted,
having been seen in many of the large voluntary muscles,
such as pectoralis major, sterno-mastoid, vastus, glut®os
maximu8, trapezius, etc., exactly analogous to the well-
known gumma of the cellular tissue,—one of the latest,
but by no means the least troublesome manifestations of con¬
stitutional infection, commencing as a hard nodulei £ the
cellular tissue, gradually leading to ulceration, and con¬
sisting microscopically, according to Robin, of “ rounded
nuclei belonging to nbro-plastic cells, or ‘ cytoblastiona,’
of a finely granular, semi-transparent, or amorphous sub¬
stance, and finally of isolated fibres of cellular tissue, a
small number of elastic fibres, and a few capillary blood
vessels.’* Bouisson remarks, speaking of syphilitic turnon
in the muscles : —' u It is difficult to determine whether
the earliest change takes place in the muscular fibrils or in
the intervening cellular tissue, although analogy would
lead us to believe that it is the fibro-ceQul&r element con¬
necting the fleshy fibres or serving as their sheath that is
first involved. 11 On microscopic examination of the
tumors in this case, the muscular fibres oould be seen
around the section of their natural appearance ; in the
interior they were few, and surrounded by a homo¬
geneous, dense, structureless material, in which I did
not detect any granules. To the feel these tumors were
firm, and felt to the knife dense and easily sliced.
The case related and illustrated by Rioord (“Iconographie,’'
plate 29) presents a history, as in this instance, of a long¬
standing constitutional infection, and its manifestation by
the formation of gummata or external deposits. The patient
received his first sore in 1824, another in 1896 ; between
1829 and 1834 he had several sores. In 1834 he got a
sore, followed by swelling of the inguinal glands,
succeeded by mucous patches. He remained apparently
cured till 1845, when " tubercules ” formed, followed by
ulceration, both on the shoulder and penis. While
under treatment, and apparently going on favourably, he
suddenly died. On post-mortem examination the heart
was found hypertrophied, the right ventricle containing
soft coagula, and its endocardial lining thickened ; not
so in the left. The walls of both ventricles contained
deposits of a yellowish matter, dense, w criant,” to the
knife, and in some places of a “ squirrhoYde ” consistence
and in others like tubercular matter in procen of
softening; “ in a word, of syphilitic tubercules, a tertiary
evidence often found in the subcutaneous and submucous
cellular tissue.” " Around these morbid products there
was no disturbance, * refoulement,’ of the muscular fibres,
for the degeneration was in the substance of the muscular
fibre itself”
From inspection of M. Ricord’s plate, the heart con¬
trary to the condition in this case, was very considerably
hypertrophous, and the deposit more abundant and tuber¬
cular in appearance.
Mr. Haldane has given a case of syphilitio deposit in
the heart, but without the co-existence of other indica¬
tions of the disease, and where death ensued suddenly.
Here also the heart was largely hypertrophous (Edin¬
burgh Medical Joxtmal),
Dr. Walshe remarks, page 355 :— u Some years ago I
opened an individual cut off by tertiary syphilis, whose
heart presented appearances suggesting the possibility of
productions similar to subcutaneous gummata being found
therein,” but no mention is made as to the condition of
the heart’s substance, whether hypertrophous or not.
With regard to this case, it is curious, and illustrative
of the modifying effects of the system, that signs of con¬
stitutional syphilis showed themselves but once in up¬
wards of twenty years, and that not till a few months
before decease did well-marked signs of general infection
develope themselves.
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ORIGINAL COMMUNICATIONS.
November 13,1868. 427
ON RAPID DILATATION WITH THE SCREW
DILATOR, WITH CASES.
By Charles Owen Aspray, M.D.,
Fellow of the Royal College of Surgeons, Edinburgh; Honorary Con¬
sulting Surgeon to the Islington and North London Provident
Dispensary.
Before commencing the use of any instruments for
the cure of stricture there are many points, such as the
state of the general health and the condition of the urine,
that should be considered. If the uric acid or oxalic acid
diathesis be present it should be removed by the appro¬
priate remedies. I have observed that in old men stric- 1
tures which formerly were very tight have relaxed con¬
siderably, and in these cases I have generally found the
mucous membrane peculiarly flaccid, and puckered into
folds. These, by acting as valves, produce the symptoms
of stricture. Under these conditions the use of Binall
instruments is contra-indicated, and the free injection of
oil will be of great advantage in facilitating the passage
of an instrument. When the stricture is suspected to he
tight, the patient should be requested to make water in
the presence of the surgeon, who would then be guided
by tne size of the stream as to the sized instrument he
ought to attempt. If the stream jets straight out from
the penis an instrument of the same size may he passed,
but if on the other hand the stream only trickles without
force we should begin with an instrument of not more
than half its size. When the urine passes only by drops
the soft filiform bougies (not catguts) should be used, if
the stricture is at the bulbous portion. Before commenc¬
ing the treatment of a deep stricture we should always
attempt to pass a full-sized instrument ; when, if there
is an obstruction at the orifice, it should be removed by
the dilator before proceeding further. Without this pre-
linainaiy precaution the case may easily be mistaken for
one of deep stricture with deviation, as the same want of
improvement will follow the passage of instruments in
both cases. An orificial stricture may allow a No. 7 or 8
bougie to be passed and yet produce retention. I have
always treated a stricture at the orifice first, even if there
was evidence of another obstruction farther along the
canal Unless removed, the orificial stricture interferes
with manipulation, and it obscures the symptoms of
progress in the deep stricture. I have frequently seen
patients treated for stricture at the bulb, when dilatation
of the canal has been carried up to No. 7 without materi¬
ally increasing the size of the stream. On trying then to
pass a No. 8, a stricture has been found at the orifice, the
existence of which was previously unrecognised. Dilata¬
tion with the large-sized screw dilator will work wonders,
as opposed to the usual method with ordinary instruments.
The meatus should be made larger than the natural size,
as there is sure to he some contraction after the operation .
Strictures in the penal portion of the urethra partake
more or less of the resilient character of those at the
orifice, often producing retention, especially after the
passage of instruments, which is very rarely the case with
strictures at the bulb. As I shall hereafter show, reten¬
tion is very rare after dilatation with the screw dilator,
whereas it" is a common occurrence after the passage of a
small instrument. Thus it will he safer to dilate rapidly up
to No. 6, than to pass a No. 1 metallic instrument, ana
withdraw it directly. The reports of two cases of stricture
will be found further on, in which ordinary dilatation
failed totally, but recovery was rapid with the use of the
screw dilator.
The instrument below was first introduced to the notice
of the profession in the Lancet, August 11th, 1866. It
has the following advantages. It will dilate from No. 1
to No. 6, 9, or 12 quicker than any instrument yet pro¬
duced. Little pain is caused, and there is seldom any
abrasion of the mucous membrane. As soon as No. 1 is
passed, dilatation can he commenced without withdrawing
the instrument, which is often replaced with great diffi¬
culty. A soft catheter may be passed over the guide and
allowed to remain, the guide being removed.
The instrument is composed of a No. 1 catheter (A),
having a small handle (B), which can he removed when a
screw is loosened. When this handle is withdrawn,
the dilator (C), [having the conical screw (D) at the
end, can be passed over the catheter, and worked by the
handle (E). The dilator may he the size of No. 6, 9, or
12, and has a thin metallic cover reaching from the handle
(E) to the screw (D), working smoothly oyer the tube
beneath. This is for the purpose of steadying the penis
while the screw works in the stricture ; it also prevents
any abrasion of the anterior portion of the urethra. The
soft catheter (F) may he passed over the guide into the
bladder after the dilator is withdrawn, and allowed to
remain. The metallic rod (G) screws into the guide (A),
so as to lengthen it while the dilator and soft catheter are
passed over.
The method of using the instrument is as foBows
The catheter No. 1 is first passed into the bladder (which
of course should he made certain by the urine passing
through it); the handle being removed and the metallic
rod screwed in, the screw of the dilator is freely oiled and
passed down the urethra until the obstruction is felt,
when the penis should he grasped firmly with the left
hand, and pulled down over the dilator while it is screwed
through the stricture. The operator must he careful
during this part of the proceeding, not to push the
guide catheter with the hand; and next to unscrew the
dilator when withdrawing it. If this he attended to, the
operation is done without pain, hut if the instrument he
pulled without any rotary motion it will require som e
force to disengage it, and be painful to the patient. The
dilator being withdrawn, the soft catheter is pushed into
the bladder over the guide, which is then taken out, and
the gum catheter allowed to remain. I have found a
soft catheter one or two sizes smaller than the dilator to
be of equal benefit with one of the same size; it is le“
trouble to pass, and produces no pain or abrasion. The
428 The Medical Press and Circular. ORIGINAL COMMUNICATIONS.
November 1% 1961
nstrumeut will afford a very rapid means of cure in cases
of urinary fistula, and in sucli cases the soft catheter
should be used. In the majority of cases it will not be
necessary to leave iu the gum catheter, and an instrument
should not be used for some days after the operation,
when probably a catheter the size of the dilator used will
pass with ease. The way of telling when the screw has
passed the stricture is very simple. As long as any part
of the screw remains in the stricture it will be felt to be
held by turning the handle, but when it has passed quite
through and the stricture presses on the metallic cylinder
only, then it is clear that the screw and handle will be
freely moveable and the cylinder be held firmly.
In tight irritable strictures, when a No. 1 is introduced
for the first time and is obliged to be withdrawn, from
the irritation produced or from the inability of the patient
to stop in bed, retention frequently follows, and the same
difficulty as at first, is experienced on each attempt to
introduce an instrument of the same size. Where the
No. 6 dilator is used under these conditions the gum
catheter should be kept in one night, and in the morning
the stream will be the size of No. 5 or 6. On the other
hand if a catheter can be retained, in two days we may
get in a No. 3, but the patient has all the pain and in¬
convenience of lying in bed with the catheter in the
bladder for that time. From the above it must be
apparent that great advantages attend the use of the
dilator.
We should always be sure that the guide catheter is in
the bladder, otherwise it is impossible to use the dilator
properly, especially when the stricture is situated in the
bulbous portion of the urethra. When the dilators, Nos.
6, 9, and 12, are used in succession a week at least
should be allowed to intervene between the operations,
no instrument being passed in the meantime. In case
No. V., given at the end, gradual dilatation up to No. 12
catheter had been employed eight months previously; the
cure took fifty-two days to effect, out of which he was in
hospital fifty-one days. With the use of the dilator, a
No. 10 bougie was passed in eighteen days, but urine was
passed in a good stream five days after the treatment was
commenced; the patient did not keep his bed a single
day, and he now keeps perfectly well with the occasional
passage of a bougie.
In most cases I use the No. 6 dilator only, and
it must be remembered that half the full dilatation
is accomplished with that instrument, and by far
the most difficult half. It may also be observed
from the following reports that all the symptoms which
are of any inconvenience to the patient disappear
directly after its use; the next day the bladder is quite
emptied, and that quickly and with ease ; there is no drib¬
bling after making water, the urine if it has been thick
previously becomes clear, and the patient does not get up at
night to micturate. From this local relief, and the con¬
sequent freedom from anxiety of mind the general health
rapidly improves, and the patient, with the occasional use
of the bougie, will remain free from symptoms of stricture
for the rest of his life.
Case I.—February 24th.—C. W. H., £et. thirty-one ;
married. Very tight double stricture at the bulb of two
years and a-half standing. He was sent to me by a patient
on whom I had operated with the dilator. Stream very
small and without force; micturates frequently during
the day, and is obliged to get up for the same purpose
at night; feels pain during coitus. He has had a gonor¬
rhoea once and gleet for six months after; he is very
anaemic ; urine normal. On attempting to pass an instru¬
ment he became faint.
February 26th.—Passed an instrument through the first
obstruction, but was stopped by a second.
March 5th.—Again passed a No. 1 into first stricture.
Tr. ferri sesquichlor., TT^xx. ter die sum.
March 10th.—Passed No. 2 into first stricture.
March 24th.—Passed No. 2 into first stricture. Cannot
attend oftener.
March 31st.—Passed No. 1 guide into bladder, but he
became faint. Tr. opii, fl^xx. h.s.s.
April 7th.—Passed No. 1 guide, and U3ed a No. 6 dilator.
The dilator passed easily through the stricture and there
was only a trace of blood. Left in a No. 41 gum catheter.
14th.—Used a No. 9 dilator and left in a soft
catheter. He kept in the catheter all night after the List
operation. Micturates only four times in the twenty-four
hours, and does not get up at night.
21st.—Passed No. 9 steel,'sound ; stream of natural
size and he has no trouble in any way.
28th.—Passed No. 10 steel sound ; thinks his stream is
larger than it was before he had stricture. His health is
better than it has been for years, and he has no pain
during coitus.
May 5th.—Passed No. 11 steel sound.
19th.—Passed No. 12 steel sound. Cured.
Case II.—R. J., aet. 60 ; stricture at orifice, which he
has had many years. He passes a No. 5 gum catheter very
frequently, but still the stream is very minute, and he
constantly suffers from retention.
June 1st.—Passed No. 5 steel sound.
6th.—A No. 3 guide was passed and a No. 12 dilator
screwed through the stricture. The instrument was very
tightly held.
20th.—Passed No. 11 olivary bougie. Is to use a No.
10 himself. Stream full size. Cured.
Case III.—R. W., jet. twenty-six ; pale and care-worn.
Had a gonorrhoea eight years ago, and was discharged from
the navy a year after. He was at Ilaslar Hospital
when he first noticed that he could not hold his water,
which ran from him all day. He has worn a urinal now
for a long time, but can pass a very minute stream for a
second or two, if he strains very hard. The bladder is
always found distended, reaching above the pubc<. He has
never had any instrument used. The stricture is situated
three inches from the orifice.
June 11th.—The point of a small catgut was passed
into the stricture.
13th.— No better.
16th.—Has a bougie passed down to the stricture daily.
26th.—The smallest catgut was passed through the
stricture. A catgut was passed on the 2nd and 4th of
July, but finding that a larger instrument could not be
passed it was determined to use the screw dilator.
July 9th.—The No. 6 dilator was used, about half the
screw going through the stricture.
10th.—He has had no dribbling in the night, and has
done without the urinal for the first time ; stream larger.
11th.—No. 6 dilator passed into stricture.
12th.—Stream much larger, does not dribble at all.
14th.—No. 3 steel sound passed.
16th.—No. 3 steel sound passed through, and No. 4
into stricture. Holds urine four hours.
18th.—No. 6 dilator was passed through the stricture.
19th.—No. 7 steel sound passed.
30th.—No. 8 steel sound passed.
He now has No. 10 steel sound passed once a month ;
he is free from symptoms of stricture and his general health
is good. Cured.
Case IV.—E. F., set. 24. Had gonorrhiea six years
ago, and gleet for six months after. Has had frequent
attacks of retention, for which he went to the Charing
cross and Middlesex Hospitals, but no instrument was
July 25th.—Found a stricture three inches from orifice,
but could not pass an instrument.
August 6th—Passed a small catgut through first stric¬
ture, but was stopped by another at the bulb. I passed a
No. 6 dilator over the catgut, and dilated the first stric¬
ture.
8th.—Stream the size of No. 3.
13th.—Passed No. 3 into the bladder.
16th.—Passed guide into bladder, and used No. 6 dilator
to the second stricture.
After this he was obliged to leave town, but I heard
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ORIGINAL COMMUNICATIONS.
November 18, 1868. 429
from his medical attendant that he had no trouble from
the stricture.
Case V.—W. P., cet. 20. Tight resilient stricture three
inches from orilice. He had an instrument passed in June
last, passes urine only by drops, and is often obliged to go
to stool from the straining when he passes water. Mictu¬
rates very frequently in the day, and is obliged to get up
for that purpose three or four times at night. I passed a
No. 1 on many occasions, but a larger instrument would
not pass.
Nov. 14th.—Passed No. 1 guide with difficulty into the
bladder, and used a No. 6 dilator. A No. gum cathe¬
ter was allowed to remain. Ordered—Tr. opii ll\_xx. h.s.s.
Sent home.
15th.—Has passed water three times in the night, and
towards morning the urine flowed by the side of the bougie.
Stream the size of No. 5.
18th.—Went to work the day after the operation.
Passed No. 5.
21st.—Passed No. 7 catheter.
24th.—Used No. 9 dilator. Ordered—Tr. opii ll^xx.
b.s.s.
25th.—Kept in a No. 8 soft catheter, which came away
into the bed about four in the morning.
26th.—Passed No. 10 steel sound ; stream large. Has
No. 11 passed occasionally. Cured.
Case VI.—W. H., a?t. 23. Very resilient stricture
three inches from orifice. Between Jan. 7th and Jan.
19th he had frequent attacks of retention, for which I
passed small catheters ; a No. 4 would never pass, and
sometimes not a No. 3.
Jan. 19th.—Passed the No. 6 dilator, and left in a No.
4h gum catheter for three hours.
20th.—Stream much larger ; no retention.
22nd.—Stream larger ; no retention. Passed No. 6
bougie.
23rd.—Passed No 7 olivary bougie into stricture.
27th.—Passed No. 9 dilator ; left in No. 5 gum catheter
for three hours.
28th.—Stream the size of No. 9.
30th.—Passed No. 9 olivary bougie.
Feb. 3rd.—Passed No. 9J. Instrument passed occa¬
sionally. Cured.
Case VII.—G. S., set. 48. Stricture at bulb. Mictu¬
rates every three-quarters of an hour, and has incontinence
of urine sometimes.
Dec. 5th.—Passed No. 3 steel sound.
22nd.—Little improvement after last instrument; passed
No. 9 dilator. Tr. opii W[xx. h.s.s.
Jan. 2.—He is much better ; has not had incontinence.
After this the dilatation was carried on in the usual
way without further difficulty, and he now has a No. 10
passed occasionally. Cured.
Case VIII.—T. H., eet. 40. Stricture in the bulbous
portion. Has had stricture six years. Stream the size of
No. 2 catheter. Gets up three or four times every night,
and micturates six or seven times in the day. The stream
is forked and twisted.
Jan. 22nd.—Passed No. 2 bougie into the stricture.
26th.—He had severe rigors after this instrument.
30th.—Passed the No. 1 guide ; used the No. 6 dilator,
and allowed a No. 4£ gum catheter to remain iu. No
bleeding or pain.
31st.—He kept in the catheter all night; passes a stream
the size of a No. 6 catheter.
Feb. 16th.—Has had no instrument passed since the
dilator was used ; has been in bed with gout. Passed No.
6 steel sound easily.
27th.—Passed No. 7 easily.
After this gradual dilatation was employed, and he has
had no trouble from his stricture since, having an instru¬
ment passed once in three weeks. Cured.
Case IX.—J. S., set. 31, married. Very tight resilient
stricture in penal portion of urethra. Instruments were
passed from the beginning of April to the end of May,
from No. 1 to No. 5, but the improvement was not great.
June 17th.—No. 13 screw used.
20th.—Much better ; passed No. 11 bougie, and after¬
wards occasionally. Cured.
-♦-
EXPERIENCES OF A REGIMENTAL SURGEON
IN INDIA.
By C. A. GORDON, M. D., C. B.,
Deputy Inspector-General of Hospitals.
(Continued from page 388.)
The nature of the injuries usually met with in Indian
warfare will best be illustrated by some examples of those
that came under observation during the mutiny of the
Sepoys in 1857-8. The simplicity of the treatment for the
most part employed on that occasion will no doubt strike
the reader ; yet it is apparent that with the cleanliness and
free exposure to the air that are practised, and are in¬
separable from active! service in that country, the con¬
dition of the subjects or such injuries is in many respects far
preferable while in the field to what they are after being
admitted into some hospitals, as those buildings existed in
connection with permanent barracks at the time to which
I refer.
For the sake of convenience I would arrange wounds
that came under notice on that occasion according to their
nature and the tissues implicated, offering such remarks as
may seem to be demanded, namely :—
A. Superficial. —The following cases will, it is believed,
be sufficient to illustrate the character, progress, and treat¬
ment of the slightest description of gunshot wounds met
with in field service, that is, those that only implicate the
cuticle.
King, 37th Foot, was, on 29th of July, 1857, wounded
by a bullet, which having passed through the left arm
superficially left as it were a bridge of skin over the chan¬
nel formed by its progress. The vitality of the portion of
skin that had been left seems to have been destroyed, as
it speedily sloughed, the sphaculated portion separating on
9th of August, after which granulation progressed favour¬
ably, and the wound healed in fifty-three days. The ap¬
plications varied. Cold water dressing was in the first
instance applied ; afterwards poultices, solution of acetate
of lead and opium, simple dressing, with for a time ad¬
hesive plaster to stimulate the surface, and again cold
water.
Bosworth, 37th Foot, was on the same occasion wounded
in the left thigh. A bullet entered its outer aspect below
the hip-joint, and running superficially downwards and
outwards, a distance of four inches and a half, escaped.
Very profuse discharge took place from the track thus
made ; but under the application of poultices in the first
instance, and then of cold water, the wound completely
healed in thirty-one days from the date of its receipt.
Murray, 10th Foot, while advancing on the fort of
Dowrarah, was struck by a bullet which ran along the top
of the left shoulder, tearing a channel through the cuticle
posterior to the acromion process. There was no shock .
Cold water dressing was applied, and on the fourth day
afterwards a line of demarcation had begun to form between
the thin layer of sloughed tissues below the track of the
missile and the healthy parts. Six days afterwards it had
completely separated, leaving a somewhat extensive but
clean granulating surface. The edges were then as much
as possible drawn together by adhesive straps ; simple
dressing was applied, and under these measures healing
steadily proceeded.
Remarks .—With reference to these cases I would observe
that the two men first named were not admitted until the
second day afterwards ; that they were treated in hospital
at Dinapore, the building being not only extremely ill-
adapted for its purpose, but at the time crowded with
wounded, the remnant of the unfortunate force that was
surprised at Arrah. Added to these circumstances was
that of the rainy season being at its height, and the at¬
mosphere consequently damp, hot, and depressing. The
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430 Tl*o Medical Brea* and Circular.
ORIGINAL COMMUNICATIONS.
November 18 , 1868 .
building was, moreover, from its construction, unsuited for
thorough ventilation, and cleanliness was extremely difficult
to maintain with only a native establishment. It is there¬
fore evident that their subjects were placed in the most
unfavourable circumstances that they could be.
B. Muscular. —Curry, 37th Foot, was at Arrah wounded
by a bullet, which having entered below the middle of the
left clavicle and passed outwards and downwards, escaped
through the deltoid muscle. The bone was uninjured ;
there occurred no haemorrhage, and the wound appeared to
implicate no tissue of importance. Under the application
of • cold water dressing, it completely healed in thirty-one
days, and at the end of that time the power of the arm
remained unimpaired.
Tawney, 37tn Foot, at the same time received a bullet
in the right leg, through which it passed from behind, for¬
ward between the tibia and fibula, but without injuring
either of these bones, or destroying a vessel. A tubular
slough in due time formed and separated. Cold water
dressing was alone applied, and in thirty-five days after
the injury he returned to his duty, the opening of exit
having been the first to close.
<7. Encysted Bullets. —Sherlock, 10th Foot, was wounded
by the mutineers at Benares. The bullet entered about
the centre of the left hip, about two inches below the crest
of the ilium, and was believed to have become firmly im¬
pacted in the bone. For some time he was treated in the
detachment hospital by Assistant-surgeon Tulloch,* and
only reached head-quarter3 upwards of four months after
having received the injury. At a consultation which was
then held it was considered advisable to make no attempt
at recovering the missile. A sinus then existed, but it
gradually healed up, and in six weeks more the external
Opening had entirely closed. He was sent to England as
an invalid.
D. Banes of Lower Extremity — Patella .—McCormick,
37th Foot, sustained a gunshot wound across the left
patella. On admission it did not appear that that bone
was anything more than grazed by the bullet ; the wound,
however, became rapidly painful, its edges swollen, and
much constitutional disturbance set in. A week after¬
wards it became evident that the patella had been com¬
minuted. A large portion of it was found to be loose and
was accordingly removed. The limb had at first been left
loose, water dressing being applied to the wound ; subse¬
quently it was secured by a splint, leeches were applied to
the knee, ipecacuan and James’s powder given internally,
with cream of tartar drinks. The pain and constitutional
disturbance continued, and when seen by me nineteen days
after the receipt of the injury he was suffering severely.
I resolved to amputate the limb, but a severe accession of
pyrexia occurring, the operation had to be postponed till the
following day; meantime the patient had an apoplectic
seizure and died. Examination of the limb discovered a
large quantity of offensive pus and gas welling .from the
knee-joint* which was then seen to have been extensively
injured.
The remarks appended to this case state that death
probably arose from Pyaemia, and that had primary ampu¬
tation been performed, the man’s life would in all proba¬
bility have been saved. It may be illustrative in these
vf Femur. —Carey, 10th Foot, nine days before admis¬
sion had been shot by a musket bullet through the left
femur. The bone was extensively shattered ; the parts in
and around the wound suppurating, disorganised, and
offensive. Amputation was as a last resort performed, but
too late. The operation took place on the tenth day after
the receipt of the injury, but on the succeeding, the patient
sank and died exhausted. This man had been carried
from place to place after the receipt of his wound, the want
of appliances putting ft out of the power of the medical
offifcer to do almost anything to relieve him. It is not often
that such circumstances occur in India, but sometimes Un¬
fortunately they do.
* Now Surgeon, 1st 11th Foot.
Remarks.— Had primary amputation been performed in
this case according to the principle laid down by Guthrie,
it is more than probable that the life of this soldier might
have been saved.
E. Bones of Upper Extremity — Forearm .—Bolan, 5th
Foot, was wounded by a bullet which entered the forearm
a little above the wrist, fracturing the radius. He received
no hospital treatment for seven days afterwards, and when
admitted had considerable swelling of the hand and inflam¬
mation around the seat of injury. Leeches, followed by
fomentations, were applied ; the untoward symptoms were
at once subdued. The limb was then placed in a splint,
cold water dressing applied, nourishing diet allowed, and
at the expiration of twelve days from his admission he was
able to proceed to join his own regiment
Knott, 37th Foot, admitted with a gunshot wound, de¬
stroying the left radius and ulna, rendering amputation neces¬
sary. Maggots appeared in the stump, but were destroyed
by turpentine, after which, under the use of cold water, and
latterly of simple cerate, granulation and cicatrization took
place favourably.
Walsh, 10th Foot, had on the same occasion received a
gunshot wound in the forearm. The bullet had entered
from behind, four inches below the elbow-joint, fractured
the radius, and escaped by a largo opening in front. No
fragment of bone had come away ; the wound looked
clean, having from the date of its receipt been treated by
cold water. The hospital into which he was brought had
at the time been crowded with wounded men, and the
building itself ill ventilated. A tendency to hospital
gangrene made its appearance in both wounds about three
weeks afterwards, ana when to all appearance they were pro¬
gressing favourably. His conditions were improved as hr
as was practicable ; opium applied locally, calomel and
opium given internally. The threatened disease was
averted, and he recovered with but loss of power in the
hand and wrist.
Humerus. —Lieut. St. John, 10th Foot, during a night
attack between the 11th and 12th of May, 1858, ww
wounded by a musket bullet, which entered at the front
of the left arm about its middle, passed directly through
the humerus, fracturing and splintering it severely. The
posterior opening was very large and tom; there was a
second aperture, as if it had been produced by a spicula of
fractured bone ; and as the missile escaped, it struck the
side, abrading the skin. The power and sensation of ring
and little finger were gone ; the others retained a little of
both. The pulse beat naturally at the wrist. The arm
was put up in splints ; cold water applied. Suppuration
attended by some fever followed. On the 19th, the dis¬
charge was very copious ; there was a good deal of «dema
of the forearm, but the wound looked healthy.
The progress of this case was satisfactory; both the
wounds healed, cold water having been the only applica¬
tion used, with the exception of poultices during a few
days to encourage the commencement of suppuration-
Union took place, but the hand remained powerless; the
general health was good ; he was sent on sick leave to
England in July, and a year afterwards, on the return of
the regiment, joined it at Plymouth, but with the naiw
permanently disabled.
(To be continued.)
The current number of the Quarterly Journal of
gical Medicine contains an elaborate paper by Dr. Austin Fjuwj
jun., in which it is more than insinuated that Sir Charles lxu
was guilty of plagiarism in connection with his asserted
covery of the functions of the roots of the spinal nerves. A*
might be expected, when Flint strikes steak, the result is •***
ling.— New York Medical Gazette. , . .
Dr. Seltzer, of Columbus, Ohio, reports in the C«*oi**o
Lancet and Observer , a case in which he removed, from tbe
bladder of a married woman, a hair-pin encrusted with calOTtt*
deposit. The patient, strange to say, could not remember
or now the pin got there ; but from the duration of thesy®
ptoms it was supposed to have been in the bladder for twei
or fourteen years.
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The Motlk.U Press ami Circular.
LEADING ARTICLES.
November 18,18G8. 431
SPECIAL NOTICE.
The Editors have much pleasure in announcing several
series of Lectures and original communications for the
forthcoming volume. Of these the following will bo
amongst the first:—
Clinical Lectures,
By Dr. Handheld Jones, of St. Mary’s Hospital.
Salivation as a Symptom of Syphilis,
By Mr. Henry Leb, of St. George's hospital.
White Gangrene,
By the same Author.
Clinical Observations on Diseases of the Heart,
WITH SPHYGMOGRAPHIC ILLUSTRATIONS,
By Balthboar W. Foster, M.D., &c., &c., Professor of
Medicine, Queen's College, Birmingham, &c., &c.
Select Surgical Cases,
By Mr. A. E. Durham, of Guy’s Hospital.
Clinical Observations,
By Dr. John W. Ogle, of St. George’s Hospital.
Influence of Certain Occupations on the
Health,
By Dm. Stmes Thompson, Gresham Professor of Medicine.
Mode of Action of the Cholera Poison,
By Dr. Ernest Sansom.
Experiences of an Army Surgeon,
By C. C. Gordon, M.A., C.B., Dep. Inspect.-Gen.of Hospitals.
Gleanings in Toxicology,
By C. Meymott Tidy, M.B.M.S., First Lecturer on Chemistry
at the London Hospital.
Clinical Midwifery,
By E. Head, M.D., London, Physician-Accoucheur, and Lec¬
turer on Midwifery, London Hospital.
Diseases and Operations of the Rectum,
By Mr. Holmes Coote, of St. Bartholomew’s Hospital.
Lectures
By Walter Rivington, M.S., M.B., B.A., of the London
Hospital.
Lectures on Man’s Place in Creation,
By Professor Macdonald, M.D., of United College^ St.
Andrew’s.
By the Same Author,
The Archetype and Homology of the Skeleton,
The Foetal Heart.
—Division of the Hamstring Tendons for Contraction of the
Knee—Removal of a large Epulis and superior Maxilla, with¬
out any incision through the Cheek—King’s operation for
Prolapsus Recti—Reduction of Axillary Luxation of six weeks
standing—Amputation of both Legs for Compound Commuted
Fracture—Epulis—Vesico Vaginal Fistula Cyst on the lower
Maxilla—Lithotomy on a Child aged six years.
By Henry G. Croly, F.R-C.S.L, Surgeon to the City of
Dublin Hospital.
Observations on
Syphilltio Deposits in the Heart,
On Syphilitic Ulcerations of the Uterus—On Fistulous
Openings in the Kidney—On Urinary Paralysis accompanied
with Calculus.
By John Morgan, F.R.C.S.I., Surgeon to Mercer's Hospital,
and Professor of Practical Anatomy in the Royal
College of Surgeons, Ireland.
Series of Cases of
Organic and Functional Diseases of the
Nervous System,
And Cases of
PERSISTENT GASTRIC IRRITATION DEPENDENT
ON DISTANT DISEASE,
I By J. Little, M.D., F.R.C.S.I., Physician to the Adelaide
Hospital, Professor of Practical Medicine in the
Ledwick School of Medicine.
Course of Lectures on the
Pathology and Diseases of the Bye,
AND THE OPERATIONS REQUIRED FOR THEIR
TREATMENT,
(Illustrated by 18 coloured lithographic illustrations and
numerous woodcuts),
By Archibald H. Jacob, M.D., T.C.D., F.R.C.S., Oph¬
thalmic Surgeon to the City of Dublin Hospital.
Contributions are also promised by R. D. Lyons, M.B.,
Physician to the Mater Miseracordia Hospital ; D. B. Hewitt,
L.R.C.S., Physician to the City of Dublin Hospital; B. W.
Richardson, F.R.C.S.I., Surgeon to the Adelaide Hospital;
Henry James, M.B., Physician to Mercer’s Hospital; J. H.
Benson, M.B., Physician to the City of Dublin Hospital.
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Course of
Lectures on Mitral Obstruction of the Heart,
By T. Hayden, F.R.C.S.I., Physician to the Mater Misera¬
cordia Hospital, Dublin, and Professor of Anatomy in the
Catholic University.
Observations on the
Treatment of some Diseases of Bone,
By J. K. Barton, M.D., T.C.D., F.R.C.S.I., Surgeon to the
Adelaide Hospital, Dublin, and Professor of Surgery in
the Ledwick School of Medicine.
Notes on Surgery,
By Philip C. Smtly, M.B., F.R.C.S.I., Surgeon to the Meath
Hospital and County Dublin Infirmary.
Observations on
Operative Procedures.
•WITH THE FOLLOWING OASES:—
iMonl of the lower Jaw and entire Submaxillar? Gland
gptel |mb Similar.
8ALU8 POPULI SUPREMA LEX.
WEDNESDAY, NOVEMBER 18, 1868.
THE INFLUENCE OF MEDICAL POLITICS ON
THE ELECTIONS.
We have devoted much space to a consideration of this
subject in its various aspects, but as the crisis is now upon
us, we may well recapitulate the points. The Irish Medical
Association has done great service in questioning candi¬
dates ; for many pledges have been thus elicited, and it is
to be hoped that individual practitioners will yet exercise
this privilege. -
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432 The Medical Press and Circular.
LEADING ARTICLES.
November IS, ISM.
The last number of our special Scotch issue contained
full particulars as to the University elections, and also an
article on the influence of the Profession, contributed by a
politician who has given much attention to the subject,
and part of which we desire to bring more prominently
before all our readers.
Mr. Moncrieff, the Liberal candidate for Glasgow and
Aberdeen Universities, must henceforth be numbered
amongst the friends of the Profession. He has made un¬
equivocal statements that, in the absence of a medical
candidate, entitle him to confidence.
Professor Lyon Playfair, having frankly accepted his
competitors programme, will, we should hope, reap the
full benefit of that gentleman’s retirement. Much as we
should have preferred an actual physician, we cannot deny
that ail the Professors sympathies must naturally be with
the Faculty, with which he has all his life been intimately
associated.
Dr. Prosser James had a much larger support than is
commonly known. Medical men of all politics supported
him, and from an analysis of the results of the canvass we
can assert that being too late in the field was the greatest
disadvantage with which he had to contend. His candi¬
dature, as has been well said, transferred medical politics
from the list of professional to* that of public questions,
and has therefore laid his brethren under an obligation not
likely to be repaid. Moreover, it has induced parliamen¬
tary veterans to consider the questions involved, and
several have given their adhesion to his views.
The writer to whom we have already alluded, sets forth
the merits of this plan in forcible terms. He shows that
it could easily be accomplished, is inexpressive as well as
effective, requires no Act of Parliament to bring it about,
and yet would give the Profession a real representative
head. These are no slight advantages of the plan, and the
critic concludes that all must “admit the claims of its
originator to the gratitude of his profession adding with
significant authority, “ Dr. Prosser James has proposed the
most statesmanlike scheme that has emanated from the
medical profession.” The writer of thatjpassage, however,
shrewdly suspected what would be the result, and pro¬
ceeded to show how difficult it is for medical candidates
to succeed. As we had better “ see ourselves as others see
us,” we pursue this phase of the question. It is argued
that medical must always be secondary to general politics,
a proposition admitted by all the medical candidates who
ever had any chance. This has been the danger, however,
to the cause, to which are added “ the well-known apathy
of medical men, their indifference to politics, their absorp¬
tion in their own pursuits, and the possibility that many
will neglect to vote at all.” We cannot deny that there is
some truth in this picture, and that therefore it becomes
medical electors to think carefully over their duty in
reference to the election.
This brings us to ask whether we ought to sink party
for the sake of medical politics?—a question that has
been ably debated by some correspondents of the Edin¬
burgh Courant , the Globe , and other Conservative organs.
Our Scotch edition contained a full analysis of this debate,
so far as it concerned the Edinburgh election, so that we
need only here repeat the nett result, that many Conser¬
vatives avowed their intention of voting for Dr. P. James,
spite of his being a Liberal, in the hope of securing a re¬
presentative of the Profession who is “ perhaps more con¬
versant with medical politics than any one living.” Others
took the opposite view, while non-medical graduates utterly
ignored medical politics.
This shows us clearly that if we are to have any repre¬
sentation of our Profession in the House we must be united
and earnest. The manner in which all other classes hang
together Is seen every day. The * disunion of doctors is
becoming a byeword. This is exemplified in the account
of Sir D. Corrigan’s contest published in the Times last
week. The Dublin correspondent of that paper thus
wrote :—
The attempt to enlist the medical profession as a body in
the ranks of Sir D. Corrigan’s supporters has been attended
with only partial success. It is stated that a careful calcula¬
tion of all the subscriptions to the election fund which have
been publicly acknowledged shows a total of only £1,135 12s.,
or less than half what was reported to have been raised.
Many of th6 contributions which continue to come in are from
persons not connected with the profession. A sharp contro¬
versy is going on with respect to the claims of Sir Dominic to
represent his medical brethren. On the other hand, there is
an organisation, called “The Irish Medical Association,”
which has since its formation strongly advocated and passed
resolutions in favour of professional representation, and it is
urged with considerable reason that a rare opportunity is now
offered of realising the object which they professed to have in
view by returning an able and distinguished member who
sympathises with the medical practitioners, and can most
effectively advocate their cause. The Council of the Society,
however, declined to convene a general meeting to promote
Sir Dominic’8 return, on the ground that the rules would not
warrant them iff doing so. A form of resolution was cleverly
drawn up to avoid the objection, and it is said the zealous
friends of the baronet almost carried it by a surprise. After
some members who thought the matter had been disposed of
had gone away, the motion was brought on in a new shape and
was rejected on a division by a majority of only one vote. On
the other hand, a large section of the profession decline to
sink their objections to the Liberal candidate on political
grounds, and justify their refusal on the ground that Sir
Dominic put forward first a political programme declaring his
approval of a policy to which they are strongly opposed, and
that had he desired to represent the profession, and not a
party, he would have avoided any reference to topics upon
which there is so great a difference of opinion, especially the
Church question. There is something like a schism in the
medical community, and it is feared that the result will be
permanent disunion. It is now divided into two sections,
who take opposite lines, and complain of each other. A
meeting convened by Sir Dominic’s professional friends was
held last evening in the Friends’ Institute, Molesworth street.
Dr. Lyons in the chair. Dr. M‘Donnell moved a resolution
declaring that it was highly desirable on public as well as
S rofessional grounds that a medical man should be returned.
[e complained of the apathy shown on the subject by some
of the leading members of the profession, and, in reference to
the objection that it was distinct representation of the whole
profession which was required, he characterised the scheme of
making a separate constituency of the doctors as quite Uto¬
pian. Dr. Hynes, who seconded the motion, said he was a
Vice-President of the Medical Association, but that he found
it required to be reformed, and he would withdraw his name
from it. Drs. Hyndman, Ashe, of Warrenpoint, O’Meara,
Fitzgerald, J. A. Byrne, Morrogh, and Sewart, spoke in sup¬
port of other resolutions. Sir D. Corrigan advocated his own
special claims, reminding them of his personal experience in
tne profession from the position of a dispensary doctor to that
of medical commissioner. He observed that it was impossible
to get into Parliament without belonging to a party, and he
would not sacrifice his political convictions. At this meeting
there were fifty-one doctors assembled. Another meeting was
held simultaneously in another place to protest against it.
A counter-declaration repudiating its proceedings was signed
by six ex-presidents and vice-presidents of the College of Sur¬
geons, as many of the College of Physicians, fifty-three hos¬
pital surgeons and physicians, twenty-eight members of the
council, and as many examiners, all electors of the city.
Never was the old proverb about doctors more aptly illus¬
trated.
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jsitpjjlemttti iff i|t
HleHtal iprtss a nir Ctrcalar.
LONDON: NOVEMBER 18. 1868.
^0fial garnet ^smkthro.
HEALTH SECTION.
& if 1> 11 » *
BY
H. W. RUMSEY, ESQ., M.D.,
President of the Section.
REVISED EDITION OF THE FIRST PORTION,
PUBLISHED IN THE MEDICAL PRESS AND CIRCULAR OF OCT. 21 ,
1868 .
Of all persons, perhaps, members of the medical profession
are the most liable to sudden and unexpected demands upon
their suppose 1 fitness for rendering help in emergencies
whether affecting the individual or the body corporate.
Thus, even in the brief history of this prosperous Associa¬
tion, it has happened more than once that the chair of the
Health Department, in spite of its great attractions, has been
left by the force of circumstances without an eligible occupant-
elect until the executive committee, in their extremity, have
been driven to send for a doctor.
Yet, in this Society, where each department has so many
complicated relations with other departments, it has been
wisely judged, and for the first five years it was happily
arranged, that some statesman, or legislator, or philanthropist,
should inaugurate and guide our proceedings, bringing to the
task all that public influence, that knowledge of social in¬
terests in general, which are necessary for the success of the
sanitary movement, himself in return receiving from the de¬
partment all that special and scientific information which may
be derived from the papers read, and the discussions herein
held, and which may thus be influentially applied to public
and parliamentary action.
Thus, if we look back at the great advantages which resulted
from the sectional presidency, first of Lord Stanley, and then
of Ijord Shaftesbury, succeeded, as they were in turn by Mr.
Cowper, Mr. Edwin Chadwick, aud Lord Talbot de Malahide—
we may reasonably regret that we have on this occasion failed
to secure some one of those public men who are known to bo
thoroughly conversant with matters of health, aud who might
have brought us more closelv en rapport with the leaders of
public opinion. In our sixth year, we reaped the bcuefit of
the practical philosophy of Mr. Fairbairn. The iutimate
relations which exist between sanitary improvements and the
skilful enterprise of civil engineers render it very desirable
(if I may be excused for making the suggestion), that this
department should sometimes bo headed by one of their pro¬
fession. During the last quinquennium, however, we have
had an uninterrupted succession of medical presidents, men of
great achievements, acknowledged authorities in preventive
and legal medicine and in the physical sciences.
No wonder that, on such a retrospect, I should have under¬
taken,* very reluctantly, the responsibility which has been
committed to me—no wonder that I feel incompetent to sus¬
tain the rdlc of my predecessors iu office, ana unfit for the
honour which has been, I fear unwisely, pressed upon mo.
The scieneo of health-preservation is an indispensable por¬
tion of the science of human society. Public health, that
branch of hygiene which concerns communities, involves the
enactment of laws, by which the safety of the whole is pro¬
tected against the errors and neglects of a part. Our depart¬
ment, therefore, has inseparable relations with that for the
amendment of the law. Both departments are now concerned
in the prospective task of reducing to order and consistency a
chaos of conflicting sanitary statutes. Both have called for
tho appointment of public prosecutors, without whom the
m ost necessary enactments may prove inoperative.
Then, private or personal hygiene might almost come under
the charge of our educational section—so entirely docs a
hearty obedience to precepts of health—as regards personal
habits and conduct—depend on early instruction, good train¬
ing, and intelligent conviction. Such obedience cannot, in a
free country, be enforced by mere police regulations ; unless,
indeed, under some future Sanitaiy Act, any very unsavoury
man might be defined a “ nuisance,” and so be brought under
the operation of the Nuisances Removal Acts.
Domestic hygiene, again, seems to be something between
public and private hygiene. Whilst the sacredness of the
family hearth must be kept inviolate, the law may sometimes
rightly and reasonably interfere, not only for the protection
of neighbouring famines, but also for the safety of dependent
and helpless inmates. Here we see, in many ways, the con¬
nection between this department and that of social economy,
especially in questions of labour and industry. How bene¬
ficial, for instance, have provisions for the prevention of
disease and accidents proved in the regulation of employments t
There can be no true social economy where there is no respect
for the rights and the welfare of others, no real education
adapted to and accepted by all classes, nor any allegiance to
those physical laws which are ordained by God himself for tho
maintenance of a long, a healthy, a useful, and a happy life.
These objects, as I understand them, constitute the elements
of Social Science.
Now, in the Health Department, at all events, on this occa¬
sion, it Beems desirable to confine our efforts principally to
matters of public health—to their scientific foundations, and
to some of their practical aspects and present bearings.
On reviewing the progress of public measures during the
past year, I have ventured to select, as the subject of this
address, a group of allied questions of pressing importance,
involving, perhaps more seriously than others, the recognition
of some first principles of natural science.
No one here need be reminded that the physical surround¬
ings of man mainly determine his degree of health, vigour,
and longevity. Now, the philosophers of old recognised four
elements of nature, sources of all things and all changes of
things, whether beneficent or malignant.
These elements of the ancients—fire, air, water, and earth
—may therefore serve me as heads under which to group a
few thoughts and suggestions on the relations of man to the
facts of his natural and social life.
Fire, I take to include and express heat, of which it is a
visible emblem and result. As the burning, purifying, and
renovating principle of nature, I shall have to notice it in its
action upon the other three—air, water, and earth.
These, when wisely employed, are our best friends, tho
prime means and necessaries of our existence. Nature, re¬
verently handled, is really our great mother; and not, as a
learned physiologist has of late facetiously called her, “a
step-mother,” to whom he attributed paroxysms of malevolent
intention.
These, our grand surroundings—air, water, and earth—are
however liable to such original disorder, they may each and all
assume such forms of danger and destruction, and they may
be so abominably perverted by human ignorance and error as
to produce, convey, and circulate among us the deadliest
poisons. But man is endowed with capacities for observing
the facts, noting the conditions, discovering the aberrations
and mistakes, determining the right uses, inventing and ap¬
plying the necessary remedial measures—so that these pri¬
maeval elements may be preserved and renewed as our
perpetual sources of health and longevity.
I take for granted that action of this kind, on behalf of tho
public health and safety, is that of the community, by means
of its legislative and executive authorities ; and I snail en¬
deavour to show, by one or two striking examples, under each
head, how incorrectly and imperfectly the first principles of
science have been acknowledged and applied in some recent
enactments of sanitary intention.
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2 Supplement to
The Medical Press and Circular.
SOCIAL SCIENCE ASSOCIATION.
November 18,1888.
I. Aib.—H ow strange it seems that society, for which man
was formed, should be the original cause of his violating that
primary natural law which demands purity and abundance of
air for his healthy existence !
No sooner, however, is a community formed, and its space
of habitation limited by neighbouring populations, than the air
which supports it inevitably becomes more or less vitiated.
In scattered populations, this continual vitiation of the atmo¬
sphere may be remedied partly by atmospheric motion, and
partly by the rapid diffusion of gases. Even the insupportable
nastiness of the air of an Esquimaux cabin finds its compen¬
sation, if not its cure, in the wide expanse of barren land,
open sea, and fields of ice, over which the exhalations of the
dirty barbarians are driven and dispersed.
But, in warmer climates, as men congregate, when towns
become the centres of active commerce, and the seats of art
and manufacture—as the crowd thickens, as every square yard
is occupied at increasing cost, and as the average space per
head continually diminishes—so does the purifying principle
of the air, Oxygen, lose more and more of its power, so does it
become less efficient in renewing the blood, “ which is the life
of man," so is it rendered less capable of burning the carbon
and other effete and noxious products of animal life.
Here, then, unless sanitary science be boldly and skilfully
applied to social existence, the masses deteriorate physically
and morally. By degrees they lose the acuteness of those
senses, smell especially, with which their Creator has endowed
them for purposes of self-preservation. The human form di¬
vine degenerates. The less favoured classes sink in the scale
of race, dwindle, alter in shape, colour, and features—they
grovel, sicken, and die prematurely. By a fatal descent, the
lord of creation reaches after, and wallowB in, the lowest gra¬
tifications, acquires the grossest habits, and manifests the pro-
foundest indifference to, if not deepest hatred of, law—divine
and human—social order, purity of life and manners.
Even the wealthier classes, upper and middle, cannot escape
the physical injury consequent upon contact with preventible
disease and mortality. Such a state of things leaves, too often,
a sad impress, moral and social, upon the leading members of
a community. The chasm between the classes tends to widen.
In the skilful employment of capital, the workman has been
too generally regarded as a mere instrument—which, as a
machine, can be procured and used at the market price ; yet
on this instrument, as a man , is thrown the sole responsibility
of maintaining himself in a state of efficiency, and of bearing
the consequences, whatever they may be, of this human crush.
Hence has grown up an antagonism of interests, a mutual
distrust, which—unless it be removed, by just and liberal
measures on the one part, of which there is now some hope,
and by a fuller knowledge of the causes and remedies of their
condition on the other—will shake the very foundations of
society, and show its apparent prosperity to be but the thin¬
nest crust of glittering matter over an abyss of revolution and
ruin.1
May I be permitted now to refer to the physical-science
aspect of this question in great towns. And if I venture to
allude to facts and phenomena, which are well known to you
all, it will be understood that I do so merely to complete and
strengthen my argument.
What, then, is the physical nature of the impurities of town
air ? I know of no one who has contributed fuller information
on this head than Dr. Angus Smith. Yet he, like others, has
left much undetermined. Excess of carbonic acid is the most
discernible injury inflicted by communities of men upon open
air, an injury revenged with fatal force upon the aggressors.
In nature, as we are told, there are rarely found more than
thirty-five parts of this gas in 100,000 of air. But in the air
of great towns are found from forty to seventy-four parts, ac -
cording to the degree of population density, and of fog or
atmospheric moisture. In confined air, among lofty structures,
the proportion appears to be greater ; in rooms said to be well-
ventilated, i.e., supplied freely with town-air, the average quan¬
tity is said to be about eighty in 100,000 ; in ill-ventilated
moms and workshops, there have been found from 100 to 700
parts—twenty times nature’s allowance !
Now, as carbonic acid prevails, the circulation of the breathers
^generally observed to slacken, the frequency of respiration to
increase, and the nervous power to fail. Much of the phthisis
and scrofula of town-populations is doubtless due to an atmo-
1 The social ami political dangers of neglecting ihc sanitary condition
of the poorer classes have been forcibly shewn by Mr. Rendle.
sphere overcharged with carbonic acid. Increased temperature,
due to season or climate, renders an excess of this gas still
more injurious. [Thus, even 1 per cent, may be endured at a
temperature under 50? F., which would be absolutely intoler¬
able at 70? or 80°.]
But, if the presence of this destructive gas be more easily
ascertained and its quantity determined, and if it also tell us
something of other gases of decomposition, it by no means
reveals the most serious cause of atmospheric vitiation. There
is much sulphurous acid in the air of smoky towns ; much sul¬
phuretted hydrogen near open sewers ; and, worst of all, there
are emanations peculiar to decomposing organic matter, especi¬
ally animal dtbris.
Thus, the air taken from high table-land in the country, is
said to contain only about one grain of organic matter in
200,000 cubic inches of air, and this mostly of vegetable origin ;
but air from a cesspool has one grain in only sixty cubic indies
—or 3,333 times as much as in nature.
The degrees of organic impurity in town air vary infinitely
between these extremes, in proportion as the known causes of
such emanations are allowed to putrefy, without prompt re¬
moval or disinfection, e.g., by means of charcoal in sewer-traps.
Dr. Angus Smith hLi observed— 44 We have in different air,
breathed by people in the same county, a substance, the
amount of which in one case is twenty-two times greater than
in the other, and in air breathed by people in the same town a
difference which is as nine to twenty-two.” He adds, 44 that
in the district in which the highest numbers were obtained,
there were, in 1855, 4‘5 deaths in the hundred.**
It is this organic matter in the air which is the most perni¬
cious result of human crowding. It is this which, in the airas
well as in the water, conveys specific germs of disease, incon¬
ceivably minute forms, capable of infinite multiplication in the
living human body. In this, then, lies the fatal secret of
density of population.
These emanations arise, as we know, in great measure, from
foul water, and from saturated and undrained soil; but in large
proportion, also, they are exhaled from living beings—from the
lungs of the diseased, from scattered saliva, and from the slrins
of the unwashed. It was generally supposed that the nitro¬
genous matter which has been detected in the condensed vapour
expired even by healthy people, came from the lungs. But a
French physiologist, M. Lemaire, has lately shown that in
healthy adults it proceeds from the uncleansed mouth, throat,
and gums, and the air about them. And he has recorded the
very disagreeable fact, that skin-dirt (composed of perspiration,
oily matter, and dust), when allowed to accumulate, is found
on examination to contain myriads of microscopic beings, vege¬
table and animal (Bacteria and Vibriones), similar to those
which he had before discovered in the air collected from the
barracks of the Fort de l'Est.
The French savant selected, of course, for his experiments,
the uncleansed—“ gui araient ,” says he with the politeness
characteristic of his nation, 44 nigligi }>nidant huit et guinzt
jours les soins de la toilette .” In our population, town and
country, there are millions who neglect such attentions for as
many months or years as this philosopher reckoned days!
You may erect baths and wash-houses, but no Act of Par¬
liament can compel their general use. Much, however, may
be done by training the young in cleanly habits.
These cutaneous emanations are dissipated in, and therefore
infect, the air. The closer the aggregation of unwashed
human masses, the more horrible must be the resulting atmo¬
spheric impurity. When, in addition to the floating organic
particles which arise from mucous discharges, we note the
pulmonary exhalations of phthisical and scrofulous persons
charged with elements of disease, believed by many to be con¬
tagious—we may obtain some clue to a source of atmospheric
vitiation in dense populations, of which there is not the faintest
popular notion.
Those most delicate physiological tests of bad air and of
defective oxidation—the blood, bones and skin of a living
child—prove to demonstration, when mere chemical analysis
fails to throw light on the case, that town air, even in its best
conditions, contains subtle poison, from which the airy up¬
land and the breezy shore are free, and that it also wants
some elements of nutrition and purification which the latter
supply.
In Dr. Morgan’s eloquent words, 44 A murky mass hangs
like a shroud over the city—a dismal list of noxious gases is
so intimately diffused throughout the air, that neither can
the earth’s heat radiate into space, nor can the warn beams
Digitized by vJiOO^lC
November 18, 1868.
SOCIAL SCIENCE ASSOCIATION.
_ „ Supplement to
The Medical Press and Circular.
3
of the summer’s sun thoroughly dissipate the suspended
canopy.** 1
Although much has been learned from the study of death-
rates, I have for some time past scrupled to quote them in
support of sanitary dicta. With all respect for the Registrar-
General and for my learned and distinguished friend Dr. Farr,
1 find these statistics full of fallacies, especially in crowded
towns, where the figures give bjr far too favourable an estimate
of that mortality wnich is strictly due to town life. I need
hardly say that the death-roll does not reveal the actual loss
of health among town masses, nor does it record the multitudes
disabled by a host of diseases and casualties, which may not
at once destroy life, though they ravage the territory of labour
and duty, ana levy a most heavy tribute upon produce and
property. For this we need an official Registration of Sickness
attended at the public cost.
“The Rev. Professor Haughton has shown that, on very
simple [mathematical principles, the density of a population
would be a factor determining the ascent of the curve of in¬
crease of an epidemic.” This would apply to the case of the
distribution or poison by a water company. “ 1 believe,”
adds Dr. Morris, in his very remarkable essay on Germinal
Matter (p. 10), “ that bad sanitary state of any kind would
be equivalent to greater proximity.’
All other sanitary appliances and reforms being equally
adopted, or equally neglected, it is certain that close proximity
of dwellings, over an extensive area, is per se a cause of un-
healthiness and deterioration of race. For it is not fair to com¬
pare a well-regulated town population, having perhaps only
eight square yards for each person to live upon, with an ill-
conditioned dirty population in the open country.
For all this vitiation of air, caused by town life, there ap¬
pear to be three natural remedies of different values in diffe¬
rent cases : motion of air; diffusion of gases by natural law;
the presence or introduction of active oxygen.
1. Now, the mere motion of air, if it be natural motion,
ix. t wind, is occasional and variable; while the generation of
morbific causes is constant. The remedy cannot be relied on,
for the air is often stagnant in circumstances of the greatest
danger. The motion of the nir in towns is impeded by the
proximity and height of buildings, probably as much as by
insufficient openings in rooms. Nor do we know that, with¬
out the admixture of pure air, foul air can purify itself by
simple motion. If the motion be artificial, it may be exces¬
sive or ill-timed, but of this again.
2. The diffusion of gases is necessarily limited by space, and
mainly by superficial space ; for of their effusion in a vertical
direction, i.e.] into the upper regions of the atmosphere, we
know little, and that little does not favour the hypothesis of
an effectual change. Gaseous diffusion is also impeded by the
very circumstances which impede aerial motion. And these
circumstances are most potential in towns.
3. But the presence of active oxygen in sufficient quantity
—and sufficiency here means abundance—were that possible
in dense populations, would be the real remedy.
Oxygen I take to be the burning and purifying principle of
nature, represented by the elemental fire of the ancients. For
flame is but the luminosity of combustion. Professor Tyndall
has shown by his curious candle-burning experiments in the
Yale of Chamounix and on the summit of Mont Blanc, that
the quickness and intensity of combustion, such as takes place
in vigorous oxidation, is in general incompatible with that
brightness of flame which depends on the presence of carbon
or other inflammable matter. The purer the air, the less
visible is the fire, yet the more effectual the burning.
The proportion, chemically determined, of oxygen in air
may not be much altered in towns, though it is sometimes
fonnd to be less : but recent discoveries tend to prove that its
energy depends on the conversion of a portion of itself into
another form, which, when obtaiued artificially, we call Ozone.
When Cavallo observed that the air which he had electrified
had a purifying effect on decomposing organic matter, he laid
the foundation of a discovery the future beneficial results of
which are incalculable.
The researches of Schonbein—now, alas ! no more—and
subsequent scientific experiments upon this agent, have thrown
great light upon its nature. By an electric current, the
volume of oxygen through which it passed was found to be
diminished to the extent of 8 per cent. Then Odling and
Soret have proved that this condensation is due to the substi¬
tution of sixteen atoms of ozone for twenty-four of oxygen.
1 Morgan on Deterioration of Race, p. 29.
We also now learn that, while ordinary oxidizable substances
absorb only the odd eight atoms, restoring the ozonic oxygen
to its original condition (though not to its original volume), a
substance—oil of tnrpentine—-nas been found to absorb the
whole of the ozone, which thus destroys itself in attacking its
enemy. Finally, we know that ozone speedily removes dead
and decaying matter “by resolving organisms into primitive
and innocuous form9.” (Day.) Men of science havo thus
arrivod, I venture to think, at the entrance of a wide field of
practical work with this sanitary giant.
Since the most delicate tests tail to detect anything like
ozone in the air of our crowded towns, we infer that in these
places our great benefactor is used up ; and that, without his
presence and aid, oxygen itself fails to purify.
Richardson some time ago observed that, when oxygen had
repeatedly passed over dead and decomposing animal matter, it
lost its power of oxidation.
We may also infer that, in these conditions, deadly germs,
carrying specific diseases or their essences, may float in
myriads about us, ever multiplying and safe from destruction,
save when, happily for us, that unseen mysterious Ozone
rashes down in the track of the lightning-flash, or ride9 by on
the tempest, or gambols in the light spray of the sea breeze.
There may be yet other substances besides oil of tnrpentine
(an antozonide, according to Schbnbein’s ingenious theory)
which may as effectually annihilate oxone, and may thus be
ever at work to cut short our natural supply of active oxygen.
In the growing compression of human masses and animal
life (I speak metaphorically), may there not be evoked a demon
of uncleanness and corruption strong enough to quench the
spirit of burning and of purification ?
Practically, then, the most essential measure of sanitary
legislation and administration would be to provide better, air
than towns supply to the people. And this object may be
accomplished by three methods :—(1) speedily removing all
the debris of animal life, and everything which by decomposi¬
tion can corrupt the air ; (2) promoting the free circulation of
air into every quarter, through every court and alley, into
every house, every room, in the inhabited area,—in a word,
Ventilation ; (3) enabling every person to breathe a sufficient
quantity of pure and good air, V.e., air having the properties of
ozone.
Our sanitary laws, if properly carried into effect, which
they are not at present, may secure the first object.
Nearly the whole of the following portion of Dr. Ramsey’s
Address was accidentally omitted in printing the last number
of the Medical Press and Circular. These paragraphs are
to be substituted for one paragraph at the bottom of column 2,
page 417.
The disinfecting quality of ordinary humus, is, I need hardly
say, quite distinct from the power possessed by sand and gravel
of promoting the oxidation of nitrogenous matters in solution.
The latter is, indeed, a good instance of mechanical agency.
But the former is a more remarkable proof of the provision
made by nature for the chemical arrest of putrefaction, and so
for our safety and preservation, if we did but reasonably
follow her indications, as the dog and fox do when they bury
their dead prey for future food. The slowness of the erema-
causis in this case as compared with the rapidity of the change
in watery solutions (sewer-water for instance) depends pro¬
bably on the more speedy and perfect contact of the decom¬
posing matter with its disinfectant in the latter case. But
the certainty of the change is as great in the mixture of
the solids, and the permanent benefit seems to be greater. The
earth-method has another advantage, viz., that the compound
may be safely dry-stored and transported without inconvenience
to any part of the country.
We, therefore, revert to our common mother—-Earth-in
adopting the Rev. Mr. Moule’s invention; and notwithstanding
certain practical difficulties attending on its domestic use,
difficulties which may be insurmountable in crowded popula¬
tions, sanitary reformers are surely right in advising the ex¬
tension of this method as widely os possible. Its successful
use in India, in military encampments, in the Buckingham¬
shire villages of Baron Rothschild, and in schools and
various public institutions, has already established its practi¬
cability and value. That the general adoption of the earth
Digitized by
A Supplement tol
* The Medical Press and circular.
SUMMARY OF SCIENCE.
’ . T
«
November 18,1818.
system in scattered populations would tend directly to econo¬
mize and protect their water supplies, is no mean argument in
its favour.
Whether, while preventing contamination of (surface and
running) waters and vitiation of air—the use of this dry com¬
pound in agriculture might possibly in any way injure the
soil—for instance, by introducing undestroyed germs of disease,
which, in the varying level of subsoil water, described by
Pettenkofer, might develop into active and dangerous energy,
is a point deserving some consideration. I am not, however,
disposed to attribute exclusively to earth the propagation of
germs of cholera or other zymotic diseases. On Pettenkofer’s
own theory, if I am to understand him rightly, water must,
in the first place, have been the means of conveying any such
specific contagium , through the soil to the level of the subsoil
water when at an unusual height; and then, on its subsidence,
when the soil in drying becomes permeable by air, the mor¬
bific germ could be conveyed to man only by means of
evaporation. The water, therefore, would be the first carrier,
the air the second, while the earth would be merely the
intermediate resting-place.
PRESENCE OF PHENIC ACID IN URINE.
M. Bulingsky says that phenic acid occurs in urine, though
he did not think that that substance pre-existed, but that it
is formed at the expense of some other substance not yet de¬
termined. It was not present in the blood. Dpgs r urine
does not contain it. The author found sensible quantities of
acetic and formic acid in the products of the distillation of
fresh cows’ urine, evaporated, and mixed with hydrochloric
acid. He added also, that he found a little formic acid in the
products of the distillation of all sorts of urine. — Cosmos.
44 THYMIC ACID,” (THYMOL) A SUBSTITUTE^FOR CARBOLIC ACID.
M. Bonilhon has proposed that we should use the above
substance as an antiseptic. Thymic acid is an homologue,
according to Gerhardt, of phenic acid. It boils at 230° C.
Its odour is feeble, and what there is of it is agreeable, recal¬
ling that of thvme. It is very insoluble in water,very soluble
in alcohol, ana dissolves in ether and oils. It does not pos¬
sess any rotating power. The thymic acid combines easily
with alkaline solutions and forms soluble salts. Upon this
property is based the process of extracting it from essence of
thyme, which we will now describe. In the essence of
thyme this body is associated with a hydro-carbon, called
thymene, isomeric with turpentine. Thymic acid possesses
the important property of combining with skin ana animal
tissues, and of rendering them imputrescible. When concen¬
trated it possesses an acrid and caustic taste, but in solution
it is very weak, and nothing is perceived but a slight taste of
thyme and a sensation of coolness, similar to that produced
by mint. To procure this solution, essence of tnyrae is
treated by an aqueous solution of potash or soda; the thymic
acid dissolves, and forms a soluble thymate ; the aqueous
solution is separated, and on decomposition by an acid the
thymic acid rises to the top ; or the essence of thyme may
be submitted to a prolonged cold, by which means it crystal¬
lises. The acid extracted by the potash does not solidify.
There are, therefore, two modifications of this acid.— Journal
de Pharmacic ct dc Chimie.
PRODUCTION OF ES8ENCE OF MUSTARD.
M. Lebaigue (Journal de Pharmacic) has proposed to make
portable mustard-plasters in the following manner: — He
covers one piece of paper with a concentrated solution of my-
ronate of potash, and a second with a concentrated solution
of myrosine. When the two papers are moistened and put
together, the essence of mustard is developed. The solution
of myronate of potash is obtained by throwing into boiling
water the farina of black mustard. The filtered solution con¬
tains the myronate of potash, as the boiling wate * has destroyed
the action of the myrosine. The myrosine * obtained by
action upon white mustard by water at 40° C. The filtered
solution will contain nothing but the myrosine, as white
mustard does not contain myronate of potash.
ON THE ESTIMATION OF POTASSIUM.
Messrs. J. Chalmers and Robert Tatlock ha e been investiga¬
ting this subj ect, one of some considerabV ^ortance, 4 4 when
we reflect,” say the authors, 44 that Glasgow and its neigh¬
bourhood are tne destination of the greater part of the muriate
of potash imported into this country from the interesting de¬
posit of Stassfurth. ” They say that these analyses come out
improperly high. It is necessary to work with a pure salt of
platinum. The authors have critically examined the different
processes for making the chloride of platinum, and give pre¬
ference to a process the details of which are too long to insert.
They form their platinum solution by precipitating washings
by excess of soda, and reducing with methylated alcohol In
estimating the potassium too high results are always got if the
solution is too concentrated. This is even produced when
pure potassium salts are used. The use of the factor 194 for
the conversion of potassium chloro-platinate into potash (or
indeed the use of any other factors than those based upon
Stas’ equivalents) is erroneous, such not being deduced from
reliable experiments.
The true equivalent of potassium chloro-platinate
Potassium . . 391370 2 equivalents 78*2740
Chlorine . . 35*4570 6 equivalents 212*7420
Platinum . . 197*1937 1 equivalent 197*1937
Equivalent of 2KC1. Pt Cl 4 (new notation) 488*2097
Phamiacy.
NEW FORM FOR THE PREPARATION OF BALSAM OF COPAIBA
M. Oan de Walle has published a formula by which he pro¬
poses to convert the balsam into an emulsion without alter¬
ing its therapeutic properties, or increasing its volume to any
extent. It is as follows :—
Balsam . . .50 grammes.
White sugar . . 25 grammes.
Honey (liquid) . . .25 grammes.
Water . . 5 grammes.
Peppermint oil . . .0*50 cent.
Aniline red (or carmine) .9 s.
The balsam, honey, and sugar arc put into a basin, and sub¬
mitted to a gentle heat, with frequent stirring. In about six
minutes it is taken off the fire, coloured by aniline, and on
cooling, is perfumed with the essential oil. (Although the
aniline colour is more brilliant, I think carmine is preferable,
as the aniline colours may frequently contain arsenic.—E.S.)
The odour of the balsam is disguised, the taste is hardly
recognisable, and its consistence is that of a jelly. The water
is the important part. At the commencement of the opera¬
tion the substances form two distinct layers, bnt after a little
time these become mixed, they become more homogeneous, and
the balsam suddenly becomes emulsionified. — Journal J
Pharmacic et de Chimie .
The Universities of Edinburgh and St. Andrew’s.--
If the conduct of the Liberals who are to be in the House is
to be augured from that of the Liberals who aspire to be there,
party loyalty will be one of the distinguishing virtues of the
force Mr. Gladstone will be called on to lead. The Liberal
candidates have, during the past few weeks, given proof of the
most disinterested preference of their cause to themselves.
To the mauy examples of such devotion that have already
been furnished, must be added that of Dr. Prosser James,
who, rather than divide the party interest, has most gracefully
retired from the candidature for the Universities of Edinburgh
and St. Andrew’s, where Dr. Lyon Playfair is the other
Liberal candidate. The correspondence on this subject, which
we publish to-day, is one that does honour to both the gentle¬
men concerned.—iter.
Maternal Impressions. —At a meeting of the Society
Physicians at Berlin, reported in the Deutsche Klinik for Sepk
5th, Herr Dupre related several instances of maternal impres¬
sions. In one, a woman in the fifth week of pregnancy saw a
sheep wounded and with its bowels protruding. She was
greatly shocked, and did not recover her composure for several
days. She was delivered at term, of a child in other respects
well developed, but lacking abdominal parietes. Another one
saw, in the first weeks of her third pregnancy, a boy with a
hare-lip, and not only was the child she then carried bom with
a frightful hare-lip, but also three children subsequently.
Printed and Published for the Proprietor, at the Office of th« Medical
Press and Circular, 3 Lincoln place, Dublin.
Digitized by '
,°°g
The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
The above may be happily to some extent neutralised by
the action of the Profession in Marylebone, where Dr.
Humphry Sandwith has received great support from his
professional brethren.
Last week a meeting, the attendants at which were all
members of the medical profession, was held ill favour of Dr.
Humphry Sondwith’s canvass.
Dr. Sandwith expressed his views relative to the present
position of the medical profession. He was strongly iu favonr
of an amendment of the Medical Act in such a form as would
protect the public from unlicensed practitioners. He would
favour the further amend ment of the Act in such a form as to
provide for the representation of the profession in the Council.
As to the public services, he thought the position occupied by
medical men in the army and navy required consideration.
In respect to the Poor Law Medical Service, he was of opinion
that the decisions of the committee of the Legislature should
be carried into effect, and that the appointment of in-door and
out-door medical officers should be for life, and he would sup¬
port their claims to superannuation. In respect to sanitary
measures, he was of opinion that the various Government de¬
partments of public health should be consolidated, and that
there should be a revision of the sanitary laws.
It was moved by D. Head, Esq., seconded by Weeden
Cooke, Esq., and unanimously carried, 11 That this meetiug is
of opinion that Dr. H. Sandwith’s candidature is deserving of
the warm aud unanimous support of the medical electors of
the borough, and believes that the measures which he desires
to advocate will tend to the advancement of the health of the
community, the improvement of the condition of the sick
poor, aod the diminution of paupers, and consequent decrease
of the rates. **
Mauy medical men who could not attend sent letters of
sympathy.
We set these questions once more before our readers,
urging all to act promptly. All along we have urged the
claims of medical candidates, and if the Profession will not
unite to carry them we confess we have no hope for union
in anything else. Whatever the result the Medical
Press and Circular will have done its part—thoroughly
and consistently.
GLASGOW AND ABERDEEN UNIVERSITIES.
The contest for this seat proceeds with great vigour on
both sides. It is a matter of surprise to many that the
Lord Advocate should have secured so many medical sup¬
porters as have promised to vote for him ; for whatever
may be said as to his acts in a single instance, it is impos¬
sible to deny that he comes forward as the representative
of Toryism, while the medical profession, as a whole, is
unquestionably Liberal. Too much capital has been made
out of the enfranchisement of the Universities, but this
subject has been fully exposed anent the contest for the
Chancellorship of Edinburgh. Something has also been
done through boasting the possibility of squeezing money
out of the Tories. These considerations, however, go for
nothing in the minds of Liberal electors, who know that
the leader of their party in Scotland would be ready to help
them so far as he could, and that no one could more worthily
represent the new constituency than Mr. Moncrieff. There
are, however, questions of medical politics that cannot be
shirked; and though these have made less noise than in
the contest for Edinburgh and St. Andrew's, chiefly be¬
cause in the latter constituency a medical candidate came
forward avowedly as a medical politician, we happen to
know that they are influencing many voters. Mr. Gordon
has received, as we know, promises of aid from medical
men because he has promised to consider some of their
grievances—mostly those relating to salary. It is but just
that Mr. Moncrieff s views should be made equally public.
November IS, 18C8. 433
We are enabled to state, on unquestionable authority,
that Mr. Moncrieff is prepared to support a thoroughly
liberal scheme of medical reform. He has full sympathy
with all classes of the profession, and is anxious to serve
the medical graduates, whose good opinion he is most
anxious to have.
We have already stated that several candidates for seats
in Parliament cordially approve the scheme enunciated
by Dr. Prosser James, and the name of Mr. Moncrieff
may safely, we believe, be added to them.
The following extract from a letter addressed by Mr.
Moncrieff to a medical graduate will be read with deep
satisfaction:—
“ I have long thought that in this as in other cases self-
government is the only satisfactory condition on w’hich
the internal regulation of professional bodies can be ad¬
ministered, and I should be prepared to carry this prin¬
ciple out in the constitution of the Medical Council. An
oligarchy in such matters is always an evil.”
We trust that after this unmistakable declaration, the
medical graduates of Glasgow and Aberdeen will rally
round Mr. Moncrieff, and so secure the return of a poli¬
tician who has long been a leader in the House of Com¬
mons, is certain to be a member of the next Cabinet, and
is thus unequivocally pledged to the programme of medi¬
cal reform on which the profession has set its heart.
THE ENFRANCHISEMENT OF THE SCOTTISH
UNIVERSITIES AND THE LANCET.
We have been favoured with a copy of correspondence
between the secretary of Mr. Swinton’s committee and Dr.
Richardson, as to the statements made by the Lancet,
concerning the help afforded to a good cause by the can¬
didate who lias been fortunate, or perhaps unfortunate
enough, to have the Lancets advocacy. We regret its
arrival too late to give it in full, but it proves satisfactorily
enough that the journal in question has been circulating
false statements, and giving publicity to private letters—
how obtained it is not for us to say. Dr. Richardson
writes—“ I have not, as president, conveyed officially the
thanks of the Association,” &c.
He also says “Permission has never been asked for the
E ublication of any communication of mine.” Further on
e adds that “ the note was a courteous acknowledgement
of a private letter.”
We are sorry to see University elections degraded by
the tactics of a professional journal to the level of the
meanest boroughs.
--
•ffrrhs on €nnmt ftspes.
Hospital versus Workhouse.
We constantly have the poor applying to be admitted
as in-patients at our hospitals when there is nothing but
want ailing them, yet we And a poor fellow refusing to go
into “the house,” although suffering from such serious
disease that he expires within a few hours of his applica¬
tion for out-door relief. We give a letter from the Rev.
J. F. Francklin, Vicar of Whaplode, to the Board of Guar¬
dians of Holbeach, Lincolnshire, they having passed a vote
of censure on him for his free expression of opinion at an
inquest.
“ To the Board of Guardians, Holbeach.—Gentlemen,—I
by no means wish you to erase your unjust vote of censure on
me from your minutes, but in common justice I claim the right
of stating the case as it regards myself. There are two sides
Digitized by (jOCK^IC
434 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
November 18, 1868 .
to every question. Pauper Biggadike—at the reoommenda-
tion of my churchwarden, who knew his abject state of want,
spoke to me about him, and suggested that I should obtain
from the Board the sum of half-a-crown per week to meet his
necessities, and he sent the pauper to me. I wrote a note to
Coxon, the relieving officer, and gave it to Biggadike for de¬
livery in my own house, where he nearly expired from the
effects of a diseased heart. I believe he delivered the note to
Coxon. That official (as appeared from the statement of the
pauper) offered him only medical relief, and at the same time
told him if he wanted any other relief he must come to the
Board. I told the poor man he need not go himself, but that
I would see Coxon at the Board at its next meeting and
arrange for his having the desired sum of relief. Sick calls
prevented my attending, and the matter was left to Coxon,
who at the inquest stated that the Board would not entertain
the case, as the pauper had not had the medical relief, and all
I had to say was nothing, because I was not a medical officer,
and the pauper must come to the house for relief, and that
was all they would do for him. The pauper was thus, in my
opinion, neglected in his utmost need ; he died within a few
hours of his hearing from Coxon that he teas to have no relief —
only an order for the house. I said at the inquest, in my
opinion he had been shamefully treated by the Board, and
thev were virtually responsible for his death ; and those who
had voted for only * the house, 9 had showed themselves bar¬
barous and unfeeling men by such cruel conduct to a death-
stricken man, whose end they accelerated by their callousness
to the wants of the deceased. I retract not one word that I
have said in this matter, and I believe the man might have
been still alive. The charge of attempting to prejudice the
jury is false. Thanking you for your vote of censure, I am,
&c., J. F. Francklin, Vicar of Whaplode.”
What is the moral of this? Let the infirmaries for our
sick poor be made so comfortable that our hospitals and
paupers will not go to their “ last long home,” because
they prefer it to “ the house.” How is this to be done 1
Let our workhouse infirmaries be thrown open for public
inspection, and for the study of medicine, and we shall not
again hear of cases like that of poor Biggadike.
The New Pharmacy Act.
The apotheoaries of Great Britain are looking forward
with interest to the time when the Pharmacy Act of last
session shall come into active operation. Within two
months the discharge of the functions of a chemist and
druggist, which are dealt with in the Act, or the use of the
titles specified in it, will be unlawful. Mr. Flowers, the
magistrate, has latterly called forcible attention to this
point, and, in speaking of a case in which poison had been
sold in quantity for suicidal uses, said that if the seller
were charged before him under the new statute, he would
have no option but to inflict a penalty of £5 for a first
offence, and £10 for a second. Chemists and druggists
who delay their registration until after the 1st of January
will be obliged to pay the same fee of £5 as if they were
coming up for examination.
The anticipation of this new Act has raised an important
question in Scotland, where apotheoaries are almost un¬
known, and where most surgeons oompound their own
medicines. When the Bill was sent down from the Upper
House to the Commons, a provision existed exempting “ all
qualified medical practitioners” from its requirements and
penalties. In the House of Commons the word “ apothe¬
cary” was substituted, and thus doubts arise whether me¬
dical practitioners who hold no lioence from the Apothe¬
caries’ Hall, can, under the Act, compound medicines.
Dublin Obstetrical Society.
The first meeting will be held in the College of Physi¬
cians, on 21st November, at eight o’clock. The Council
h»Ye invited a number of visitors, and no visitor will be
admissible without a card. The ballot for the election of
officers will open at eight o’clock.
The Council recommend the following list of candidates
for election:—
President —J. Ringland. Vice-Presidents (two to be
elected)—J. A. Byme, Wm. Jameson, G. Johnston, H.
Kennedy. Treasurer — H. Halahan. Secretary— Or. H.
Kidd. Committee (five to be elected)—L. Atthill, T. E
Beatty, F. Churchill, J. Cronyn, J. Denham, J. Isdell, J.
R. Kirkpatrick, A. H. M'Clintock, S. M. M'Swiney, J. H.
Sawyer.
Homoeopathy at Aberdeen.
The various comments that have lately been made in
reference to this subject, seem to a large extent one-sided.
The reason that the matter has so long been kept from be¬
ing public talk is scarcely apparent. The communications
we have received this week are scarcely adapted for publi¬
cation ; but no doubt the question will not be suffered to
rest after the adjourned meeting of the Governors of the
Infirmary.
The Late Dr. Hillier.
University College has lost one of its most promising
servants in Dr. Thos. Hillier. He attained very highhonoon
during his course at the University of London. He was
one of the first, and certainly one of the most hard-working
Officers of Health. His manual on Skin Diseases was well-
known, and the writer was studying his last clinical work
on Diseases of Children, with a view to a lengthy review,
when his melancholy death was announced. Dr. Hillier
had, wo hear, even taken his passage to the Cape, in the
hope of arresting disease of the lungs, when the sudden
death of his brother from an accident prevented him, and
he rapidly sank and died on the 7th’inst., at the early age
of thirty-seven.
Excision of Joints.
The first meeting of the Royal Medioo-Chirurgical
Society of London was devoted to this important subject
Mr. Henry Lee read a paper giving the results of cases of
excision of the hip, knee, elbow, and wrist joints. Pro¬
fessor Humphrey, of Cambridge, gave the results of hh
experience since a former paper on the same subject His
number of operations now reaches thirty-nine. Excision
is now generally recognised by British surgeons as a proper
operation in selected cases.
Physician or Surgeon.
In all large towns the distinction of these branches is
well understood, and it is right they should be regarded.
The governors of the Cumberland Infirmary have lately
had the duty of appointing a physician to their charity.
There were three candidates—one of them, a member of
the Royal College of Physicians of London, and therefore
of necessity a pure physician. This gentleman had also
been a lecturer in the Newcastle school, and an Examiner
at the University of Durham. With such a candidate
before them we are astonished to learn that they elected
the surgeon to the city police force, who is also reported to
be a surgeon to several dubs, and therefore we suppose a
general practitioner. In London no institution appoints
surgeons or general practitioners physicians. We do not
say the offices are absolutely incompatible, but we do
think it a bad precedent, and we should regnt-to nee the
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NOTES ON CURRENT TOPICS.
November 18, 08 . 435
wholesome custom changed, as it could not fail to injure
the charities and promote unpleasant feelings amongst men
who ought to be on the best of terms.
Dr. or Mr.
A rather ludicrous incident took place in reference to
an election in England. Some one declined to allow that
a candidate who was LL.D. had the right to call himself
doctor, and asked to look at his diploma.
In Scotland Mr. Swinton, LL.D., repudiates the doctor-
ship* and is hard upon his opponent, Professor Playfair,
who is also LL.D., for using it. Will someone in authority
say whether a doctor of laws is to be addressed as Dr. or
Mr.? His right seems to us as clear as that of a D.D., but
perhaps the Universities who dub men doctor will give
judgment.
RoyaliSouth Hants Infirmary.
This Institution has, according to the Southampton
Titties, received presents of photographs and other pic¬
torial adornments for the walls of the wards. Other
generous donors have thought f of the younger patients
and sent scrap-book3 of coloured prints on calico, &c.
This is another movement in the direction we have
already pointed out.
The Army Blue-book.
The new Blue-book has reached us this week. It is
as heavy and as full of statistics as usual, and will afford
us many opportunities of referring to the numerous sub¬
jects so ably treated in it.
Certain figures with which it abounds must first be
disposed of. The following analysis has, to a large ex¬
tent, already appeared in the daily press :
Twenty thousand four hundred and ten recruits were in¬
spected in 1866 ; 6,811, or 334 per 1,000 were rejected at the
primary inspection, and 950 at the secondary inspection,
making a total of 7,761, or 380 per 1,000 rejected in the
aggregate, and leaving 12,649 to pass into the army. Com¬
pared with the results in 1865, the proportion rejected shows
a reduction of 46 per 1,000. Of 8,315 recruits passod at tlie
primary inspections by army medical officers, 208 were sub¬
sequently rejected, while of 5,384 passed by civil medical
practitioners, 742 were rejected, these numbers being respec¬
tively in the proportion of 25 and 140 per 1,000 of the recruits
found fit in the nrst instance, against 38 and 149 per 1,000 in
1865. The results, therefore, for 1866 ehow a lower ratio of
rejections in both groups than in the preceding year. The
rejections at primary inspections by army medical officers, com¬
pared with these by civil practitioners, were in the propor¬
tion of 373 to 260 ; but when the recruits had passed through
the secondary inspection the difference in the results amounted
only to 26 per 1,000. Compared with the results of the pre¬
vious year, there was a marked decrease in the proportion of
English recruits rejected, a slight decrease among Irish
recruits, and a slight increase in the proportion of Scottish
recruits rejected. Out of every 1,000 recruits, 697 came from
England and Wales, 78 from Scotland, 219 from Ireland, and
«uc from the colonies and foreign parts ; these figures show a
considerable increase ir. the proportion of English, but a de¬
crease in Scotch and Irish recruits, compared with the pre¬
ceding year. The highest ratio of rejections was among the
recruits for the Foot Guards, and the lowest among those for
the Household Cavalry. Compared with the results for 1865,
there has been a reduction of about 8 per 1,000 in the defects
of the lower extremities, and in loss or decay of many teeth,
per 1,000. The following are the most frequent causes of
unfitness :—Diseases of the eyes and eyelids, 882, or 43 per
1,000 : varicose veins, 721, or 35 per 1,000; small or mal¬
formed chest or curvature of spine, 723, or 35 per 1,000;
defects of lower extremities, 604, or 30 peT 1,000 ; variotele,
542, or 27 per 1,000 ; muscular tenuity, 525, or 26 per 1,000 ;
disease of heart, 513> or 25 per 1,000; unsound health, 414>
or 20 per 1,000. Less freonent causes of rejection were
syphilis, loss or decay of teeth, hernia, ulcers, wounds, and
cicatrices. Tho highest proportions of rejections were in the
class of mechanics—419 per 1,000 ; and in the class of manu¬
facturing artisans, 400 per 1,000 ; the lowest, exclusive of
boys, was among the professional class, and among labourers,
&c. Of every 1,000 recruits examined by army medical officers,
286 were unable to read or write, 87 were able to read only,
and 707 were able to read and write. Tho ages of the recruits
of 1866 show that enlistments under 18 years of age and at
25 years of age and upwards were less numerous than in 1865 ;
but there wa3 a considerable increaso in tho proportion between
the ages of 18 and 20 years.
Lord Rector Moncrieff.
Last Saturday afternoon the election to the Lord Rec¬
torship of the University of Edinburgh terminated in favour
of Mr. Moncrieff, and we doubt not tho learned Dean of
the Faculty of Advocates will worthily fulfil the duties of
the office. He succeeds Mr. Carlyle, whose term of office
has expired. The proceedings excited much interest among
the students. Active canvassing had been going on for
some time by the supporters of Mr. Moncrieff, Mr. Ruskin,
and Mr. Lowe, and numerous meetings had been held.
The polling was between the hours of eleven and one; the
polling-booths were in the class-rooms of the University,
and under the superintendence of Professors. During the
day, at the entrance to the University and in the quad¬
rangle, peas and small bags of flour were freely thrown
about by excited partizans. Mr. Lowe’s name was with¬
drawn after 80 votes had been polled for him, his sup¬
porters making the following statement:—“ Mr. Lowe
having been withdrawn after the first quarter of an hour
by a majority of his' committee, the votes recorded as the
result of the poll must not be taken as showing the number
of his supporters.” Shortly after one o’clock the result
was declared as follows:—For Mr. Moncrieff, 607; for
Mr. Ruskin, 425—majority for Mr. Moncrieff, 182. The
announcement was received with loud cheers by Mr. Mon-
crieff’s friends, who afterwards met in their committee-
rooms, when congratulatory addresses were delivered. Mr.
Ormond, chairman, said that, in spite of the most strenuous
opposition, they had put Mr. Moncrieff at the head of the
poll, and he was sure that in doing so they had done a real
practical benefit to the University. He believed that Mr.
Moncrieff would not only be an honour to the University,
but a practically useful Rector.
We trust this election is but the forerunner of a greater
success at Glasgow and Aberdeen.
The candidates for the Physicianship of the Royal South
Hants Infirmary, rendered vacant by the retirement of
Drs. Joseph and William Bullar, are Dr. Soott, who is
now Physician to the Infirmary, and T. Trend, Esq. Dr.
Joseph Bullar has held the appointment for many years.
It has been notified that the Female Hospital in course
of erection at Montpellier hill, Dublin, will be ready for
occupation in March, 1869.
It is in contemplation to build recreation-rooms in the
Royal Barracks, Dublin, on the same plan as those erected
in Richmond Barracks.
The Glasgow University Building Fund has reached
nearly £103,000. It is thought that Lord Stanley and Mr.
Lowe will have a close run for the Chancellorship of the
University of Glasgow.
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436 The Medical Pros and Circular.
HOSPITAL REPOltTS.
November IS, 1888.
Dr. Balthazar Foster has been elected Physician,
and Mr. Goodall Surgeon, to the General Hospital, Bir¬
mingham.
Winter in the North has begun in earnest. A week
ago the water in Lake Windermere was frozen. There
were 11 degrees of frost there on Sunday >veek. Northern
lights and lunar rainbows were beautifully distinct in the
neighbourhood.
The accounts from Russia and the Baltic also indicate
that winter has already set in with a probability of
severity.
LONDON HOSPITAL.
CASE OF VARICOCELE DEPENDENT ON SELF-ABUSE.
Under the care of Mr. Rivington.
W, T., set. 17, joiner, was under the care of Mr. Curling
at the London Hospital, and transferred to Mr. Rivington.
The patient, whose aspect was characteristic, had prac¬
tised self-abuse for five years, and for the last two years
seminal discharge had followed the act. This habit he was
accustomed to practise twice a day, but now, on an average,
not more than once a month. The discharge was some¬
times thin, at others more consistent. Latterly his general
health became affected ; he grew weak and nervous ; his
appetite failed so much that at times he could not eat
anything. His sight suffered, and he became subject to
pains of an aching and gnawing character in the left side.
The veins of the scrotum on the left side were full, and
nothing but operation appeared likely to be of service.
Mr/Kivington passed a couple of hare-lip pins, with an
interval of half an inch, through the scrotum, behind the
veins and between them and the vas deferens. Pieces of
card were used to protect the skin, and the twisted suture
was applied. Subsequently the veins were divided subcu¬
taneously between the pins, with a tenotomy knife. This
is the mode of operation adopted by Mr. Curling.
After the operation there was some swelling of the tes¬
ticle and increase of pain. Both soon subsided. A firm
deposit occupied the seat of the operation, and the pins
were removed on the fifth day. When last seen, about a
month afterwards, the left testicle was a little larger than
the other, and the plastic matter remained in situ round
the veins.
CASES OF HERNIA.
Mr. Rivington has had several interesting cases of hernia
at the London Hospital, which we hope to publish in
another impression.
He informs us that he has had lately two cases of
femoral hernia, the swellings being small, which he has
reduced by the taxis, after four days* strangulation. These
small protrusions in the femoral region are generally con¬
sidered difficult of reduction. One case occurred at the
London Hospital, and the other in private practice. In
the former, the House-Surgeon had judiciously abstained
from attempting reduction for more than a few minutes,
but it was reduced very speedily. The reduction of the
latter did not occupy more than eight minutes, and Mr.
Rivington believes tnat cases are sometimes cut which are
amenable to the taxis.
RICHMOND SURGICAL HOSPITAL.
Case under the care of Mr. William Stokes.
(Reported by Mk. William R. Browne.)
MULTILOCULAR OVARIANTUMOUR; OVARIOTOMY; UN¬
SUCCESSFUL RESULT.
Maria L., a married woman, set. fifty-seven, was ad¬
mitted into the Richmond Hospital on*the 14th of last
September, having been recommended to Mr. Stokes by
his colleague Dr. Lyons. The patieut never had had any
children. She first observed enlargement of the abdomen
in the spring of 1864, but never sought for any medical
or surgical advice until she came unaer Dr. Lyons’ care
last February. The tumour had then reached an enor¬
mous size, the girth at the umbilicus being fifty-three
inches. The catamenia had always been regular and she
had enjoyed excellent health in every way until the
tumour began to grow. About two months previous to
her admission to the Richmond Hospital she suffered
from considerable pain in the upper portion of the tumour,
and at this situation a peritoneal friction sound was dis¬
tinctly audible, even to the patient herself. The attack,
however, soon completely subsided. At the time of her
admission into the Richmond Hospital, she was greatly
emaciated and suffering much from abdominal distension.
In other respects, the patient was in good health. At
this time Dr. Beatty and Dr. Byron kindly saw the case,
in consultation with Dr. Lyons and Mr. Stokes, and the
opinion arrived at was, that notwithstanding the ema¬
ciated condition of the patient, the case was one for
which the operation of ovariotomy was indicated.
On September 15th the patient, having been previously
brought under the influence of chloroform by Dr. J. A
Ross, was brought into the operating theatre of the Rich¬
mond Hospital. Mr. Stokes commenced by making a
longitudinal incision four inches in length midway
between the umbilicus and pubes, and a careful dissec¬
tion down to the peritoneum was then made. That
structure was then raised off the sac of the cyst by small
hooks, and carefully divided in the direction of the
original incision. On opening the peritoneum, some
clear straw-coloured fluid escaped, and then the shining,
white sac of the cyst was brought distinctly into view.
Mr. Stokes then thrust a large trocliur with caoutchouc
tubing attached into the interior of the cyst, and the fluid
contents were allowed to flow through the tubing into a
large bucket underneath the operating table. Several
quarts of a clear tenacious honey-like fluid were evacuated
from the first cyst. This being emptied Mr. Stokes, with¬
out removing the trochur, thrust it into the second cyst,
and the fluid contents of this were found to differ com¬
pletely from those of the first, being of a dark brown
chocolate colour, opaque, very much thicker and more
tenacious. Twenty-seven quarts of fluid were evacuated
from these two cysts. The tumour having now suffi¬
ciently collapsed, Mr. Stokes passed his hand gently
between the sac and the peritoneum to determine whether
any adhesions existed. These were found principally at
the upper portion of the tumour, and were Broken down
without much difficulty. The sac was then slowly and
carefully drawn out through the incision, and the pedicle
was found to be narrow and of considerable Length. The
folding hinge clamp was then applied, the handles re¬
moved, and the pedicle divided with a scalpel. The
edges of the wound were then carefully brought together
above and below the clamp by several points of silver
suture, great care being taken to include the peritoneum.
Strips of adhesive plaister were placed across the wound,
dry lint dressing applied, and the patient immediately re¬
moved to the adjacent ward and placed iu a bed pre¬
viously warmed by hot jars, etc. The patient soon after this
rallied, took some warm brandy and expressed herself as
greatly relieved and gratified at the operation having been
concluded. At this time (11.40 a.m.) her pulse was 115,
and soon after she fell into a quiet sleep.
1. p.m. Still asleep, pulse 104. Shortly after this she
awoke and had a little burnt brandy which she appeared
to like. Mr. Stokes again 6aw her at 4.15 p.m. with Mr.
Fleming. Everything was apparently progressing favour¬
ably, no head symptoms, pain in abdomen, sweating or
vomiting. The surface of the body maintained an
equable warm temperature. Pulse 120. At 9.45 PJt
she was again seen by Mr. Stokes. Took some iced brandy
and a small quantity of chicken broth.
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LITERATURE.
November 18,1868* 437
Second day. 1 a.m. Complained of great restlessness,
with pain over the pubes, accompanied by slight retching,
which was checked, and the pain alleviated by the ad¬
ministration of a very small quantity of burnt brandy.
Pulse 112. Some difficulty in breathing, which was
relieved by raising her shoulders.
3 A.M. Pulse 130. Had slept a little. Does not com¬
plain of any pain or uneasiness. At 11.30, a change for
the worse occurred, a cold clammy perspiration appeared,
the pulse rose and became very wealc. She had also
frequent retching and great prostration. Nutritive
enemata were now administered frequently, and had the
effect of making her rally somewhat, but this improve¬
ment did not la3t. She gradually sank, and at 5.20 p.m.
she died.
The post-mortem examination revealed the usual evi¬
dences of extensive peritonitis. The intestines were
much distended with flatus. Some fluid was also found
in the cavity of the abdomen, resembling that contained
in the cyst, and lymph was found effused over the surface
of the liver. A fibrous tumour, about the size of a small
orange, was found attached to the fundus of the uterus.
-♦-
SEA-SICKNESS*
We can well remember some years ago, when “cribbed,
cabined, and confined ” in the Peninsular and Oriental steamer
bound for Cadiz, the horrors of the sickness caused by the
troubled waters of the Bay of Biscay. In a moment of in¬
tense suffering we mentally resolved never again, if not com¬
pelled by the direst necessity, to cross the ocean, except that
small portion of it which forms the Straits of Dover ; and
notwithstanding that an unconquerable yearning has often
prompted us to seek the great Western Republic, and witness
there a portion of the human race free from the incessant
struggle for existence which so mars the pleasure of a life spent
in Europe, the recollection of the horrors of sea-sickness, as
experienced in our own persons and that of our friends, has
sufficed to turn the scales in favour of remaining on this side
of the Atlantic.
Well may the myriads who are daily and hourly enduring
such terrible agony as that inflicted by the remorseless wave of
the ocean cry out for some method by which this mass of
human suffering may bo abated. After all, perhaps, suffering
is above all the most grievous complaint we have to endure.
Death it has been often said is no great evil, whilst nervous
agony is what we should above all things endeavour to assuage.
The discoverer of a remedy for sea-sickness, just as the dis¬
coverer of the properties of chloroform as an anaesthetic, or of
the ether spray apparatus, would certainly be a great bene¬
factor of humanity. To have effected this great and splendid
task is an achievement claimed by the author of the work we
are now about to notice. Not that this is the sole advance in
therapeutics to which he aspires, the treatment and prevention
of sea-sickness being only one of the numerous applications of
the system of neuro-therapeutics, of which he is the well-known
and most ingenious author.
There is one point in the discussion of the author's remedy
for sea-sickness which is so completely an d priori one, that we
think it necessary before wc go into the arguments pro and
c ontrd the main doctrines, to notice it at once. Dr. Chapman
having invented his bags for containing ice and applying it to
the spine, has taken out a patent for these bags. By doing so
he has offended a large number of persons in the medical pro¬
fession, who are in the habit of saying that no medical man
should ever possess or take out a patent. We said that this
objection requires to be met fairly and in limine t else we might
have our faith in the author's testimony as to scientific facts
shaken by the belief that bis ethics were faulty. First of all
then there is much truth in what Dr. Chapman says, when he
remarks that “ a right appreciation of the claims of medical
science and a due regard for the public welfare, have conjointly
* “ Ss*-8ickneiM f and How to Prevent It.” An explanation of it*
Nature and succesaftil Treatment through the Agency of the Nervous
System by means of the Spinal Ice-bag. By John Chapman, M.D.,
M.R.C.P., Physician to the Farriogdon Dispensary. London: Trubner
A Co., Paternoster row. 1868. Pp. 112.
necessitated professional repudiation of men who deal in
secretly com funded, or quack medicines.” . . . But the
same cannot be said of the grant of an exclusive privilege for
a term of years, of making and vending a surgical instrument,
or any mechanical instrument for a medical purpose. This
privilege implies secrecy , and all the privilege the patent
confers is that of an exclusive right for a term of yean of
making the patented article ; and I am constrained to affirm,
that, in so far as the policy, the expediency, the morality, the
dignity, in short, the principles generally approved by the pro¬
fession, condemn the patenting of mechanical inventions in
connection with medicine, precisely so far do they condemn the
holding of copyrights in medical and surgical works, and the
titles of medical journals.” Dr. Chapman evidently considers
the copyright of a book, or the patent-right to an invention, to
be among the most certain grounds for claiming property which
can be brought forward, superior probably to the power of ac¬
quiring property by bequest, or by means of the transference
of landed estates from one person to another. And we are not
indisposed to deny his argument, the more so that we have
frequently heard it said that Dr. Richardson, who has lately
given such a boon to suffering humanity by his invention of the
ether-spray apparatus, instead of reaping a splendid reward for
his services, has (except by means of a small subscription
raised among the members of his own profession,) been rather
damaged in pocket by benefitting his fellows. Now, if we read
Dr. Chapman’s letter to the British Medical Journal , published
in the Medical Press and Circular, Oct. 16, 1867, we find
that he there says—“ I have been informed that soon after Dr.
Richardson invented his ether-spray instrument, Her Majesty's
physician, Dr. Jenner, said if he were Dr. JUchardson he would
jxitrnt the instrument .” And further on we read, “ Before I
patented the spine-bags I consulted the President of the
College of Physicians, Sir Thomas Watson, and the head of
the Privy Council, Mr. Simon, and both these gentlemen ex¬
pressed the opinion that I was justified in doing so.” Such
quotations in our humble opinion show that Dr. Chapman is in
all probability right, and the majority of the profession wrong,
in objecting to his patenting an instrument which is by no
incans mysterious or secret.
Having got rid of tills obstacle, which prevents many from
judging of the testimony given by Dr. Chapman and others as
to facts in nature, we now come to examine the testimony.
Whether Dr. Chapman’s speculations as to neuropathy be true
or no, there is no doubt that they contain many of the features
of a correctly formed theory. He gives us in an admirably
clear introduction, a synopsis of his views os to neuro-physio¬
logy, setting out from the assumption that the sympathetic is
the excito-motor nerve governing the vascular system, and that
the functional activity of the glands is excited or maintained
by a stimulus from the cerebro spinal axis. The former of
these assumptions is now pretty generally admitted since the
clear demonstration given of the fact by Bernard and Sequartl.
The latter proposition is an extension of the views of Bernard,
Ludwig, and Pfluger. Bernard proved that the parotid and
submaxillary glands receive their nervous supply on the one
hand from the brain and spinal cord, and on the other, from the
sympathetic ; and demonstrated by experiments on animals
that when the former are in action the maximum of blood is
supplied to the glands and the maximum of Baliva secreted,
whilst when the latter are in action it modifies the volume of
the arteries and regulates the supply of blood. Dr. Chapman
states that he has discovered that by applying heat along the
spine he stimulates the glands of the don and mucous mem¬
brane, and by applying cold he restrains or depresses them, thus
increasing or arresting their secretions. According to our
author then, the mucous and cutaneous glands act under the
control of a special set of nerves derived from the brain and
spinal cord, and distinct from the sympathetic. Glandular
action, in short, and glandular inaction, are due, the first to a
preponderance of cerebro spinal influence, the second to a pre¬
ponderance of sympathetic nerve force. He maintAins that all
glands possess positive motor-nerve fibres from the cerebro¬
spinal axis, even in the cases when anatomy has not discovered
such to exist. From these postulates Dr. Chapman requires
our assent to the importance of endeavouring in all cases of
excessive discharges from glands, such as diarrhoea, leucor-
rhoea, bronchorrhoea, &c., of endeavouring to paralyse this
cerebrospinal influence, and thus inhibiting the supply of blood
to the glands which causes the discharge.
So much, in brief, for the theory ; and now for the verifica¬
tion of the law, our author points to the evidence adduced by
a number of medical men, among whom we perceive with plea-
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438 The Medical Press and Circular.
TRANSACTIONS OF SOCIETIES.
November 18,1808.
sure many most distinguished Dublin practitioners, as to the
rapidity with which cases of diarrhoea, dysentery, delirium
tremens, constipation, vomiting, dyamenorrhcea, amenorrhcea,
menorrhagia and leucorrhcea, cholera and diabetes, have been
cured. Paralysis and epilepsy have, according to much excellent
medical evidence, been frequently cured by the application of
this theory. If vomiting on land be under the dominion of this
mode of treatment, we shall of course not be surprised to find
that sea-sickness is amenable to it; but in page fifty-seven, our
author gives us the physiology of sea-sickness as follows He
holds that “ the proximate cause of sea-sickness consists in an
undue amount of blood in the nervous centres along the back,
and especially in those segments of the spinal cord related to
the stomach and the muscles concerned in vomiting. This
condition is induced by the movement of the vessel in (he
thinks) three ways ; first, through the brain ; second, through
the ligaments of the spinal cord ; third, through the abdominal
and pelvic viscera. If by one or several causes the amount of
blood circulating in the spinal cord be increased considerably
beyond the normal amount, all the nerves emanating from it
partake of the increased activity of the cord itself, and convey
from the centre to the periphery of the nervous system an ab¬
normally large number of exciting impulses. Those parts of
the body which are subject to the will, the purely voluntary
muscles, resist these impulses most easily, and only in extreme
oases, therefore, are their ordinary functions deranged ; but
the involuntary or purely organic functions being unsustained
by cerebral influence under the direction of a dominating
will, have their usually regular and tranquil life easily dis¬
turbed and thrown into confusion by the unwonted number of
exciting impulses transmitted to them from the pretematurally
excited spinal oord.”
In page 61 he gives further details, which seem to us very
rational. “The movements and shocks, and the irritation
caused by the continually changing portion of the hollow vis¬
cera, produce an abundance of abnormal impressions upon the
nerves distributed to the various organs : these impressions are
conveyed through the medium of the complex visceral nerves
aud sympathetic ganglia to the spinal cord, thus inducing an
excessive reflex activity, and hence the transmission of a pre¬
ternatural amount of motor force to the stomach and bowels,
and, indeed, to all the viscera, as well as to the thoracic and
abdominal muscles.” Such is the very plausible theory pro¬
pounded by our author ; and now for the verification of the
induction. As we ourselves (we are ashamed to say) have
neglected the opportunity, which numerous voyages to the
Continent have afforded to ourselves (very bad sailors as we
are), of verifying this important theory on our own person and
that of our unhappy friends, we must listen to what other
medical men have to say.
Case 24 is given by Dr. Lee, of Philadelphia, and seems, of
itself , quite a sufficient verification of the theoiy. A lady, in
her return voyage from Havanna to the United States, en¬
countered very severe weather. “Violent and distressing
retching set in, with scarcely a moment’s intermission. She
rapidly became prostrate, the blood leaving the head and ex¬
tremities, which were very pallid and cold, and what was still
more alarming, severe spasmodic contractions of the muscles
of the extremities, with intense pain in the lower part of the
abdomen, set in.” The husband becoming alarmed, now de¬
termined to apply the ice-bag without further delay. “ Obtain¬
ing assistance, he carried Ms wife, more dead than aKve, and
conscious of but one desire, as far as her anaemic brain was
capable of consciousness—namely, that of being thrown over¬
board—down to the state-room, and had the ice-bag filled in
all its compartments. The effects of its application was little
short of miraculous. In thru minutes the retching ceased , and
the spasm was calmed. In a quarter of an hour vie had fallen
into a quiet deep ; and in half an hour her hands and feet were
of natural warmth, and her face had regained its wonted
colour. In two hours she awoke, greatly refreshed, and ate
two slices of toast, with a cup of tea, and from that time did
not miss a single meal.”
Some persons entertain an opinion that the use of cold to the
spine may in some cases prove dangerous ; but this seems en¬
tirely to be disproved by a letter in the Lancet of Dec. 8, 1864,
from Mr. Bradley, surgeon of the Cunard Service. He says :
—“ In severe cases of sea-sickness, when other remedies have
failed, I have very generally found the spinal ice-bag do great
good. I have applied it to young children, delicate women,
and old people. In no cases does it do harm, but in the great
majority of instances it soothes the nervous irritability^ which
so commonly accompanies sea-sickness, induces sleep, and bo
enables the stomach to receive light food, and consequently re¬
lieves exhaustion.” Many other letters are printed in this
work to the same effect; and there can be no doubt that sea¬
sickness seems, in very many cases , to be prevented by this ad¬
mirable and simple method. The moral we would derive from
perusing tMs admirably written work is, that we ourselves feel
emboldened to absolve ourselves from a rash vow never to
cross the Atlantic. Armed with one of our author’s ice-bags,
we are determined to dare “ rabiem noti ; ” and we invite all
our readers to peruse this work carefully and without preju¬
dice, and our medical ones to make a careful trial of a process
which so rationally promises to abolish one of man s greatest
sufferings—sea-sickness. ........
There is one point on wMch we would, if permitted, lixe to
dilate a little; and that is as to the absolute necessity m
medical matters of exercising a little of that chanty which is,
after all, the foundation of afi religion. Unfortunately, as yet,
in the noble profession of medicine, but little of this feeling
can be said to exist. That fraternity wMch we dream of, a
but a dream. A little of it, indeed, is found in the metropolis
of European civilization, Paris—even the word confrere de¬
notes that the spirit at least of fraternity exists, even if tfcs
struggle for a living often cause ungenerous conduct between
the brethren. We have no such expression. In this country,
alas I fraternity is unknown. A narrow aristocratic and
domestic feeling of exclusiveness everywhere prevails, even m
the profession of medicine, wMch, above all othere, should be
that most filled with the spirit of the Teacher who said, love
one another.” Our most eminent men are perpetually wrang¬
ling, and saying ungenerous things of one another, whether in
London or in the provinoes. Were it not for this, there couki
be but little difficulty in testing the value of the method ot
therapeutics proposed by our author. Each medical society,
were the fraternal feeling but fostered, would eagerly resolve
itself into oommittee for the investigation of any such ratww
and innocuous proposed as that made by Dr. Chapman for less¬
ening the sorrows of life. It is time, indeed, that a great social
revolution of some kind should take place, when we
want of real feeling and common fairness as that which m
proMbited even the discussion of our author’s patent-ngW
views in what is never tired of vaunting its pretension to be
the organ of the whole profession. Let us beware of the oron
of trades' unions. They have many advantages; bnttte
divine art of healing must not imitate their selfish praotnea
- ♦ -
famriktus of
MEDICAL SOCIETY OF LONDON.
Monday, Nov. 2nd, 1868.
Dr. B. W. Kichardson, F.R.S., in the Chair.
Mr. Alfred Cooper exMbited a Calculus, extracted fnm
the bladder of a boy aged twelve by the lateral operabouot
lithotomy. The boy bad been in the West London Hospital
for seventeen days without showing any symptoms.
Mr. Cooper also exMbited three Polypi of the RectuiMO®
of which he had removed by ligature from a child, one from *
lady, and one from a gentleman. All the cases had been mis¬
taken for haemorrhoids. , ...
Mr. Henry Smith showed a Stone, weighing five-and-a-mR
ounces, wMch he had removed from a womanh bladder. She
had suffered eight or ten years from the disease. He extracted
the calculus piecemeal by an incision made through ttc
vagina and the neck of the bladder. The patient had since
Mr. Smith also exMbited a Stone from the female bladder,
in wMch case be bad performed the usual operation of fatso*
trity. At the second operation there was some difficult y ®
introducing the lithotrite, when the cause of the obstructs®
was discovered to be a large fragment, as big as a smaD wal¬
nut, wMch had become impacted in the urethra.
removed by slightly incising the meatus, and the patient am
well. ,
An animated discussion then followed on the quesoonw
dilat ing the urethra, Mr. Walter Coulson and Mr. Bryantbonjj
of opinion that rapid dilatation was seldom, if ever,
by incontinence, whereas alow or gradual d ilat a tion waa
tended by that distressing sequel.
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Hie Medical Press and Circular.
CORRESPONDENCE.
November 18, 1868. 43d
Mr. Henry Lee then read a paper on
THE MEDIO*LATERAL OPERATION OF LITHOTOMY.
The author described the way in which he now performs litho¬
tomy, and which he has named the Medio-lateral Operation.
He gave the particulars of three cases in which this operation
had been performed. The first of these had occurred upwards
of twelve months ago. The medio-lateral operation, he said,
was performed in the following manner:—The patient is placed
in the ordinary position for lithotomy, and a grooved staff hav¬
ing been introduced, an incision is then made in the median
line of the perineum from before backward. This incision
should extend through the posterior half of the perineum, ter¬
minating two or three lines in front of the anus. From this
point this incision is continued for a quarter of a circle round
the front and left side of the rectum. The finger of the left
hand may then be put into the wound, and the rectum pressed
back, whilst an additional touch or two with the knife separates
it still further from the parts in front. The forefinger of the
left hand is now passed into the rectum, and the knife, with
its back towards the bowel, is passed at the posterior part of
the central incision, and in the median line, into the membra¬
nous portion of the urethra. With the finger as a guide this
is done with great ease and certainty. A bistoury or knife,
with a probe as its extremity, is then passed into the same
opening, and made to slide along the staff into the bladder.
The blade of the knife is then directed towards the patient’s
left side, and somewhat backward, and as it is withdrawn the
heel of the knif e passes in the direction of the original incision
through the skin. The point of the knife remains very nearly
in the median line. A free external incision is thus produced,
involving no important parts, with a small opening into the
bladder. The urethra being opened, the median line is reached
with the greatest facility with the finger, and the incision into
the bladder is in the same way very easily dilated. The for¬
ceps, or any other instruments that may be used, are also in¬
troduced more directly into the bladder than in the ordinary
lateral operation. In this operation all the usual accidents
and difficulties which are likely to occur in lithotomy are
guarded against. With the finger in the rectum as a guide,
the urethra may be opened without difficulty, and a probe-
pointed bistoury, being guided by a grooved staff, cannot well
fail to enter the bladder. The incision into the prostate gland
is made from within outward, and this he (Mr. Lee) considered
an advantage. An incision made in the opposite direction
partakes more or less of the nature of a stab, and the point of
the knife, even when guided by the most skilful hand, will
sometimes wander from the groove in the staff.
The medio-lateral operation for lithotomy is performed in far
less time than it requires to describe it, and Mr. Lee had been
impressed in operating both upon the dead and living subject
with the facility with which it is accomplished. The instru¬
ments used are an ordinary staff grooved in the median line, a
common narrow scalpel cutting on one ride only, and a curved
bistoury with a probe projecting two lines beyond the termina¬
tion of its cutting edge.
The accompanying woodcut shews the line of the external
incision in the medio-lateral operation for lithotomy.
In children a single incision with the scalpel is generally suf¬
ficient, but in adults the circular part of the wound should be
deepened either before or after the urethra is opened. Should
the stone | rove lame, there is no difficulty in obtaining more
room at the nesk of the bladder by making an incision in the
prostate gland on the right side, as well as upon the left. This
St easily accomplished by the probe-pointed bistoury introduced
upon die finger, and guided by it. 4
The external incision in the medio-lateral operation combines,
as it appears to Mr. Lee, the advantages of all the different
incisions which have been recommended. It affords sufficient
room for the use of instruments. These may be introduced in
the median line, and the rectum is not likely to be displaced or
injured. The operation as a whole is, he thinks, the simplest
in conception, the easiest in execution, and the least liable to
be attended or followed by any unfavourable complications, of
all the operations for lithotomy.
Mr. Bryant advocated the plan that he had been taught—
of using a straight staff. He believed that almost any stone
of reasonable size could be removed by the lateral method.
Mr. Lee’s plan might be useful in very large stones.
Mr. Walter Coulson and Mr. Teevan respectively spoke
of the importance of cutting, not dilating the prostate, and
exhibited calculi that they had removed.
The President gave a succinct history of the operation of
lithotomy, and showed that whatever operations were per¬
formed, death is in proportion to the age.
Mr. Charles Hawkins said that the mortality was greater
in private than in hospital practice, the reason being that hos¬
pital patients applied earlier for relief, and were more ready to
undergo the necessary operative procedures. Private patients,
on the contrary, hoped on until their kidneys and bladder be¬
came diseased.
In reply, Mr. H. Lee thought that his plan of operation was
very easy to perform, and he believed that dilatation of the
prostate was not only very possible, but expedient.
After a few remarks from Mr. Gregory Smith and Mr.
Mason, the meeting adjourned.
At the last ordinary meeting of this Society Mr. Thomas S.
Griffiths, of Wrexham, was proposed as a Fellow. This gentle¬
man, in joining the Society, presented to the library the fol¬
lowing valuable books, viz.—
1. “ The General Practise of Physicke,” by Chris. Wirtzung,
in Germane, translated by Jacob Mosan. Date, 1617.
2. 11 The Breviane of Health,” by Andrew Boord, Doctor of
Phyrick ; an Englishman. Date, 1587.
3. * ‘ A Briefe Treatise, wherein are to be found divers good
and spedall Helps for many Diseases,” by Walter Cary. 1587.
4. “ Guilielmi Harveii, Exeroit. Anatomical de Motu Cordis,
et Sanguinis Circulo.” 1661.
5. “ Aphoriami Hippocratis,” cic. icclxxv.
6. “ Galeni Comentarius,” mdxxxvii; and
An engraving of Harvey, by Houbraken, date 1739 ; and
A mezzo tin to portrait, three-quarter length, of Dr. Jenner.
Monday, Nov. 16th, 1868.
Mr. Spencer Watson on u A Case of Injury to the Knee-
joint and, also, a Specimen of Comminuted Bones from a
Gunshot Wound.
Dr. Leonard Sedgwick will exhibit an improved Uterine
Speculum.
Mr. Alfred Cooper, a Case of Carcinoma.
A Ventilating Urn for the rick-room, and for the diffusion
of vapour or warm air, invented by Mr. Jones, of Aylesbury,
will be shown.
Mr. Thomas Hunt on “ Phases of Physic in the Present
Century,”
W. E. Poole, Registrar.
— — ♦-
TIMIDITY.
TO THE EDITOR OF THE MEDIAL PRESS AND CIRCULAR.
Sib, —One of the causes which prevents the advancement of
the interests of the profession is the timidity of its individual
members. A certain journal—the Lancet —has held a leading
position for many years, and by unscrupulous personalities has
frightened even our leading men. Those who are behind the
scenes and know how the wires are pulled think nothing and
care nothing for what the Lancet says. But it is notorious
that a large number of medical men render implicit deference
to the utterances of this more than Delphian oracle. Others, of
an acuter turn, make use of the journal for the publication of
their oases and lucubrations because it has a lar^e circulation,
and it is their interest to do so. Wisely and sagaciously do they
act in their day and generation ! Such are some of my own
friends and acquaintances, who have stood absolutely aghast
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440 «fhe Medical rresi and Circular. NOTICES TO CORRESPONDENTS.
November 18, 1866.
at me for my great imprudence, as they term it, in attacking
the Lancet in your Journal of Oct. 7. One says, “ It was very
imprudent of Rivington to attack the Lancet —one never
knows what may happen.’ 1 Another says, “ It was very im¬
prudent of you to beard the Lancet —it has great influence
—they will never forgive you.” Well, suppose they don’t,
whoever they are—not more than half-a-dozen little great men
at the outside—what does that matter to me ? Justice and
honesty were on my side ; and bo long as I adhere to justice
and honesty, malevolence can do me no harm. But what I
wish to point out is that if all who have felt aggrieved and
ashamed at the conduct of the Lancet would not be afraid of
coming forward in their own names, and saying so, the power
which has been a terror to them would be effectually broken.
Its life would be in danger, and if it wished to retain it, it
would have to repent ana amend its ways. Its silence is sug¬
gestive. Possibly even now it has repented. There are men
connected with the Lancet whom everyone respects and appre¬
ciates. Before the Sub-Editor left the Lancet in September
(why did he go ?), these gentlemen were permitted to sit round
a table and express their sentiments, and enjoyed the privilege
of discovering, as soon as the journal was issued, whether their
advice had or had not been followed. It is probable that they
have now a little more weight in counsel, and can keep the
paper in the paths of innocence and truth. Let us hope that
it may be so for the good of the profession. Surely, as it is,
the medical body stands low enough in public estimation ;
surely there is disunion enough already within our ranks. All
our energies are required to solve the great problems before
us, to make the Medical Council truly representative of the
varied elements of the profession, to liberalise and quicken
our corporations, to reduce to order our educational chaos, to
raise the position of overworked and underpaid medical men,
to improve the social status of our body politic, to render more
efficient our public charities, and to diffuse throughout the
community those sound views on sanitary subjects which will
further limit tho prevalence of quackery, and bring the boons
of science and the blessings of health still more effectually
within the reach of the poorest of our fellow citizens.
I am, Sir, your obedient servant,
Walter Rivington.
MEDICAL JOURNALS AND MEDICAL CANDIDATES.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir, —A few weeks ago Mr. Rivington boldly exposed in
your columns the disgraceful conduct of the Lancet as to a par¬
ticular institution. In the course of his masterly letter, which
must have produced confusion amongst the “ clique of con¬
spirators,*’ he incidentally alluded to another instance in which
that journal has misrepresented the profession—viz., the con¬
test for the Universities of Edinburgh and St. Andrew’s. For
that seat two physicians were candidates ; but, while loudly
professing to desire medical men to be returned to Parliament,
the Lancet did all it could to ignore, and afterwards to oppose,
both Dr. Prosser James and Dr. Richardson. It was clear, in
fact, that long ago, in this, as in so many other instances, the
Lancet deliberately ignored the profession. It has been long
known to a few, that in Bedford street all the finer profes¬
sional feelings and all past vauntings have been sacrificed to
low trade instincts. Yet there is a conventional decency
which might have been observed, if only to save appearances
and shield the honour of the one or two respectable men who
still consent to be on the staff of the once leading medical
paper. Disunion and petty jealousy may ruin the profession,
and, alas! we are scarcely surprised ; but during the life of the
late Mr. Wakley no one could have imagined the depth to
which his journal would descend. Suppression of facts is the
least sin on this oocasion. Perversion of them does not tell all.
Not only has it opposed both medical men, but omitted the
name of one from a professedly complete list, and refused to
discuss his proposals for medical reform, although at the
moment its columns were open to analogous schemes. In
fact, all through this contest it has trampled on all its former
professions, and done all in its power to deprive the profession
of the representation it all along pretended to desire. The
worst of such conduct is, that confiding minds may not see
through the trick, and this is exemplified in your other con¬
temporary, which virtually takes a side in politics. The Me¬
dical Times , clinging with all the energy of decaying nature to
Toryism, has professed to sink politics whenever medical can¬
didates come forward. But how has it fulfilled this profession ?
With all the power it could exert it naturally enough
supported Dr. Richardson—the one brilliant member of its
staff—who has arrested the action of a discerning medical,
public, and, probably, thereby averted its absolute extinction.
Yet, on his retirement, it belied all its former professions by
ignoring the other medical candidate, and speaking of Dr.
Richardson as the professional candidate. Why? Is it the
Conservatism which reigns in the Medical Times , and which
it loves more than the profession ? When that organ boasts,
week after week, of supporting medical men, are we to under¬
stand “ Liberals always excepted?” It is surprising that
Dr. Richardson’s paper should thus have acted.
Yours faithfully,
Edwin Hearns, M.B.
Southampton, Nov. 10, 1868.
NOTICES TO CORRESPONDENTS.
Thomas J. Momaoiian, Tuam.— Before anyone can be bound as Ap¬
prentice to an apothecary, the law renders it necessary that he shall be
examined by the Court of Examiners of the Apothecaries' Hall, and shall
have obtained “a Certificate of Apprentice" from the Court; but in
case the pupil has obtained “a Certificate in Arts" from any of the re¬
cognised licensing bodies, (‘‘the Certiflca’es in Arts "of the Queen's
University, and of the College of Surgeons in Ireland arc recognised) tbs
C mrt will admit him to examination for “the Apprentice Certificate,"
upon any Friday during its sittings, at the hour of Two o’clock, p.m.,
when the examination will be limited to Latin, Greek, French and Eng¬
lish. “The Arts' Exsmination " at the HaU does awsy with the necessity
of the latter examinaton.
Mb. Simpson, Norwich.—T he trial took place some three and a-hslf
years since.
Dr. Croft.— The subject is scarcely within onr province.
Dr. E P. 8tarut.— Cases of Dropsy differing in their Etiology, Treat¬
ment, and Termination, shall appear as soon a* possible.
Dr. Johnson.— No reply has yet been received from Mr. Trimmer,
Secretary to the Royal College of Surgeons of England. Further en¬
quiries will be instituted.
Dr. Cranko. —The journal shall be sent as desired.
Dr. Lake.— Owing to the great pressure, we are compelled to again
postpone your letter on 44 Poor-law Reform."
44 Two Cates of Paralysis In Connection with Typhus," under the care
of Dr. Grimahaw, in type.
Dr. Haslett.—Y our letter “On Consultations" shall appear, if pos¬
sible, in our next
Dr. Thomas 8wah 44 On Coroners," see previous reply.
Sir,—C an you or any of your readers kindly tell me how sulphurous
acid is applied to certain cases of sore-throat, or if the mode of doing bo
is described in any book ? Information on this subject, early given, will
greatly oblige. A PnAcrmojrER.
The best mode of applying sulphurous acid to the throat is by burning
Duncan and FlockharL'a sulphur pantiles and inhaling their fumes; and
tho next best method is by the inhalation of sulphurous acid in notation,
by means of Clarke’s Spray Producer.
Ed. Medical Press akd Circular.
Communications with enclosures have been received from Dr. Waters,
Chester ; Mr. Dorling, Edinburgh ; Mr. Hardy, Dublin ; Dr. Ramsey,
Cheltenham ; Dr. Sharp, Rugby, Dr. Peirson, Mr. Horace Swete, Westim;
Dr. Benson, Dublin; Dr. Pratt, Poole; Mr. J. Rand, Walton; Mr. J.
Waring-Cnrran, Spalding; Weeden Cooke, Esq., London ; M. A. Harte,
Esq., Plymouth; Mr. Sondford. Mr. Barker, li Morgan, Hsq., Dublin;
Dr. Maurice, Kerry ; Dr. J. W. Lane, Bishop's Castle ; R. M. Craven,
Esq.. Hull; Dr. Barr Meadow*, London; F. B. Courtenay, Esq.,
London ; Dr. Thomas, Glasgow ; J. Aston, Esq., Wadtngham ; Dr. Ben¬
son, Dublin; the Medical Society of London: Dr. Drysrlale, London;
Dr. Burder, Bristol; Dr. Cranke, Ulverstone ; W. S. Whatford, Es^,
Brighton ; Mr. Gray, Edinburgh ; Mr. Marshall, London ; Dr. Calvert,
Manchester; Dr* Elliot, Carlisle; Dr. Caplin, London; Dr. Starkey,
Ballinasloe ; Arthur G a in gee, E*q , Edinburgh; the President of the
Iloslar Hospital; U. Fitzmaurioe, Esq.. Listowel; Dr. Swann, Abbey-
Leix ; Dr. Barton. Dublin, Dr. Me. Donnell, Dublin ; Ac., Ac.
Several Original Communications and other articles sre in type, but
unavoidably postponed.
Commujc cations acknowledged from Dr. Gordon, Dr. Johnson, Dr. Le-
theby, Dr.Symes Thompson, Dr. Balthazar Foster, Dr. McCall Andersen,
Dr. Durham, Mr. Curling, Dr. Wilson Fox, Dr. Day, Dr. Handfield Jones,
Mr. Sansora, Mr. Holmes Coote, Dr. C. Nesbitt, Mr. Cans ton, Mr. H.
Lee, Sir Randald Martin, Dr. Southey, Dr, Fuller, Mr. Adams, Dr.
Waters.
-♦-
APPOINTMENTS.
Carter.— Albert Edward Carter, Honse-Surgcon of Toxteth Park Work¬
house. has been appointed Medical Officer of the No. 1 District, Tox¬
teth Park, Liverpool.
BOOKS, PAMPHLETS, Ac., RECEIVED.
A Manual of the Diseases of the Eye. By C. Macnamxtra. London:
John Churchill and Sons.
Array Med cal Department Report for 186b Vol. VIII. London:
Harrison.
A Manual of Chemistry. Third Edition. By George Fownes, F.FLS.
London : John Churchill and Sons.
Report of the Proper Principle of Drainage. By Lieut.-Colonel C. B-
Ewart, R. E.
An Appeal to the Electors of Great Britain. By 44 The Times of
India."
The Elements of H*ai and of Non-metaUie Chemistry. By F. Guthrie,
B.A, PjlD.. Ac. London: Van Voorst, Paterno»ter row.
Organopathy. By William Sharp, M. O., F. R.8.
The Anatomical Basis of Therapeutics. By William Sharp, M 9*
F.R.8. London : Henry Turner A Co.
The Practitioner, No. V.
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fjlft Atari JfrtM & (CimlM.
“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, NOVEMBER 25, 1 868.
CO NTEN TS.
PAOC
Royal Collxok op 8ubobokb in Ireland.
Introductory Address by William Har¬
grave, Professor of 8uigery. 441
ORIGINAL COMMUNICATIONS.
On Heat-Stroke. By C. Hand field Jones,
If.B. Cantab, F.R.8. 445
Gleanings in Toxicology. No. I.— On
Poisoning by Nitrate of Baryta. By
Chis. Meymott Tidy, M.B., M.8., Joint
Lecturer on Chemistry at the London
Hospital. 447
Ventilation. By Henry MacCormac, H.D. 449
LEADING ARTICLES.
A raw Words about Combatants and
Non-Combatants . 450
Tut British Fool. 451
The Navy Report. 451
PAQR
NOTES ON CURRENT TOPICS.
Scarlet Fever. 452
Sudden Death of a Surgeon. 45 8
Edinburgh and 8t. Andrew's Universities’
Election. 458
The Pharmacy Act in Scotland. 458
Medical Club. 453
A Champion of Medical Reform. 453
Dublin Obstetrical Society. 454
The Pathological 8ociety. 454
Health of Dublin for the Past Week.... 454
Over-Housing. 454
Election to the Meath Hospital, Dublin.. 454
Medical Men in Parliament. 454
Medico-Social Pencillings of London Life
and Practice. No. 1. 455
SCOTLAND.
Health of Scotland. 456
Edinburgh Philosophical Institute. 456
PAQE
HOSPITAL REPORTS.
8t. Geo roe’s Hospital—
Dr. Ogle’s Cases of Abdominal Tumours 456
TRANSACTIONS OP SOCIETIES.
Medical Society of London ...... 457
Army Medioo-Chirurgical Society of Ports¬
mouth . 45®
Medical Club. 45S
CORRESPONDENCE.
Medical Representation in Parliament.... 459
Chilblains... 460
The Society of Arts. 460
Medical News, Notices to Correspondents,
Ac. 460
ROYAL COLLEGE OF SURGEONS IN IRELAND.
Opranro of the Surgical Ssssion for 186ft—9.
|lttrobnciorg &bbr*«*
BY
WILLIAM HARGRAVE,
Professor of Surgery.
Mr. President, Vice-President, Members op Council, and
Gentlemen, —In considering the progress of medicine and of
the profession, it has experienced two remarkable epochs within
a few yean ; one of which has been subjected to the test of
experience, and has more than fully proved its value, though
passed by the Govemmeht against great ignorance, prejudice,
and opposition. I allude to Mr. Warburton’s Anatomy Bill—
the greatest boon ever granted by the Government to our pro¬
fession, which has not alone humanised the study of anatomy,
but has also facilitated the cultivation of it in all its details and
departments ; so that even the fair sex can now study it, and
profit by it. Gentlemen need not laugh at this statement, when
I inform them that prior to and during the great French Re¬
volution of 1789, a Parisian surgeon, who taught anatomy and
surgery, named Andravi, was assisted by his daughter,
Mademoiselle Andravi, who prepared his subjects for his ana¬
tomical lectures in the most perfect and neat manner by her
dissections. It has done more in effecting a great moral change,
by removing from it a great cause of immorality, dissipation,
and degradation, never to return. In olden time some national
honour would have been conferred on Mr. Warburton for the
peat benefit he conferred on science and on humanity ; but as
it is, so long as sickness and disease exist in these countries, and
the necessity of anatomical studies, his memory will never
perish. All have agreed on the benefits of this measure.
The second epoch is the passing of the Medical Reform Act.
The differences of opinion entertained concerning it does not
at all surprise me. As to the value and benefits derived from
this measure, and of its working, also as to the endeavours of
the Medical Council under the Act to be of use to the profes¬
sion, some consider it to be of no use, others laugh at its recom¬
mendations, which they consider powerless, consequently use¬
less, but which are considered and framed with great delicacy
and practical good sense, both for the profession and for the
licensing bodies ; while another party is specially severe, and
has more than onoe publicly stated and condemned in no un¬
measured language the endeavours of the Council to carry out
in the fullest manner the powers given to them by it, inditing
their shortcomings, but not awarding a scintilla of credit for
the good it has effected—if not against the opposition of the
Universities and Colleges, oertainly in the first instance it was
not met in a kindly spirit to carry out the recommendations of
the CounciL Could this have arisen from any jealousy from
the senior institutions to a junior one ? Another section of
the profession thinks the Bill should be repealed, and a new
one sought for, evidently to meet their views, which would be
going from bad to worse, and “ ’tis better bear these ills we
have than fly to others that we know not of.” Lastly, some
maintain that the Council consists of nothing but committees
—the strangest of all charges against it.
Such individuals and cavillers know nothing of the working
of public bodies, the chief business of which is carried out by
such arrangements. I need scarcely allude to our Parlia¬
mentary councils to prove the great importance of committees ;
certainly as to the Medical Council, their committees enjoy no
sinecure, when some of them devote almost the entire of the
day to these duties—of course including the sitting of the
CounciL
These different and antagonistic opinions can be reconciled
and wrought into harmony if the profession would but study
what has been the result of this Act up to the present time,
imperfect as it is confessed to be in some of its powers.
Permit me to make a few remarks on the benefits derived
even now from it, bearing in mind its title, “ An Act to Regu¬
late the Qualifications of Practitioners in Medicine and Sur¬
gery,” while the third clause constitutes the formation of a
council styled, “The General Council of Medical Education
and Registration in the United Kingdom.”
If we examine this Act, it presents to our consideration the
following five subjects bearing specially onthe student entering
on the study of his profession :—
1. Preliminary or classical education and examination.
2. Registration of the students.
8. Time and duration or period of his professional study.
4. Professional examinations.
5. The “ British Pharmacopoeia.”
I shall in the first instance solicit your attention to the
Pharmacopoeia, though the last in my list.
Since the passing of the Medical Act in 1858, no less than
four Acts have been passed by the Legislature to amend and
improve the original one ; the one which I wish particularly to
direct your attention to is the last, passed in 1864, “ An Act
to Incorporate the General Council of Medical Education and
Registration, and for other purposes.” This Act has made the
Council a corporate body, has given it a common seal, and
allowed it to purchase land for the corporation ; these privi¬
leges were never asked for by the Council—nav, not even
thought of by it; but what it sought for from the Government
was the sole right over the “ British Pharmacopoeia/' which
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was granted, provided the Colleges of Physicians of England,
Ireland, and Scotland would resign their rights over their re¬
spective Pharmacopoeias. The only condition required with
this boon was that the Government should decide on the price
of the work. These Acts prove in my judgment that the
Government are favourably disposed both to the Council and
to the profession.
2nd. Preliminary and classical examination claim our next
attention, and is of daily increasing importance, which the stu¬
dents cannot over-rate. The question arises—When is it to be
undergone ? whether before entering on their medical studies
—any period during them—or immediately before their final
examination for the licence or diploma ? I regret to say that
it is not yet carried out in a unanimous spirit by the various
licensing bodies ; still the greater number of students pass it
before commencing their professional studies, a few during
them, and very few delay tUl their final examination. The re¬
commendation of the General Council (and a good one) is to
pass the preliminary examination before entering on the profes¬
sional studies. At the preliminary examinations the certificates
granted by our College are classed into three classes ; 1st, 2nd,
and 3rd, or pass certificate, which has the effect of inducing
candidates to prepare themselves to obtain the first one, which
all through life is evidence of a sound preliminary education
and strict testing examination. It is but right to mention on
this occasion that the preliminary education and examination
are considered so important, that the Council have undertaken
to make such arrangements as will give uniformity in them as
to time, subjects, and place, independent of all the national
educational and licensing bodies, which will be the first move
as to uniformity in action for professional examinations.
3. Registration of students, which is for the purpose of as¬
certaining the name, date of preliminary examination, and
place of study. None can deny but that the General Council
have acted with judgment to ascertain what general education
the pupils have had before entering on the study of their pro¬
fession ; Btrange to say that some of the Universities have Bet
at nought these recommendations. I must give the students
of this College the credit that, with very few exceptions, they
are not disposed to neglect their registrations.
4. Professional education and curriculum. The effort is being
made by the Council to establish, as far as can be effected, or as
near as can be, uniformity in the curriculum for the Btudent,
order and method in their attendance. This is a more diffi cult
subject to arrange than at first it seems to be, for each body is
so wedded to what they consider the best, and which they have
pursued for such a number of years, that they are tardy in
making any decided changes in their curricula. However, ac¬
tion is now decidedly +a1tat> on this important question—a cur¬
riculum of ten subjects—Anatomy, General Anatomy, Physio¬
logy* Chemistry, .Materia Medica, Practical Pharmacy, Medi¬
cine, Surgery, Midwifery, and Forensic Medicine—which must
be well known by strict examination of the student before he
can obtain his qualification to practise his profession. This
curriculum could be much improved by adding Botany to it,
and which I expect yet to see done. It is now submitted
to twelve members of Council as a committee sitting en
permanence, which are empowered to seek for the opinions
of professors, lecturers, and other medical practitioners in the
three king doms on it, and to report them to the permanent
committee, who .are to make the final report to the Council
next year for their decision and adoption.
If uniformity in preliminary education and examination, in
registration, and in professional education is attained, then will
follow that of professional examinations, both theoretical and
practical.
Without waiting for additional legislation, a great advance
has been made in the examinations for the licence to practise,
by separating them into half-yearly, quarterly, or even yearly,
which relieves the student of the heavy responsibility of under¬
going, at the same and one examination the testing of his four
years study and the knowledge derived from it.
^In addition to these efforts of the Council to benefit the pro¬
fession, is that of the visitation of examinations of the various
licensing bodies, from which much improvement has followed,
by inducing some of them to elevate the standard of their ex¬
aminations to a higher rank, thereby adding to their own cha¬
racter and reflecting it on their students.
Though admitted by all that the Council have no direct co¬
ercive powers to cany out their recommendations, which for
the present, to my oonviction, is both wise and prudent; yet
they poeeeas indirectly great power, by appealing to the Pnvy
Council to support them, to have their recommendations acted
on. Clauses XX., XXI., XXII., give this power to the Medi¬
cal Council.
I have thus endeavoured to give a succinct view of the
exertions of the General Medical Council to advance the
common weal of our profession, and remove from it a reproach
too often brought against it, and most prominently before the
public. “ There is probably no profession in its aggregate or
corporate capacity excites so little the interest of the public, as
that which professes to cure or alleviate the ills resulting from
the physical constitution of man.” This reproach is not founded
on fact, but an evidence of the ntter ignorance of our profes¬
sion by those who have made it. Let our motto be—“ Tu ue
cede malis sed contra audenlur ilo ” ; and we all in bond JUk
put ourselves in thoroughness to our work for the public, for
the profession, and for ourselves ; we will then represent a
well-proportioned, graceful, and lofty column, its firm, broad,
and solid base immovably fixed upon a sound, comprehensive,
and practically useful preliminary education, the shaft orna¬
mented with professional studies of an extended range, while
the capital constitutes the Corinthian order, crowned with the
honours of the well-trained mind, which none can deprive it
of. You then go forth through the world conquering and to
conquer, by your courtesy, independent action, and mind.
Let me now pass from the Medical Council and its en¬
deavours for the advancement of the profession, which will do
its duty to it at all hazards, to the special objects of this lec¬
ture —what suggestions I would make to the students to occupy
their four years of study most profitably to themselves.
Some years since, when examined as President of the Royal
College of Surgeons, by Mr. Grogan's Parliamentary com¬
mittee, for restoring the grants to the Dublin Hospitals, the
first question put to me, was: What is the ch a r acter of the
Dublin Surgical and Medical School ? My reply was : It ii
essentially practical. How proved ? By the unrivalled facili¬
ties of teaching and learning anatomy ; by its superior clinical
teaching ; and by its hospital courtesy, which allows the pupil*
of every other hospital to witness, not alone rare operations,
but also rare cases in medicine; and all the works issuing
from it are also essentially practical; and by the manner in
which the private schools, recognised by the Royal College of
Surgeons, discharge their important trusts in good t e a c h in g.
I sincerely hope and entreat that no student who is now
commencing the study of his profession, or resuming his
studies, will be content with the meagre idea of merely scrip-
ing through his examinations for his Letters Testimonial to
drug his fellow-man, and to perform bungling and injurious
operations upon them. As you have now entered voluntarily
on the occupation of your life, make up your minds to devote
yourselves to the study of your profession in such a manner
that in after life, when engaged in practice, you will retire from
any case, however complicated it may be, with the happy re¬
flection that you have none, not your best, but the very best, for
your patient.
The essentials of your profession are—Anatomy, Physiology,
Suigery, Hospital attendance, Pathology, and Chemistry, the
great science of the day; all the others rest upon these funda¬
mentals for future character and success. To enter on some of
the specialities bearing upon the teaching and learning of sur¬
gery and medicine, we ore now at the commencement of, not a
transition stage, but a complete revolution, the first great step
being to organise a new system to supersede the one which has
been in operation so successfully for so many years, and intro¬
duce a better one, a great part of which is utopian. One pro¬
position is to change almost in Mo the acquiring the know¬
ledge of anatomy, stating both in print and orally that oaa
year of the study of anatomy is sufficient for a surgeon. This
proposal appears to me, when advocated by sane men, as one
of the most mischievous ever made ; it is worse then a mis¬
take, it is a blunder.
We all consider this an age of progress, of advancement is
arts, sciences, and of everytning of advantage to the human
race, ; this is a step backwards, it is only that of an impossi¬
bility. Let the student be ever so diligent, attentive, and
thorough in work—recollect, I am not alluding to transcend-
entals, such as John Hunter, a man who appears once in some
thousand years—but the pupil of fair ability, intellect, and
diligence. Wbat 1 consider to be the Alpha and Omega, the
very backbone—yes, the “re mXw " of surgery and mediriw
is anatomy ; all the others are accessories to that great founda¬
tion. If such a system as now thought of is ever adopted, the
nation, for its own safety, will rise against it as one man, and
prevent it being adopted by any bcenongbody. To quote tte
words of Lord Denman, 14 it is a delusion, a mockery, mad a
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November 25,1868. 443
snare.” The Ethiopian cannot change his akin, nor the leopard
his spots, neither can any licensing body make a good practical
suigeou for one year’s anatomy, let his work for that period be
ever so sedulous and energetic : even the time required by our
College of three sessions, is sufficiently short to make the
anatomist which I designate a scalpellary , and not a lingual
anatomist—wide is the difference between the two men—one
knows it by honourable and untiring use of his scalpel and for¬
ceps, which is never forgotten; the other, principally from
books, which afford but an ephemeral and fleeting recollection
of it It may be asked—When is the time to commence to
learn anatomy ? I adviso you, from the first winter session.
If not acquired in early life, it is a blank after that period, to
which you will never return.
It is not my province to enter into details on this most im¬
portant department of medical science ; but I will bo allowed
to advise you to learn thoroughly Uie osseous system; if acquired,
more than one-half of surgical anatomy, as to operative pro¬
ceedings and correct diagnosis, will be always in your posses¬
sion ; medical anatomy is much benefitted by it, equally per¬
manent in your recollection ; in addition, this knowledge will
induct you into a very interesting scientific subject—fossil re¬
mains—and to zoology.
To perfect the study of anatomy, so anxious are the pro¬
fessors to afford every facility to tne class that we have added
considerably to the staff of the demonstrators, having now
nine of these gentlemen sedulously devoted to that object.
Surgery and hospital attendance, to be of permanent benefit
to the pupil, should be commenced in the very early part of
his studies. The sooner he enters on the legitimate exercise
of his faculties, always in his possession and at his command,
namely, his five senses, the portals to knowledge, to observe,
then will follow comparison, reflection, and judgment, the more
advantage will he derive from hospital attendance ; and as
such a pupil he is always accumulating facts of inestimable
value in his future professional career. So impressed am I
with the value of hospital attendance, I would if possible return
to the practice in my student’s days. Being an apprentice, I
had the great opportunity of attending hospital for five years ;
hut siuco the period of four years’ professional study seems
now to be recognised and acquiesced in by all the licensing
bodies, the pupil ought to enter as a perpetual one at the com¬
mencement of his first session, and devote a portion of each
day to the observation of cuses and their treatment
It is evident to me that all licensing bodies err as to hospital
attendance, for the purpose of obtaiuiug a practical knowledge
of not only surgery, but also of medicine, requiring but 27
months ; in place of that period it should be at least 36
months, and not dove-tailing, as it were, these most important
subjects in to so short a period as that we have mentioned. What¬
ever advocates may say and advance that this time is suffi¬
cient, do they ever reflect when a young man enters an hos¬
pital for the first time, let him De ever so observant, and
with a well-trained mind, he must pass some time for obtain¬
ing an insight of what is before him, and what ho is to acquire;
bearing in mind I am not speaking of the exceptional student,
but one of fair ability, observation, attention, reflection, and
self-culture. Again I impress on all to enter as pcrpetuals
for their four years into hospital duties, always being enabled
at the same time to learn the valuo of practical pharmacy.
Patholoyy 9 for the great advantage derived from it in the
science of therapeutics, and in elucidating disease, will claim
much of your attention in conjunction with hospital duties, in
the study of surgery and medicine, that is the time to learn
it; if neglected and the opportunity is not availed of, in after
life almost its cultivation is nil, for in private practice much
of the pathological investigations are very unsatisfactory, in
roost instances being too hurriedly made to be of much value;
while if in hospital, suppose a patient succumbs to heart
affection, renal disease, to nernia, either operated on or not,
having attended to any of these cases daring life, sometimes
the cause of death will be revealed in the most satisfactory
manner, always impressed information will bo the result.
Some advocate tne founding of a special professorship on
this subject, but I adhere to the opinion that the hospital and
its mortuary is the proper field for its effective study. To
make pathology really valuable it must be studied from cause
to effect, which can ouly be done by following the case from
the commencement to to its final termination ; if in death,
then the result is revealed. Plates are of some service, by
practising the eye on what is termed morbid anatomy, but
thev do not convey what is really indicated by practical
pathology. Four great results follow from your hospital at¬
tendance, namely, practical surgery, practical medicine, prac¬
tical pharmacy, and practical pathology.
Chemistry, the great science of the day, without any com¬
ment from me, will recommend itself to your serious atten¬
tion and study, not alone from its great importance and value
it in every department of your profession, butjalso from the
adjunct it is in acquiring a knowledge of pharmacy. This
College affords every facility for being thoroughly informed on
it in all its departments, general, practical, organic, and inor¬
ganic chemistry, under the able and accurate teaching of our
learned Professor of chemistry, in whose family chemical
science is hereditary.
If the student is well informed on these fundamental sub¬
jects, the imperishable foundation is laid for the sound know¬
ledge of Materia Medica and Therapeutics, practice of medbine,
midwifery, forensic medicine, and the other subjects which
are accessory, and will not be found difficult, but on the con¬
trary pleasure will attend their studies. One caution is most
necessary when attending midwifery; for that session anatomy
must be abandoned, not alone in the dissecting room but every¬
where else. This will prevent the introduction of disease to
the parturient woman, confirmed and acknowledged by, I
believe, all obstetricians.
Latterly, two questions are beginning to be agitated by
medical men and reformers, namely, the question of lectures,
and the attendance on them—whether they should be com¬
pulsory, optional, or mixed—whether some should be com¬
pulsory and others optional; also the issuing of certificates,
termed by some the certificate system. The idea is now
commencing to seize the minds of these individuals that there
are too mauy lectures, and no time for reading, reflection, or
self*culture—that the student is over-lectured, in fact over¬
weighted, and these sympathising men are apprehensive that
the camel’s back will break under the feather weight of the
lectorial load. Now, what is the fact in this College since its
foundation ? Lectures have always been in its curriculum,
and I have never heard the pupils complaining of the lectures
being too numerous ; it is the easiest and most facile thing in
this life to excite discontent, and worse, when once so excited it
is not so readily recovered from. So that if the apple of discord
is thrown by serious or mistaken reformers on this question,
the student will ultimately become indifferent even to the
attendance of one course of lectures. Is the student over¬
taxed ns to lectures in this College ? The curriculum which is
the most extended of all the licensing bodies, for a period
extending over four years requires three Courses of Lectures
ou Anatomy and Physiology, three on Demonstrations and
Dissections, three on Surgery, two on Chemistry, one ou
Materia Medica, one on Practice of Medicine, one on Forensic
Medicine, one on Midwifery, and one on Botany—in all six¬
teen lectures are attended. Of these lectures eleven in tho
winter sessionexleuding over a period of four years, and
five in the summer sessions ; at the rate of three lectures each
winter, and allowing full time for hospital attendance and
practical anatomy.
The advantages derived from lectures are not a few; they
combine both theoretical and practical information, i.e., an
appeal to the senses which reading fails to impress in that
effective manner, so as to make the book work permanent and
no further information required ; another benefit derived from
them is the confidence engendered between tho pupils and
lecturer, so that he can speak frankly to them of errors of
prognosis—diagnosis—consequently, of practice. He can give
an accurate and succinct description of some diseases which
the pupil has not seen. How few have seen glanders, hydro¬
phobia—perhaps tetanus, cither idiopatliic or traumatic—and
other rare affections. The lecturer has tho advantage of
ascertaining if his class is keeping pace, or making progress
with his instructions by examination of his previous lectures :
and is always a referee. They are good aids in strengthening
the memory, and if the pupil will follow tho lecturer by re¬
flecting and reading in the ovening on what he has heard during
the day, he can then compare it with wliat the book teaches ;
so he has the advantage of learning from two sources the
opinions of two different men, and deriving information from
each of them. What utopian substitute can be found for good
lectures I am at a loss to discover.
In tho same category with lectures is the granting of cer¬
tificates, or os it is called the certificate system ; I have heard
one condemn them in the following words, “ the tyrannous
system of certificates has lowered the profession during the
last forty years that may be the case elsewhere, but not in
this country. Another speaker I have heard, not alone sup-
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444 The Medical Press and Circular.
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porting their tyranny, but adding’ they are “ a farce—dis¬
honest and immoral.” With all this condemnation the same
gentleman still sigus the condemned certificate. Admitting for
argument’s sake that there maybe some laxity in granting cer¬
tificates, but denying in toio that they have lowered the pro¬
fession these last forty years in Ireland, or that they are a
farce, the cause of dishonesty or immorality—as long as the
attendance on lectures is required, so long will certificates be
demanded. Besides the lectures and the certificates there is a
third questio vexata, namely, the attendance on lectures. To
ascertain the presence of the class, some advocate a roll-call,
which is nothing but loss of time with a large class, and not
satisfactory evidence of the attendance of it. It has been tried,
and failed. Inscribing the names of the pupils is not more
beneficial to attain that end. Othors suggest a marker to
come into the theatre for that purpose. I doubt if much
satisfaction will accrue from it.
To meet this question and to solve it, some suggest com¬
pulsory attendance on what they consider practical and de¬
monstrative subjects, as Anatomy, Chemistry, Materia Medica
—optional for what they consider the systematic lectures. I
cannot see the reason for such a distinction : the former might
be left to take care for itself, but the latter might be compul¬
sory—however, there should be no difference, no exception,
“ no halting between two opinions.” But admitting that all
should be compulsory, I would raise my voice against such an
unnecessary proposal. We might compel the presence of the
body, but we cannot command the attention of the mind. 1
incline still to leave it optioual. In this College all lectures
are demonstrative, not alone on Anatomy and Chemistry, but
on Surgery and Practice of Medicine, by drawings, casts,
pathological preparations—so the whole course should be made
compulsory. I will merely state in the presence of the
President and Council of this College, my experience of the
students : the juniors are diligent and numerous both in at¬
tendance and attention; the seniors, on a lecture which
they think they know, may fall off in attendance, but
on subjects they are not well acquainted with they are most
regular and numerous in their attendance. Recollect it is not
the mere lad that we are legislating for, but youths of a certain
age, who are morally bound by their engagements when en¬
tering at any school to fulfil them, as honourable and
truthful men. To solve this question I would prefer to
paraphrase partially the advice of the poet of America
“ By winning words to conquer willing minds,
And make good lectures do the work of duty.”
It is but right to state that the examinations are everywhere
becoming more and more practical, and less theoretical answer¬
ing is required. From henceforward our College will require
practical evidence from the candidate of his proficiency in
operative surgery, both upon the dead subject and upon the
living one ; in the first, by operation on it; in the second, by
the application of bandages, splints, measurements for and
the application of trusses of all kinds, their mechanism and
value, also the knowledge of instruments. I also look forward
to the time when the candidate will be tested in hospital prac¬
tice by cases submitted to him for examination for tneir prog¬
nosis and dingnosis, course of the disease and treatment, and
in case of a fatal termination what pathological results might
be expected ; these are additional reasons for pressing on you
a longer hospital attendance than is at present required by the
licensing boards, which will give the additional advantages of
more extended observation, comparison, reflection, judgment,
and experience. I have no doubt that the student now com¬
mencing his profession will have to undergo this ordeal before
he receives his diploma.
I need scarcely add, that in our examinations, councillors
attend them, as in the character of assessors, so that each
candidate for the diploma is examined separately, and not in
class, which is undoubtedly the best way of ascertaining his
professional knowledge. That by class is very superficial, and
not testing sufficiently his information ; the sooner it is aban¬
doned, and the single and separate examination adopted, the
better for the character of that licensing body, also for their
pupils.
Hygisne.
There is another department of science particularly appli¬
cable to our profession—that of Hygiene, perhaps soon to
experience the name of State Medicine, and which, of all :he
national educational and licensing bodies, was founded first by
his Collego so far back as 1811, and we havo had lectures in
the summer delivered on it During the past one we have
had a most practical course on this subject This theatre was
crammed to the very top by professional and non-professional
gentlemen, and especially by ladies. I can affirm that many
of the last-named visitors availed themselves of the informa¬
tion and practical suggestions of the Professor, and applied
them with much benefit in their families. From what I wit¬
nessed of the conduct of the gentle and fair sex, they devoted
the most intense and active attention to each lecture, affording
a good example for some of our students to follow. On this
occasion we had the right man, Dr. Cameron, in the light
place, with the enviable distinction of being the gallant Pro¬
fessor of the College justly merited by him. Here is a blanch
of science which ladies have voluntarily pursued, as compeers
with man, not for sentimental excitements, not for reading
maudlin and mawkish novels of no earthly value, which break
down the tone of the mind, and unfit it for studies of a more
valuable, exalted, and reflective character. All honour is doe
to such ladies for so nobly emancipating themselves from inch
trammels and slavery. To those gentlemen who intend enter¬
ing the Army and Navy, I would advise to attend these lec¬
tures, not alone for their intrinsic merit, bat also as preparing
the way and making it straight when they enter Netley, whew
hygiene is one of the most important subjects attended to in
that institution. A friend ana former pupil of mine was one
of the first appointments made in the Abyssinian Expedition,
from the evidence he afforded of his knowledge of hygiene. I
have somewhere read that that Expedition owed its marked
success to the engineering and to the medical hygienic depart¬
ments.
Mr. President and Council,—It may be considered irrelevant
before this audience that I am taking a leap in the dark, and
following a vain shadow, to make any allusion, or introduce
in any manner a medico-political question ; but, gentlemen, in
this very critical age, when all are exhibiting such unprece¬
dented and unusual energy in the political, religions, moral,
and intellectual world, I freely adopt the dictum which has
come to ns from Athens, when she was at the zenith of her
glory, that every member of a free state should have his
opinion, and declare it, that no man should stand or remain
neuter ; Pericles was the Athenian who enunciated that noble
political maxim. What I am solicitous to direct the attention
of the seniors and juniors of those present, and by* them
throughout the country, is, if possible, to pledge each candi¬
date at the approaching election who aspires to the honour of
a seat in Parliament, to support by words, and vote the justice
of giving to the Poor-law medical officers of this country a
retiring superannuation allowance when broken down in
health and not able to continue their labours. Our College
has generously and liberally expended large sums of money m
advocating this measure of tardy justice to the profession, irre¬
spective of being their alumni or of other Colleges. If the
Irish members will act together in the next Parliament as one
man, which they should ao, this claim will be acceded, but if
not carried, it is not lost; we must not despair. Let ns bear ia
mind what our own poet says : “The straggle for justice, once
begun, though often baffled, is ever won and under the per¬
severing action of our College it shall be obtained. I may add
that I was one of a deputation from the College who waited
on Mr. Chatterton, the Attorney-General for Ireland, in 1887,
in London, from whom they had obtained a promise that a
clause securing proper fees tor medical witnesses would be in¬
serted in the Common Law Courts Bill. The pressure, how¬
ever, of other business on Parliament, and the adjournment
of the House, prevented the fulfilment of this promise. Iks
two missions wnich seem destined for the College to fulfil are:
1st. To maintain its status and character as the head of the
surgical profession in this country ; Second. The protection
and direction of that profession. Let its motto be, “Ests
perpetua , ctfloreat semper .”
In this time of progress, with the competition so much
awakened in all classes for personal advancement, I cannot
avoid alluding to the great additions which are being annually
made to the numbers of students, but also to the nnmeroas
educational divisions of the classes which now come to this
city for instruction. I recollect when there were but three of
them—divinity, law, and medicine ; to which there ia now
added the C.E., the chemical, those for civil appointments
both at home and abroad, as well as those for the military mad
constabulary services. Of all these classes, I ask is the
medical one inferior to any of them in intelligence, high aspi¬
rations, conduct, and determination to execute their
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as the educated gentleman, and above all as the sincere Chris¬
tian ? If the answer is not favourable, the fault does not rest
with the profession, the noblest which can be selected by the
well-regulated and trained mind, but with yourselves ; conse¬
quently, “the sooner you put your house in order the better/’
and remove the slur cast upon all of us by the irregularities
of a few among you. Be assured that the contrasts between
you and other students, in place of being diminished by num¬
bers, will be increased in future, indeed now is ; and your con¬
duct will be more observed, scanned, and commented on by
all parties. “ Bo not deceived/* the public is not mocked ;
as “you sow so shall you reap.” Then prepare yourselves for
this just and merited ordeal by the public.
A few observations upon myself, holding the honourable
position as one of the Professors of Surgery, will be permitted
me to make, which will bo brief. I am here iu a twofold
capacity, my duty being not only to teach surgery, but also a
higher one, if possible—to instruct you how to teach yourselves
surgery. I will give you the scaffolding as well as I can ;
you will have to Duild the house, finish, complete, and em¬
bellish it. Aud recollect that a professor, like other men, is
capable of improvement; and the great law of doccndo discos
can be fulfilled in him as in other men.
To all students, especially to those commencing the pro¬
fession, I desire them to know, aud for them never to lose
sight of it for an instant, that medical men are now expected
to hold what is termed in academic language a double first—
or an exceptional high scientific position in society, and much
sought for in the array ; if ho fails in attaining the first, it is
doubly necessary for him, aye, imperative to acquire the quali¬
fications, character, and tastes of a gentleman.
To induce you to persevere in your studies I will quote the
opiuions of two very celebrated men, Dr. Johnson, and Mr.
Gibbon, the historian of the Rise and Decline of tho Roman
Empire. The first says :—“ He that waits for an opportunity
to do much at once may breatlio out his life iu idle wishes, and
regret at the last hour his useless intentions and barren zeal.”
Of all the professions or pursuits that can be selected, this
quotation is specially applicable to ours—I would almost say
written for it—for such are its peculiar duties that it is only
by availing ourselves of occasional spare moments, when once
engaged in the hurry and anxiety of practice, that anything
can be achieved ; i.r., our profession is so peculiar in its
engagements and interruptions that no man can lay down a
fixed time to perform the work he has on hand. As you ad¬
vance in your professional career you will verify this quota¬
tion ; so you will have to train yourselves, ab initio , to what
may be termed desultory but active habits of business—a term,
perhaps, not well chosen, but yet expressive of what I wish
to convey. So much for tho active occupancy of your time.
The second quotation, from the no less celebrated writer
Gibbon, says “ every man who rises above tho common level
lias received two educations, one from his teacher, the second from
himself, the most important and most permanent;” sentences
worthy of being inscribed in letters of gold in all educational
institutions as an incentive to the student to sustain him in
his duties. Never bo satisfied with mediocrity, if so, you will
never even attain but fall short of it ; and he who strives for
the mastery must be temperate in all things.
I present to you what I consider the type of the profes¬
sion—“ when augnish knits tho brow, ministering agents then
art thou ’’—the gray goose quill and the scalpel. When used
as they should be, instruments of great good ; if the contrary,
instruments of great evil, often followed by sudden death, or
prolonged suffering terminating in death. So in their use
* * to yourselves be true, and it must follow as the night the
day, you cannot then be falso to any man.” To conclude, in a
few words I will give you the elements of success, not alone
in our profession, but in every other profession—self-respect,
self-esteem, self-reliance, and self-culture or teaching ; method
in jour studies, which comprises the habits of punctuality,
accuracy, steadiness, and despatch in what you arejengaged
in, resolution to perform always what you have resolved to do.
Acquire concentration of thought, cultivation and strengthening
0 f tie memory, perseverance and courage, thoroughness ana
tx-dthfulness in all your work. Shall I add the words of Car-
jinal Richelieu—nothing is impossible to the young man.
jtt&cUur e socii8 f consequently cultivate the acquaintance and
friendship of the well-conducted of your fellow-students, which
^yjll bear good fruit both in time present and in time to come,
rp^lnk nothing in your conduct and studies unimportant or
jf^iiicrent ; attend to trifles, which lead on to perfection,
w liicb is not a trifle; follow the Divine precept, “Whatsoever
ye would that meu should do unto you, even so do unto
them —then you can never be at fault. Never let day or
night pass by without remembering ‘ * what the Lord nath
done, ” and in all your transactions remember tlio final accounts.
Act up to these suggestions as honourable and upright men,
and bB satisfied with the issues as awarded to you by Him
who careth for each and all of us, and is the giveb ov
EVERY GOOD.
-» - -
ON HEAT-STROKE. 1
Bx C. Handheld Jones, M.B., Cantab., F.R.S.
(Continued from page 425.)
Dr. Palmer has favoured me with the following history
of a case under his care. Mrs. S., ret. 34 (about), widow,
had suffered a slight attack of sunstroke in India about
eight years before. On June 13th ? a very hot day indeed,
after driving out in an open carriage, when she felt the
sun very much, was seized within three or four hours
with severe headache, giddiness, faintness, nausea, lan¬
guor, chilliness, and actual rigors. When seen two hours
later the face and neck were scarlet, and the conjunctiva?
injected ; she complained of intensely severe headache,
felt most across the forehead and along the superior
longitudinal sinus, of intolerance of light, and much pain
of back and loins. Her surface was then dry and hot to
the touch, but she felt cold internally. She was anxious
arid alarmed, her tongue quite clean, lier pulse very little
disturbed. Cold was applied to the head, warmth to the
feet, free ventilation enjoined, and an ammonia diapho¬
retic prescribed. The following day she complained of
having a cold, her throat was sore inwardly and swollen a
little externally. Purgatives were of much benefit, and
she was convalescent in about a week. The same day (the
closest and most oppressive that had yet occurred) she
walked out for an nour in the morning and drove out
soon after, the sun at that time not shining strongly. At
2 p.m she felt low and tired ; at 6 p.m. was found by Dr.
Palmer in just such a state as before—feet cold, shivering
strongly, yawning, feeling sick, with intense headache,
the right eye bloodshot, the face and neck scarlet, a rash
iusfc like that of scarlatina on chest, pulse oppressed, skin
not but not actually dry. In a few hours reaction set in ;
the pulse was 100, small and weak ; she was restless and
anxious. The next day she had vomited several times,
the cutaneous hypercemia had nearly or quite gone. The
subsequent symptoms were obstruction of the right nostril
as by a cold, redness of the right eyelids, and severe pain
of the right side of the face. The quantity of muous
secreted by the right nostril was extraordinary, such as
she had never before had in her life ; it lasted several
days.
I am indebted to Mr. Hickman for the following his¬
tory of a case which came under his immediate observa¬
tion. The gentleman, cot about 35, was sitting reading
by the window, in the month of May, with his head ex¬
posed to the sun. He felt the heat much, but although
feeling very uncomfortable he did not quit his seat imme¬
diately. All at once he was seized with a sudden violent
pain shooting through his head from one side to the other.
It was so severe and unexpected that he was compelled
to jump up and cry out, but it was gone in a moment,
leaving merely a heavy, full sensation behind, which
gradually diminished while he kept quiet and in the
shade. By the afternoon he had quite forgotten the occur¬
rence, till he was again reminded of it by a seizure as
sudden and violent as that of the morning, which came
on while he was out walking, and pulled him up in his
walk as if he bad been shot. From this time for some
weeks not a day passed without his having these attacks,
i 1 Read before the Hanreian Society, 16th October, 1S66.
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sometimes only two or three, at others as many as eight or ten
in the day, coming on at all times, and under every variety
of circumstances, and in spite of every care in avoiding
exposure to the sun, the slightest degree of which was
sufficient to cause the sense of fulness and of weight in
the head. Occasionally, also, there was severe general
headache, coming on towards evening, but usually quite
gone in the morning. After a few weeks the attacks
became gradually less severe and less freauent, and at
length appeared to have ceased, but after a long drive in
an open carriage much exposed to a hot sun, he was again
seized with the sudden acute pain in the head. This con¬
tinued to recur several times a day, was followed by
headache, and finally settled down into a constant head¬
ache, aggravated by passing through any sunshine, and by
reading or any occupation requiring a concentrated atten¬
tion, and was accompanied by general debility and by
much nervous irritability. Some relief was obtained at
first by gentle purgatives, and by bathing the head with
cold water, but latterly the bathing seemed to increase
the headache. A fortnight at the seaside brought great
relief to all the symptoms, which were, however, brought
on again by the hot and long railway journey when
returning, and permanent relief was only obtained after
the cool weather set in.
Summing up the phenomena observed in these cases of
English heat- stroke, we find that they have reference to
the intellectual nervous centres, and those of motion and
sensation ; to those presiding over the heart and the
stomach, and to the vaso motor centres. Symptoms of
disorder of the hemispheres are stupor, dulness of appre¬
hension, loss of memory, vertigo, unconsciousness, sleep¬
lessness, anxiety, delirium, alarm, nervous irritability, and
severe headache. Intolerance of light and confused vision
or blindness announce the implication of the optic lobes.
The participation of the cord, with its developments into
the large basal ganglia of the encephalon, in the disorder,
is shown by the rigors, the pain down the spine and in the
back and loins, by the persistent motor ana sensory semi¬
paralysis occasionally noticed. The collapse, faintness,
and dying sensation imply an affection of the cardiac
ganglia ; w hile the unilateral hypenemia of the eye and
nostril, and the generally diffused hypercemia of the face
and neck, point clearly to paralysis of vaso motor centres
or nerves. It is probable that the nerves of the intra¬
cranial arteries were affected much in the same way in
some instances as those of the face and neck were in the
last case, and this may have been to some extent con¬
cerned in producing the delirium and headache.
The sequela) to heat-stroke may be briefly but correctly
described as ardent fevers with acute delirium, remittent
and intermittent fevers complicated with various visceral
congestions, or quasi-inflammations constituting the
earlier epiphenomena; and a perfect multitude of dysocs-
thesiac and other nervous derangements constituting the
later. In both it is still the same story that we have
already had so copiously illustrated, viz., primary pre¬
dominant disorder of the nervous system ; the sympa¬
thetic centres, however, being more involved in the
one, the cerebro-spinal in the other. By Sir It. Martin’s
kindness I have been enabled to see and examine for
mjrself several sufferers from sunstroke in India, and can
quite confirm his statements in the general relative to the
multiform and extraordinarily various disorders with
which these patients are afflicted. Some suffer with cere¬
bral debility, incapacitating them from attention to any
business, some become actually demented, others epileptic,
others quasi-hysterical ; some have deafness or impaired
vision, some local palsies, some itching or a peculiar erup¬
tion. These statements are taken from Sir R. Martini
work. He has favoured me with the notes of a case which
deserves record as a curious example of (as I regard it)
a vaso motor spasmodic neurosis. Major-has suffered
two seizures during the hot weather under direct solar
exposure, almost amounting to insensibility. The first
was in 1850, and the effects soon passed off. The second
was in 1851, and was more severe, being followed by
fever. During four years from this last illness uueasy
feelings in the right arm and swelling of the hand of that
side occurred at noon of every day at all seasons, and
eventually the liver became enlarged, accompanied hy
some loss of power over the right arm. In April, 1866,
he was first seen in London, when impaired power of the
right arm had become more marked, with the old nuffi-
ness of the right hand in the night. Together with ia-
ternal remedies, the chlorine hath was ordered three times
a week, and soon a decided improvement was apparent in
his general condition, as well as in his local symptoms.
But it was observed that while he was in the bath (he
took 24) the right side of the forehead and face, the right
hand, and the fore part of that arm, remained perfectly
dry, whilst all other parts were running down with per¬
spiration. However long he remained in the bath the
skin of these parts continued dry and harsh as parch¬
ment. The limitation of the dryness by the median line
was very apparent on the face. It appears to me that in
this instance, owing to a morbid state of the afferent
nerves of the dry districts, the stimulus of the chlorine
vapour caused contraction of the minute arteries supplying
the cutaneous glands, and so impeded their function.
Just ns an irritable state of the retina causes persistent
contraction of the orbicularis palpebrarum.
The persistency of these disorders is scarcely less.than
their multiformity, and it almost amounts to this, which
is perhaps the gravest misfortune of all, that a man who
has once received a severe coup de solcil is never again
the same man that he was. His nervous system has
undergone a peculiar enfeeblement, which makes it ever
prone to lapse into some form or other of functional dis¬
order, and renders it incapable of enduring any strain.
Even in temperate climates, the original integrity of cere¬
bral nutrition is not fully regained, and exposure to the
injurious influences which induced the first attack are
almost sure to reproduce the distressing symptoms with
great severity. At the same time the character of the
disorders, their often temporary occurrence, the juvantia,
and the apparent recovery which may ensue under favour¬
able circumstances, tend strongly to impress the physi¬
cian’s mind with the idea that the morbid phenomena
are not dependent on any demonstrable structural lesion,
but belong to the same group as neuralgia, epilepsy, and
insanity.
I subjoin a record of the state of a patient who has been
under my observation about two years, which affords a
good example of the sequelae of English heat-stroke. Mr.
vVh., set. 47, a strong-looking, well-made man, seen Sept
25, 1866. He never could Dear heat well, but is braced
and benefited hy cold. His memory has failed somewhat
the last three or four years, and his eyesight also. For
more than three years he had been in close attendance on
an invalid, and his nights rest had been much inter¬
rupted. This ceased at the end of last October, and he
remained pretty well up to the end of May. While at
Seven Oaks he had an attack one hot day after he bad
been out in the heat a good deal. In this he did not lose
consciousness, but sunk down on the ground, and re¬
covered before long enough to walk twenty or thirty
yards to his house. The left side was most affected, but
the right leg also suffered. Since then no material
change has taken place. At present the motor power of
the left side is impaired to some extent, but he can grasp
strongly. He cannot walk more than 200 yards, but this
is more from giddiness than weakness. The sensory
power of the left side is impaired ; he feels as though be
were walking on India rubber balls, or as if his feet were
in a poultice. This dyscesthesia is not constant, but i*
readily brought on by anything that excites him. At the
posterior part of vertex of the head there is a tender spot,
on tapping which he feels a jarring in the tips of his
left fingers. After walking a little Ins head turns giddy;
he feels, he says, like an imbecile; and there comes on a
dull, dead feeling at the heart. He could bear very littk
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noise or conversation at first, or any excitement. A short
journey eight weeks ago tried his head excessively ; 44 he
thought he should have gone mad.” Can only read for a
few minutes at a time ; the letters are apt to get confused,
and his eyes ache. He is emotionally excitable, has fits
of crying. His heart, lungs, and kidneys seem quite
soumt Some possibility of syphilitic infection admitted.
At the right side of vertex there is a depressed spot from
which a piece of bone was taken out many years ago, but
there is not the least tenderness there, and the morbid
sensations which come on in the head do not start from
this spot. Under a generally tonic treatment he ha 3
mended considerably, but remains subject to great varia¬
tions, sometimes feeling almost quite as well as ever, at
others greatly depressed. His power of walking has
greatly improved ; some days he has been able to walk
several miles, but he is obliged to be cautious in exposiug
himself to the sim. Relapses have frequently occurred,
but they have been on the whole less severe, and he has
recovered from them more quickly. The alterations in
his condition have often been remarkable ; sometimes,
but not always, traceable to unusual strain or excitement;
and it is curious (as observed both by himself and his wife)
that the over-exertion does not tell on him immediately,
but after three or four days. During the relapses be has
sometimes perfectly unilateral left side affection, a feeling
as if he had no use of the limbs, or of any part of that
9ide, or of the face. Sensations come on at the back of
liis head which pass down his back into both hands, and
give rise to the feeling as if there was dirt crammed under
the finger nails, or as if his left foot was melting away.
He does not know always when his feet are touching the
ground. These sensations are almost indescribable, are
attended with giddiness and inability to walk well, nnd
great lowness of spirits, more or less insomnia, irritability
of temper, and a degree, in fact, of mental derangement.
Though he looks the very picture of health he is quite
unmanned, timid, nervous, and incapable of applying
himself to business. One of the evidences of improve¬
ment was his being able to shave himself, which he had
been a long while unable to do. He could not bear
the sight of a razor. The diagnosis of heat-stroke, as
the chief motor of the morbid process, is borne out by
the mode of attack, the nature and variability of the
symptoms, the effect of excitement anti heat, and the
juvantia. Had actual organic lesion existed, the symptoms,
according to my experience, would have been much
more constant, and deterioration would almost certainly
have been the result under the treatment, and not im¬
provement J ust as dyspnoea is most considerable when
the lungs are sound, so cerebral disorders are more com¬
plex and manifold when the encephalon remains structu¬
rally intact,—a cause of disordered function existing in
both cases. Patients in this state deserve sincere com¬
miseration, quite as much, I believe, as any who are
tortured by neuralgia. Tlieir malady is very real, and
admits of relief by means of physical agents judiciously
managed, though on a superficial view one might be ready
to class them with “ malades imaginaires."
(To be continued.)
GLEANINGS IN TOXICOLOGY.
No. I.
ON POISONING BY NITRATE OF BARYTA.
By Charles Meyjiott Tidy, M.B., M.S.
Joint Lecturer on Chemistry at the London Hospital.
I was requested by Charles C. Lewis, Esq., coroner for
Essex, to examine and make an analysis of the stomach
-if a man who had died under the following circum-
i fauces :—
W. H., set. 4G, single, a carman in the employ of the
Messrs. Volckman, living at Stratford, had always enjoyed
good health, with the exception of occasional but slight
attacks of rheumatism, which however had never been
sufficiently severe to keep him from his work. Having
complained of a slight pain in the shoulder, one of his
fellow-workmen recommended him to take some sulphur,
and on the following day (Saturday), when his landlady
was going into the village to make sundry purchases, he
requested her to bring him in a quarter of a pound of
sulphur. She did so, brought it back, and gave it to
deceased. He then asked her to mix it for him in a little
water. She thinks she mixed about a quarter of the
powder with water in a mug. As he had complained
during the day of a slight attack of diarrhoea, she recom¬
mended him to take the dose in the morning (Sunday),
and not over-night as at first he had intended. About
half-past six in the morning his landlady heard him cry
out, “ I am poisoned.” She at once run up to him anft
replied, “ Nonsense, you cannot be poisoned with flowers
of sulphur whereupon he opened nis mouth and showed
her it was covered with blisters. Mr. Kennedy, of Strat¬
ford, was sent for between nine and ten o’clock on the
Sunday morning, and upon looking at the sulphur
detected something of a crystalline nature in it. The
man was then in a state of collapse, and died about
twenty minutes past twelve, that is about six hours and a
half after he hail taken the mixture. There was a partial
loss of voice, coldness in the extremities, intense pain in
the bowels, a burning pain in the throat, partial convul¬
sions, with violent vomiting and purging.
On Monday evening Mr. Kennedy made a post-mortem
examination, and reported as follows :— 11 Body well
nourished, muscular rigidity well marked. The mem¬
branes of the brain were congested, the vessels being fully
extended with dark colored blood. The left pleura was
adherent, the left lung being very much congested, the
right slightly so, especially at the edges. The heart was
large and flabby, both sides full of black blood. The
duodenum was highly congested; there were several dark
congested spots about the rectum.”
I received the stomach from the constable, and upon
opening it noticed that in some parts there was merely a
slightly increased vascularity, the redness in other parts
being of a very much deeper character. Ramifying over
its entire surface I observed vessels filled with dark blood,
which were more marked and in greater number near the
pyloric end. This general florid appearance extended to
that portion of the duodenum which I received attached
to the stomach. The stomach contained abont four and a
half ounces of a reddish fluid, which had a neutral reac¬
tion. I also received the small intestines, which through¬
out their whole length presented a slightly, though very
slightly congested appearance. The rectum was highly
congested. The mug was also forwarded to me from
which deceased had taken the mixture, containing some
powder at the bottom *, and likewise the packet from
which the landlady had taken the powder she had mixed.
On examining the powder I found it had very much the
appearance of ordinary sulphur, save being somewhat
lighter in appearance. On igniting a small quantity on a
piece of charcoal before the blow-pipe, it deflagrated most
Drilliantly, giving a distinctly green light. I then made
an analysis of it, and found in every 100 grains 51*52 of
barytic nitrate. There was also potassic cnlorate present
with sulphur in the powder. Upon examining the
stomach for both mineral and organic poisons, I detected
distinct traces of barytic nitrate, and also the potassic
chlorate. Of course there was no doubt left in my mind
that the man had taken the powder, and that death had
resulted from the action of the nitrate of baryta.
There was sbme reason for suspicion how this baryta
became mixed with the sulphur, and I therefore requested
that a sample should be sent me of the sulphur from the
drawer of the chemist of whom it was said to have been
purchased. Upon examining this I found it to contain
G76 per cent of barytic nitrate. I then examined fifteen
different samples of sublimed sulphur bought from fifteen
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different chemists’ shops, all of which, however, I found to
be perfectly pure. Indeed, it would scarcely be worth while
adulterating flowers of sulphur. How, then, did the
baryta get into the sulphur ? It was plain that the mis¬
take had originated in the chemist’s shop, but at first it
was not easy to account for the difference between the
quantity of baryta found in the powder given deceased
and that in the chemist’s drawer. The chemist (who, bv-
the-bye, was a woman) asserted that she had never had
any baryta in her shop, but the after evidence proved thi3
to be a mistake on her part. The explanation was
gathered from a late assistant, who knew of the presence
of a packet of green fire in the shop, as he had sold some
only a short time previously. There was no doubt, there¬
fore, that this had been mistaken and sold by this lady
chemist for sulphur, and that she threw the little
remaining behind in the packet over and above the
quarter of a pound that she was serving, into the sulphur
drawer. And this fully explained the difference between
the quantity of barytic nitrate in the two samples.
I was unable to find upon record a single case of
poisoning by nitrate of baryta, nor yet of any experiments
that had been made with it to determine the quantity
that will destroy life. I made therefore the following
experiments at the special request of the coroner. I
must here acknowledge the assistance kindly rendered me
by Dr. W. B. Woodman in watching the animals and
assisting me in the post-mortems.
Experiment 1.— August 10/4.—Gave a rabbit ten grains
of nitrate of baryta as a powder, mixed with a little sugar.
It was found dead in less than an hour.
Post-mortem , August 13th.—Rigor mortis persistent.
Fur veiy rough. Pupils widely dilated. Brain and
membranes congested. Lungs congested and very rotten.
Heart.—Both sides full of black blood. Pharynx natural.
Liver: very rotten; in some parts deeply congested.
Kidneys : slightly congested. Stomach full of food ;
broke down at once with the least touch ; florid appear¬
ance over the whole inner surface. Duodenum slightly
congested. Small intestines not congested, quite empty,
and appeared transparent. Rectum deeply congested.
Bladder empty. I found a trace of the poison in the liver,
and in the stomach in considerable quantity.
Experiment 2.— August 10/4, 7.30 p.m.— Gave a rabbit
five grains of nitrate ot baryta in the form of a bolu3, with
flour and sugar.
9.30 p.m. —Found it lying on its side slightly convulsed.
PuDils widely dilated. * Fur rough. Has been purged
violently. Respiration 80, shallow and laboured. Aortic
pulse 120, but hardly to be felt. Almost dead.
August 1 1/4, 11.20 a.m. —Only just alive ; insensible,
and cannot be roused.
7 p.m. —Cardiac pulsations 160. Respiration 120. All
but dead. Takes no notice, but apparently sees and hears.
Is getting cold. Died at 10 p.m.
Post-mortem, August 13/4,—Fur rough. Pupils widely
dilated. Buttocks stained with faeces. A little frothy
mucus about the mouth. Brain apparently normal.
Heart.—Both sides contained black clots ; the right side
being most distended. A little staining of the endocar¬
dium. Lungs.—The lower lobes deeply congested, in
fact, in the stage of red hepatization, almost passing into
apoplexy. Stomach so softened as to tear with the least
touch; distended with greenish food, consisting apparently
of bran and com. Second stomach nothing unusual.
Duodenum somewhat reddened as to its mucous membrane.
Rectum much congested. The remaining intestines
apparently normal, containing a little milky fluid and a
little faecal matter. Urinary bladder full. Liver soft and
congested. Kidneys apparently normal. I examined the
urine and the liver for the poison, but was not able to
deteot any. Distinct traces, however, were to be found in
the stomaoh.
Experiment 3. —Gave a small terrier (August 17th,
4.30 p.m.) thirty gTaius of nitrate of baryta on meat.
6.45 p.m. —Violent purging and vomiting. Insensible
and appears dying. Convulsive twitebings.
8.15 p.m. —Died, after severe convulsions.
10.15 p.m. —Rigor mortis strong. Some tliin light
brown faecal matter about the anus.
Post-mortem , August 18/4, 12.30 p.m. —Rigor mortis
persists. Pupils widely dilated. Brain normal. Thorax.—
Both sides of the heart contain black blood, the right side
in greater quantity. Lungs considerably congested.
Abdomen.—Stomach reddened, soft and distended with
food. Duodenum slightly congested, which congestion did
not extend to the other parts of the small intestines.
The rectum was considerably inflamed. The kidneys were
slightly congested. The liver was considerably congested
and softened. I found the nitrate of baryta both in the
stomach and in the liver.
Experiment 4.— August 13/4, 5.30 p.m. —Gave a small
terrier ten grains of nitrate of baryta on a piece of meat.
9 p m. —Very lively.
August 14 thy 11.45 a.m. —Very quiet. Does not take
much notice. Has been considerably purged.
9.30 p.m. —Heart beats 160. Has passed a formed
colorless stool.
August \ 5/4, 11.30 a.m. —Seems much worse. Cardiac
beat9 128. Slightly convulsed. There has been con¬
siderable vomiting and purging. Respiration unequal
and irregular.
9.35 p.m. —All but dead. Getting stiff. Hardly seems
to feel. Reflex actions almost gone. Has dragged itself
a foot during the last hour.
August 16 th, 11 a.m. —Considerably better, but very
shakey on his legs.
8.30 p.m. —Very little power in hind legs, but seems
gaining power in the front ones. Fell on attempting to
jump down two feet.
August 17 th, 1 p.m. —Hungry. Has been violently
purged. Looks thin, shabby, and spiritless. Ha3 passed
a great deal of urine.
August 19/4.—Has quite recovered.
Experiment 5 .—August 13 th, 5.30 p m. —Gave a large
skye terrier twenty grains of nitrate of baryta on meat.
6.30 p.m. —Looks dull, and is dribbling from the
inoutk.
9 p.m. —Slight vomiting and purging, but otherwise
seems tolerably well.
11 p.m. —Very quiet. Has slight convulsions
August 14 th, 11.45 a.m. —Restless, but appears re¬
covering.
August 15 th .—Fast getting well.
Experiment 6.— August 17/4, 11.45 a.m. — Gave a huge
dog thirty grains of nitrate of baryta on meat
August 18 th, 9.35 a.m. —Convulsions ; cannot stand.
Violent purging. Fur rough. Looks very stupid and
shakey on the legs.
12.30 p.m. —Seems to have quite revived.
August 19///.—IIa9 eaten a good meal and is mnch
better. Recovered in a few days.
Experiment 7.— August 17th, 4.30 ;un.—Gave a large
dog sixty grains on meat and in powder.
6.45 p.m Able to stand, but seems tottering and very
thirsty.
12 p.m. —Slightly convulsed. Looks dull and heavy.
August 18M, 10 a.m. —Better.
12.30 p.m. —Has passed a great deal of water and been
much purged.
3 p.m. —Still passing a great deal of water. Slight con¬
vulsions, and paralysis of back legs. Takes but very little
notice of anything going on about him.
8 p.m. —No use in bis hind legs. Heart beats 100.
August 19f4.—Is considerably better ; gradually re¬
covering use of his legs. Seems hungry and drinks
enormouBlv. The dog was quite well and running about
afte* two upys.
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ORIGINAL COMMUNICATIONS.
November 25, 1866. 449
Experiment 8. —August 24th, 2.40 p.m .—Gave a big
dog 120 grains of the nitrate on meat. Within an hour
there were violent convulsions, with excessive purging
and vomiting. Apparently was in considerable paiD.
Drinks everything put in its way, and passes an enormous
quantity of urine. Died at 5.20 p.m.
Post-mortem, August 25 th, 1.30 p.m.~ Rigor mortis per¬
sistent. Brain normal. Thorax.—^Esophagus natural.
Lungs deeply congested. Clots in both sides of the heart.
Abdomen.—^Stomach the seat of acute inflammation,
spreading over its entire surface. No ulceration or per¬
foration, but there were black spots of extravasated blood
distinctly visible on the mucous coat. The stomach con¬
tained some brown grumous matters. The inflammation
extended to the duodenum, and affected more or less the
whole length of the alimentary canal, but was most of all
conspicuous in the rectum. The bladder was empty.
The liver was deeply congested, and the kidneys sligritly
so. I was able to detect the poison in the stomach, aver,
brain, and muscles.
I append the following tabular statement of the results
of our experiments :—
riment
Animal.
Dose.
1 .
Rabbit.
10 ere.
Died in less than one
honr.
2.
Do.
5
)«
Died in 27 hours.
3.
Small Terrier 30
ft
Died in 3| hours.
4.
Do.
10
it
Recovered in five days.
5.
Large Dog
20
tt
Recovered in two days.
6.
Do.
60
tt
Recovered in two days.
7.
Do.
120
»
Died in 2§ hours.
VENTILATION.
By Henry MacCormac, M.D.
The question of ventilation is far from being exhausted.
In ventilating, the great object to aim at, is to render the
house air, particularly the night house air, pure as is the
air outside the house. I say by night in especial, because
by day the nose and other organs of apprehension are awake,
whereas by night they are asleep. By day the waking man
can more or less take care of himself, while by night he is
helpless and defenceless comparatively. If he go to bed in
tainted air, he breathes this tainted air the long night
through. If it be tainted when he lies down, it is tainted
tenfold when he gets up. People, some people, say that
night air is unwholesome. What do they mean. Can they
exclude night air. Is not all air by night, night air. Oh,
but say these people, we sleep in a big room, we have plenty
of air. But what signifies now much air you have if it be
bad air, unwholesome air; will the mere bigness of the en¬
closure make it good. Can any air prove wholesome that
is not renewed. Will the air in the remoter parts of the
room, the unbreathed air, come over of its own accord to
your lungs and suffer itself to be breathed. It will not do
so any more than the loaf will come to be eaten or the book
to be read when it lies there. You just breathe more or
less the same stagnant air which subsists about you, let the
room be never so large. It needs movement, constant
movement, to renew the atmosphere and tender it effec¬
tively safe and wholesome. It needs the window to he
pulled down by night, and nothing less in these regions, at
least as houses are at present constructed, will suffice.
Two expedients may be resorted to in order to promote
ventilation. By the first expedient there is the ordinary
chimney opening below. But above this is a dwarf wall, or
septum if you wul, composed of six inch majolica or otner
tiles set in a suitable bronze or iron frame, and secured with
ornamental bolts and nuts at the intersections. This frame,
the top of it, should rise four or six feet above the grate.
Abo*e, there is a second opening regulated by a concealed
valve covered by a handsome mantelpiece. This arrange¬
ment, or something similar, minus the valve, subsists in a
rude but effective fashion in many of the farmers* houses in
the north of Ireland; and it iB pleaaant on going into these
farmhouses to find how well the ventilation, so far as the
kitchens and dairy ventilation are concerned, is promoted.
A person may stand or sit before the fire and feel that the
ventilation is satisfactory above the height of his head in
either case.
The second procedure which may be conjoined with the
first, has never in its entirety been set forth before. And
should it ever come to secure general adoption, I trust that
those who in this case are to benefit by it will not omit to
connect the arrangement with the originator, imagine
then a good, plain, low, straight-barred grate, with or with¬
out splayed sides, and an iron, copper, or thin terra cotta
back. Behind this back is a hot-air chamber communicating
by one or more openings of—say two feet—-joint section,
with the open air. This chamber should otherwise be of
sufficiently large dimensions, and communicate by other
openings with the living room,—for example : the back
oi the room, the joint sections of the warm-air openings or
outlets being equal to the joint sections of the cold-air in¬
lets, the whole in every case being under the control of slide
valves. In the fire-front there is an ornamental bronze or
metal screen (electro-plate would look well,) in two valves
or slide doors imning on rollers, one to one side, the other
to the other Bide behind the chimney jambs, the ornamental
apertures of the screen being fitted with thin green or other
glass, or Russian talc. In the thick of the wall on each side
of the fireplace a duct or ducts are to run to the ceiling,
terminating behind the perforated cornice above and below,
one on each side of the fireplace, in grated openings so
arranged, th£ screen in front of the fire for the time being
closed, as to supply the fire with the foul air of the apart¬
ment as drawn down from the ceiling and, pari passu , to fill
the room with tempered air, that is to say, air tempered to
50° or 60° of Fahrenheit. It would not be needful to keep
the screen or screens constantly closed, but only sufficiently
so, and sufficiently open to cheer up the fire and effectively
ventilate the apartment with tempered air. A cheerful
fire I say would result with more or less complete ventila¬
tion, as well as perfect safety. Our sitting and bedrooms
might thus be provided with renewed and tempered air at
once by night and day, coupled with every beautiful,
artistic, and healthful appliance besides.
The Public Health.— Tho following statistics aro from
the returns of the Registrar-General for the week ending
November 14th. Dnring the week 3,288 deaths were registered
in the metropolis and in 18 large towns of the United King¬
dom, the annual rate of mortality being 27 per 1,000 persons
living. Last week the annual rate of mortality was 25 per
1,000 in Ixmdon, 29 in Edinburgh, and 27 in Dublin ; 22 in
Bristol, 21 in Birmingham, 31 in Liverpool, 29 in Manchester,
85 in Salford, 27 in Sheffield, 22 in Bradford, 83 in Leeds, 2t
in Hull, 21 in Newcastle-upon-Tyne, and 33 in Glasgow. The
deaths registered in the metropolis during the week were
1506. It was the forty-sixth week of the year, and the
average number of deaths for that week is, corrected to allow
for increase of population, 1,564. The deaths in the present
return are less by 58 than the estimated amount, but are 110
more than the number registered in the preceding week.
From zymotic diseases the deaths were 345, the corrected
average number being 364. Eight deaths from small-pox. 38
from measles, 116 from scarlatina, 8 from diphtheria, 27 from
whooping-cough, 58 from fever, and 14 from diarrhoea, were
recorded. Small-pox is still fatally prevalent in Sheffield ; in
the seven past weeks of the current quarter no fewer than 81
deaths have boen referred to this disease in the borough, of
which 15 occurred last week. In the preceding 13 weeks,
ending 26th September, the number of fatal cases had been
182. From diseases of a zymotic character the proportion of
deaths resulting has during the past few weeks been excessive
in Manchester, Liverpool, and Leeds. Scarlatina has been
prevalent in Dublin, and also in several of the English towns.
From diseases of the brain and nervous system in the week
ending November 7tb, there were 126 deaths ; last week the
number was increased to 154. From disease of the organs of
circulation the rate of mortality increased from 61 to 83, and
tho deaths from diseases of the respiratory organs (phthisis
excepted) increased from 287 to 317. Phthisis caused 165
death?, bronchitis 166, and there were 109 from pneumonia.
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LEADING ARTICLES.
November 85, ISH
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The Medical Press and Circular is published
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every Wednesday morning. Price 5 d. Stamped 6 d.
By Post to Annual Subscribers , .£12 6
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Annual Subscription, post free , Ten Dollars.
gptol Jfress mtfo Cimtfor.
“SALU8 POPULI SUPREMA LEX.”
WEDNESDAY, NOVEMBER 25, 1868.
•-♦-
A FEW WORDS ABOUT COMBATANTS AND
NON-COMBATANTS.
Military officers are divided into combatant and non-
combatant. The former attend to the discipline and drill
of the troops; the latter pay, provide for, and heal them.
The former are designated by titles of military rank ;
those who pay the troops have of late had bestowed upon
them honorary titles of the same kind ; but those who
provide for and heal the soldier have as yet only attained
what has been termed relative rank, except in India,
where “executive” officers fill all the commissioned grades
of the commissariat department, as they do many other
positions in non-combataut branches of the public ser¬
vice. Among the more prominent positions occupied by
them may be enumerated commissioners and deputy-com¬
missioners of provinces, inspectors and superintendents
of police, cantonment magistrates, charge of native
princes, superintendents of telegraphs, not to speak of
charge of liorse-breeding establishments, experimental
farms, and last, though not least, as sanitary commis¬
sioners. Nor are we to suppose that their advance from
one military rank to another ceases or remains in abey¬
ance while they are employed in these very non-comba¬
tant positions. Far from it. So in this country and the
colonies, although doubtless in a lesser degree than in
India, a somewhat similar state of affairs holds good.
No person now thinks of questioning the right of the.
Engineer Department to military rank, and very recent
events have sufficiently proved how ably may an officer
of that distinguished corps organize and conduct military
operations of a most difficult and intricate nature ; yet
we cannot forget that the recognition of this branch of
the service as a combatant one is still matter of recent
history. Then let us allude to the Military Train, a
branch of the army which, without in any way dia-i
paraging the valuable services performed by it 9 officers"
and men, can scarcely be considered combatant in the 1 ]
same sense as a squadron of dragoons or a battery of I
artillery.
It follows, therefore, that the purely military titles oi
rank do not, as the public services are at present consti¬
tuted, give the slightest indication of the nature of the
duties performed by its possessor ; and perhaps this is
among the circumstances that have of late induced an
intelligent and a tax-paying public to consider whether
there are not really a great deal too many u combatant ”
officers in its pay, and whether there are not among them
a needless number of grades of rank. Regarding the non-
combatant branches, we will restrict our further remarks to
the Medical Department ; and surely there is no person
who has had the opportunity to consider the necessities of
the army who fails to see that not only are its members
not over numerous, but that they are barely able to con¬
duct the duties required of them in a time of peace, and
totally inadequate for the demands of a sudden war.
In no other branch of the army is the amount of
foreign service performed by its individual members so
great as in the medical department ; in none are the
periods of home service so short ; and in none do so many
casualties by sickness and death occur. It is often said,
and not without cause, that whereas “ combatant * officers
returning from abroad for the benefit of their health
obtain leave of absence in a liberal manner, as they should
do, this privilege is in the case of the medical officers cur¬
tailed to its very smallest limits, the result of the policy
being that many are sent to the tropics only partially re¬
covered, and thus curtail their efficiency in the service,
for it is only in that light that the question can most
practically be viewed.
But there is another point from which it is to be con¬
sidered. It is really not so much in times of peace that
the value of an efficient medical department becomes
apparent as during periods of war, and it is w ith a view
to that condition that all arrangements directed towards
the efficiency of the army should be made. Now, no
person will surely assume that the medical department of
our army is too large, or, indeed, that it is large enough
to meet the requirements of such a contingency. It was
practically found not to be so during the Crimean war;
it was sorely tried during the Indian mutiny ; and what
between the greater celerity with which recent experience
shows that war may be begun by European Powers, and
the list of casualties that may be expected to occur in a
series of battles fought with all the modem appliances, it
is to be feared that our existing establishment would be
altogether inadequate to the task thrown upon it Let us
briefly refer to what is related in regard to the recent wars
in America and Prussia, that we may the better point our
moral. During the early days of the war in the former
country we read that there existed a great want of medical
men and hospital attendants, and that the commencement
of the contest between the North and South under such
circumstances “ raised terror and confusion, not only in
the army, but among the whole people and it is also
asserted that during the early part of the civil war, before
the establishments for transport of the woundedhad reached
the complete state which they subsequently attained, the
wounded of one side who fell into the hands of the oppo¬
site did not always meet with that impartiality of treat¬
ment which, according to theory and the convention of
Geneva, contending armies should show the sick and dis¬
abled. Regarding Prussia, we learn that four days after
the battle of Koeniggratz corpse on corpse, exhaling
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LEADING ARTICLES.
November 25,1868. 451
poisonous odours, lay unburied round the half-mined
walls of the churchyard of Heronewos. The neighbouring
chateau was filled with six hundred wounded, with no
water, no food, no help ; and others were left upon the
field of battle for three days, there having been no means
of removing them.
According to calculations based upon the results of these
campaigns, it has been assumed that the casualties in any
one action fought against an European enemy, and with
modem instruments of warfare, would amount to about
12 per cent, of those engaged, and of that number
8 per cent would require hospital treatment and
accommodation. In the days of the Peninsular war the
casualties were far more numerous, the loss in killed and
wounded being in many instances 24 per cent., and in
some 33, several such actions being fought at intervals of
a very few days. It is fair to assume that with the pre-
seut improved means of land and water transport cither
actions would n>w be more decisive than they then were,
or that a succession of them would be fought more rapidly
than was then practicable. When, therefore, we consider
that one medical officer can only really do justice to a
number of wounded varying from thirty to fifty, according
to the nature of their injuries, that the casualties among
their own ranks arising from sickness and other causes
must be provided for, and a sufficient number kept in
reserve to meet any of the unlooked-for emergencies that
in all campaigns must be provided against, we have ample
reason to utter a word of warning against any curtailment
being made in the present medical establishments of the
army. There exists ample scope and mom enough for
the exertions of economists among the various ranks of
combatants. As to the non-combatant, to which these
remarks more particularly refer, any pruning that may be
applied should be confined to a very few of the top
tw igs ; those that have shown little vitality, or those that
instead of figs have brought forth wild fig*.
- ♦ -
THE BRITISH FOOL.
Truly the great constituency of fools—a most import¬
ant and numerous section of the great British public—has
no cause for complaint that its influence is disregarded or
its interests unrepresented. From the peeress whose folly
takes her to Bond street to buy the “ Magnetic Water of
the Sahara” at twenty guineas a bottle, down to the agri¬
cultural chawbacon, whose idiotcy costs him no more than
sixpence for Zadkiel’s or Old Moored Astrological Alma¬
nack, every form and grade of gobemouche is catered for,
and certainly none can complain that the article provided
wants piquancy.
The one quality which appears requisite for those who
claim the patronage of the British fool is entire faith in
the illimitable credulity of those whom they serve. Their
difficulty is not to adjust accurately the boundary line up
to which they may invent lies without running the danger
of being detected ; it is rather to endeavour to reach the
infinitely distant point at which their falsehoods become
too preposterous for the credulity of their constituents.
One might really believe that the “ Magnetic Water of
Sahara,” at twenty guineas a bottle, requires a very abund¬
ant degree of credulity ; but, really, beside some of the
ludicrous cheats which appear to receive credence from the
fool agricultural, the magnetic water is probability itself.
We have before us “ Old Moore’s Royal Almanack, con¬
taining the Voice of the Stars, Daily Weather Predictions,
Royal Nativities, &c., &c.,” and we are told that tens of
thousands of sixpences are expended by the British fool
on its purchase. Such a farrago of impudent lying may
sell as a curiosity, but we must believe that many of those
who buy also read and believe.
With all the astronomical make-believe with which the
predictions are sauced for the palate of the fool, we have
nothing to do. It is a little too much for us to suppose
that the clodhopper of the period knows what they mean,
if indeed they have any meaning at all. The predictions
as to public events are guesses as to what may happen next
year about as astute as any of the readers may have formed
for himself; and of course as some of the events are all
but certain, and most of them every one knows to be very
probable, we are rather surprised to see the list of last
year’s fulfilled forecasts, for which Old Moore credits him¬
self, so small as it is.
An extract from the preface is too good to be lost. It
appears that there was another Moore, who, like Captain
Wragge, in “ No Name,” engaged in “ moral agriculture,”
but found the soil unfertile, and accordingly abandoned
the astrological dodge. Here is the peean of Old Moore :—
“The cautious proprietors of ‘Moore’s Almanack* struck
their colours ; in other words, they struck out the monthly
astrological predictions, aud substituted for them accounts of
the institution of the various Saiuts days! This substitute
may bo to the advantage of the ‘ritualists,’ bat it is ant
adapted to the requirements of the farmers of Englandwho
were the chief supporters of that Almanack. This substitute
is a confession of weaknes* on the part of our contemporary ;
for it was evidently felt that it was impossible to compete
successfully with this Almanack in the matter of Astrology ;
so, the vessel being in danger of foundering, the most valuable
part of the cargo was thrown overboard, to give it a chance of
weathering the tempest of competition.”
We are reminded of the old woman who for half a
century every day boiled herself an egg. She was under
a delusion that a spell which she made daily use of would
prevent the saucepan from boiling over. Every day of the
fifty years she used the spell, and every day the saucepan
boiled over in spite of the charm, and yet at the end of the
half century she was as firm a believer in the efficacy of
her preventive as if she had never known it to fail.
We congratulate the farmers of England on the delicate
compliment which Old Moore pays them in claiming them
as his children. To those who have a character for in¬
telligence to lose, we advise a criminal prosecution against
Old Moore for malicious libel.
- ♦ -
THE NAVY REPORT.
The Navy Blue Book is in the hands of our naval
readers, but not a few of those engaged in civil practice
will be interested in some of its contents. As usual, and
in accordance with its title, statistical matter forms a large
proportion of the heavy volume, but there are manv facts
revealed by the array of figures that call for the deepest
thoughts of medical men and statesmen. If an analysis
have little interest to our naval brethren, who possess the
book, they will remember that we often occupy a good
proportion of our space with subjects in which their
brethren in civil life only possess a secondary interest.
Besides this^xcuse for devoting space to the book, it is
also true th ™ many conditions that affect the health of
the Navy influence the home population, and both the
Army and Navy reports, therefore, have an interest for
the whole community, as they exemplify the results of
certain hygienic conditions. We have in the reports an
account of the total naval force, and separate accounts of
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452 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
November 95, 1868.
the forces at each of nine stations, besides the appendix of
various contributions. The whole is worthy of the naval
medical department of a great maritime country. It ap¬
pears that during the year 99 per cent, of the men at the
nome stations went on the sick list. This seems a fearful
percentage; even if we take into consideration that as many
go on the list several times, some would not go on at all
during the period named. When we remember that
the persons referred to are picked lives, as the insurance
offices say, and that a seafaring life is very healthful, we
may well be surprised at the extent of the sickness, and
look for other causes of this state of affairs. The great
point to remember is, perhaps, that many of the cases are
really trivial, and would not appear as illnesses at all in
civil life in the rank from which sailors are taken, inas¬
much as many would neither abstain from work nor seek
medical advice on account of slight ailments. In the Navy
the medical officer, not the sailor, decides when any one is
ill enough to go on the list Considering how much easier
prevention is than cure, and how desirable it is to meet
the first symptoms, we are glad to see that the service
adopts the only proper plan.
“The mean force corrected for time was 21,200, and the
total number of cases of disease and inj ury entered on the sick
list 20,961, which is in the ratio of 9887 per 1,000 of mean
force, being a decrease, compared with the preceding year,
equal to 30*4 per 1,000. Of these 654 were invalided and 171
died, tho ratio of the former being 26‘1 and of the latter 8 0
per 1,000 ; the invaliding rate being 3 and the death rate *9
in excess of the previous year. The daily loss of service from
febrile diseases, including the exanthemata, was in the ratio
of 1*2 per 1,000 of mean force ; from diseases of the brain and
nervous system, *3 ; of the organs of respiration, 67 ; of the
heart and blood-vessels, *6 ; of the alimentary canal, *9 ; of
the liver, *2 ; of tho genito-urinary organs, 9*6, of which 77
wero from syphilitic diseases. In 1865 the daily loss of
sorvice from syphilis alone was in the ratio of 10*8 per 1000.
The daily loss of service from rheumatism was in tho ratio of
3*2 per 1,000 ; from diseases of the bones and joints, *3 ; of
the special senses, -0 ; of tho skin and cellular tissue, 9 6 ;
from dyspepsia and debility, *9 ; and from wounds and in¬
juries of various kinds, 57. The average number of men sick
daily was 8957, which is the ratio of 42 2 per 1,000 of mean
force, being a slight decrease as compared with the preceding
year."
It will be seen from our quotation that only 171 died,
so that the rate was only 8 per 1,000, and the invaliding
rate was but a trifle over .26. Such diseases as catarrh,
influenza, rheumatism, and tonsillitis go far to make up
the large figures, and their comparatively slight nature
relieves what would otherwise be a sad catalogue.
More than half the sickness of the year in the Navy
arose from what may fairly be classed as preventible dis¬
eases. Contagious fevers carry off their share, and
these diseases it is now thought by many ought to be
“ stamped out ” of all civilised communities. These are
mostly contracted ashore, and this fact is one that points
clearly to the great dangers to which sailors are exposed.
It suggests again the subject of venereal diseases, which
form such an immense proportion of the naval maladies.
Here we should remark that there is some improvement
in this respect in the present figures over those of the
previous year. This will be attributed by many to the
operation of the “Contagious Diseases Act,” and thus
we are brought face to face with a problem, which in
spite of the enthusiasm of some of our mo9t ardent
workers, we may safely assert is not yet satisfactorily
solved.
We are aware that many are ready to think that a
more strict execution of that Act, and an extension of it,
would go far to preserve our sailors from almost all
danger. There are, however, other quest As involved,
and they cannot be shirked, even if it should appear clear
that this presumption is well founded. Men who have
seen prostitution in all the cities of Europe, and observed
the efforts of Governments to cope with the evil, are
less sanguine than some of the doctrimtres who persuade
themselves of their ability to stamp it out. Be that as
it may, no one will deny that the effort to protect both
soldiers and sailors from the ravages of venereal diseases
is one that commends itself to philanthropists as well as
to medical men, while it is of the utmost interest to the
statesman.
But we are forgetting the fevers. Here is a passage
which we commend to our readers as a sample :—
“ The case of fever occurred in the person of the assistant
sick-berth attendant. He had been frequently on leave, and
while on shore slept at nights with his friends at Mill-bay,
Plymouth. In the close vicinity of the back of the house one
of the main sewers of the town discharged its contents, and
the patient stated that * often the smell coming into his
room on opening the window was awful.* ..
In most instances they had been taken ill when on
shore on leave, and being seen at their lodgings were
at once taken to hospital thenoe. In Table IV. a death
from primary fever appears. It occurred in the person of a
seaman who contracted the disease when on leave, and died of
typhus fever, it was certified, at his lodgings after ten days’
illness. . . . There were two cases of primary fever in
the Castor, one of which appears to have been of considerable
severity, the patient having been 55 days under treatment
The severity of the attack is said to have been probably depen¬
dent upon the miserable locality in which the man lived, which
was in the low town of North Shields, and is described as t
disgustingly filthy aud overcrowded locality on the right or
north bauk of the Tyne. . . . The disease was very preva¬
lent in the county of Donegal, and there were several deaths
from it in the neighbourhood of RatlimullaD, within two miles
from where the Defence was anchored. Although the disease
was eminently contagious and infectious, it is somewhat diffi¬
cult to account for its appearance on board ship, more especially
as the first person attacked was a very young officer who
seldom visited the shore ; and when on shore was not so likely
to visit fever haunts as the general run of the ship's company.
It must, however, be confessed that the neighbouring village
was a locality in many respects highly favourable for the gene¬
ration of such febrile complaints, the streets being without
channel drains, stagnant pools of water close to tne houses,
revolting and unwholesome smells whenever the streets are not
washed by heavy rains, back yards uncleansed, and filth even
trickling from tnem into the open streets, into which the house
nuisance is flung unsparingly night and day. For the most
part tho houses have only two small rooms, and often cattle
and human beings sleep together in them. . . . There
was only one case of primary fever in the Frederick William,
but it proved fatal. It occurred in the person of a seaman
who was taken ill while on shore on leave, and brought on
board labouring under the disease ; and on making inquiries
as to the locality of his lodgings it waa discovered to be in a
very filthy place in Queenstown, called Old street, in close
vicinity to a slaughter-house, with an open sewer close by, and
at all times crowded by emigrants.**
-
gfrrha on farrrwt $0p».
Scarlet Fever.
Scarlet fever is still very prevalent in the metropolis,
882 deaths having been recorded during the last eight
weeks. Last week 3 deaths occurred in the sub-district
of St. Mary, Paddington ; 11 in the sub-district of Ken¬
sington Town ; 3 in the sub-district of St. Paul, Hammer¬
smith ; 2 iu the sub-district of Fulham; 4 in the sub¬
district of Chelsea South ; 6 in the sub-district of Chelsea
North-west; 2 in the sub-district of Golden square; 2
in the sub-district of St. Giles North; 2 in the sub-district
of St. Clement Danes; 2 in the sub-district of St Andrew,
Eastern Holborn; 2 in the sub-district of Saffron hill,
Holborn; 4 in the sub-district of Hoxton Old Town ; 3
in the sub-district of Haggerstone West; 2 in the Town
sub-district of Bethnal green; 6 in the sub-district of
Mile End Old Town, East; 3 in the sub-district of Bow;
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NOTES ON CURRENT TOPICS.
November 25, 1868. 453
5 in the sub-district of St. Paul, Deptford j and 2 in the
sub-district of West Plumstead.
Sudden Death of a Surgeon.
Mr. Johnson, President of the Bridewell Hospital,
London, suddenly expired at the conclusion of Divine
Service at the Foundling Hospital, on Sunday week. At
the close of the service he was seen to stagger and fall on
the floor. Medical aid was promptly at hand, but life
was found to be extinct. Mr. Johnson had been out
shooting the previous day, and was thought to be in good
health. Heart disease was considered to be the cause of
his death.
Edinburgh and St. Andrew's Universities'
Election.
On Tuesday, the 17th inst., the constituency of these
Universities met for the purpose of nominating candidates.
There was a large attendance. The Vice-Chancellor, Pro¬
fessor Christison, presided, and having read the writ for the
election, Professor Syme proposed Dr. Lyon Playfair. He
remarked that the Universities have desired to be repre¬
sented in Parliament by some one who is intimately ac¬
quainted with their interests, and who, from his experience,
might afford a free communication between them and the
Government. On these grounds he had no hesitation in
proposing Dr. L. Playfair, a man of cultivated mind, who
had acquired free access to the sources of authority in all
departments of Government, and was able to express his
opinions, whether orally or in writing, freely and forcibly.
He had attracted the notice of the late Sir Robert Peel,
had discharged Government appointments, was held in
high regard by the late Prince Consort, and, if not a me¬
dical man, which had been alleged against him, he had
passed through a complete medical education.
Principal Tulloch seconded the nomination, chiefly on
the ground that Dr. Playfair came forward as a member of
the great Liberal party. After referring to the great ques¬
tion of the day, he said, Dr. Playfair is in a position to
render enlightened and valuable services to the Univer¬
sities, and he will render them in connection with the great
Liberal party, to which, I have no doubt, the future of the
country is committed.
Sir John M’Neill proposed Mr. Campbell Swinton. He
supported him, he said, on the ground of his having worked
hard to obtain the franchise for the Universities. In pro¬
posing Mr. Swinton he professed himself no party man;
he respected both parties when he thought them honest,
and despised either when he thought them dishonest. Yet
he was opposed to the question of the day—the disestab¬
lishment of the Irish Church, and declared himself ready
to support the man who is opposed to it also. He con¬
sidered that no constituency was better qualified for the
franchise than theirs, and hoped they would place Mr.
Swinton in the position he proposed for him.
Professor Sharp seconded the proposition. He consi¬
dered that on account of his earnest endeavours in promot¬
ing the interests of the Universities, and advancing educa¬
tion in Scotland, Mr. Swinton had shown himself worthy of
their support. Addressing his medical friends, he said it was
at Mr. Swinton’3 suggestion that the present Government
accorded to all M.D.’s not only the franchise, but all the
privileges of Members of the University Council After
expressing his strong and decided opposition to disestab¬
lishment, he pictured Mr. Gladstone with his large book
on the State conscience, and parental government, and the
rags and tatters of his high church antecedents still hang¬
ing about him, leading the onslaught against the Irish
Church. His speech throughout excited the meeting, and
produced repeated cheers and counter cheers.
The Vice-Chancellor asked if a poll was demanded, and
Professor Syme and Sir John M’Neill stated that they did.
It was appointed for the 30th November. A vote of
thanks was given to the Vice-Chancellor.
The Pharmacy Act in Scotland.
Tiiere seems to be some doubt as to the operation of
this Act. The Lord Advocate states that the substitution
of the word u Apothecary ” for “ Legalized Pract it toner,”
in the clause—which gives the former the power of selling
and keeping open shop for compounding of medicines—in¬
flicted a great hardship on the Profession. The President
of the College of Surgeons, after examining the Act,
declares that the licentiates are constituted legally qualified
apothecaries. He decided, however, to take the opinion
of counsel
Medical Club.
On Friday, November 13th, an adjourned General
Meeting was held at the Club, Sir William Fergusson,
Bart., in the chair. The report of the committee and the
amended rules were unanimously adopted. It was also
resolved to establish a guarantee fund for the next two
years for the purpose of meeting any extra expenses that
might arise, by which means the original foundation of the
Club, that is, the irresponsibility of its individual mem¬
bers, might be preserved. Nearly £300 was pledged, the
number of subscribers being 125. These efforts it is to be
hoped will have the effect of putting the institution on a
successful and permanent basis.
A Champion of Medical Reform.
Among the many subjects laid down, or rather, we should
say, held up for Reform , we find Medicine, whose cham¬
pion is none other than an impious quack, boasting of the
cognomen of “Felix Sandyfirth,” but whose real name is
Grayson. This scoundrel, when brought before the magis¬
trate at Bow street last week ou the charge of publishing
an obscene book, which he sent to the boys on board of
Her Majesty’s training ships, stated that he wished to pro¬
mote reform in everything, and had endeavoured to wrest
the noble science of medicine from charlatanism. But un¬
fortunately this poor innocent was victimised by our much-
abused Guardians of the Peace before he had time to carry
out his charitable designs ; his publications were seized
and destroyed with a number of stereotype blocks, and
some medicine, which were to complete the desired refor¬
mation, whilst the proprietor of these valuables was him¬
self again remanded by the magistrate with the polite
intimation that if he continued these filthy practices he
would certainly be committed for trial So far, we thank
Sir Tkoma3 Henry and the police, that they declined to
look upon this worthy and his disgusting artifices as the
champion of Medical Reform ; at the same time, heartily
desiring that the hordes infesting the best thoroughfares of
every large town may be brought to expiate their crimes
for the misery inflicted upon so many innocent families, by
a judicious application of the lash of public execration and
the prison cat.
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NOTES ON CURRENT TOPICS.
November 25, IStt.
Dublin Obstetrical Society.
The Society inaugurated its thirty-first annual session
on Saturday evening last in the presence of a very numerous
assemblage of the profession. The chair was occupied in
the first instance by Dr. George Johnston, the outgoing
President, and the lately-elected Master of the Rotundo
Hospital, and subsequently by Dr. Ringland. On a ballot
it was found that the following officers were elected :—
President—J. Ringland. Vice-Presidents—J. A. Byrne,
G. Johnston. Treasurer—H. Halahan. Secretary—G. H.
Kidd. Committee—T. E. Beatty, F. Churchill, J. Cronyn,
J. Denham, A. H. M‘Clintock, The report of the Society
was read, which represented it in a very flourishing state.
For the first time, its financial condition had, by an in¬
crease in the rate of subscription, been brought into a
satisfactory state. The Society numbers at present six
Honorary Presidents, six Honorary Vice-Presidents, sixteen
Honorary Members, 150 Members, and seven Associates.
The Council announce that they “ have made an arrange¬
ment with the editor of theMEDicAL Press and Circular,
whereby abstracts of the papers read at the Society will
be published in that journal.” The report having been
adopted on the motion of Dr. M‘Swiney, seconded by Dr.
Atthill, the following resolution of regret at the death of
the late President, Dr. S. L. Hardy, was adopted on the
motion of Dr. M'Clintock, seconded by Dr. Churchill, the
President of the College of Physicians :—“ That we desire
to express sincere regret at the death of our late President,
Dr. Hardy, and to record our recognition of the active and
increasing interest he took in the welfare of this Society
during his twenty-seven years of membership, as well as
our warm admiration of the suavity and sterling honesty
which invariably characterised his intercourse with his
professional brethren.” An eloquent memoir of the late
President was then read by Dr. M'Clintock, and of it an
abstract will appear in our pages in due course. After
votes of thanks had been passed to the Presidents of the
Royal Colleges of Surgeons and Physicians, and to the
Governor of the Apothecaries’ Hall, the Society adjourned.
The Pathological Society.
This Society held its usual meeting on Tuesday, the 3rd
inst. A report was read from the Committee on Morbid
Growths, and a variety of specimens were presented by the
different exhibitors, who explained their nature, and they
were passed round the room for the inspection of the mem¬
bers. We have not space to enumerate them, but no doubt
they afforded subjects of great interest to those who were
present.
Health of Dublin for the past Week.
TnE deaths registered during the week w ere 163—83
males and 80 females. The average number in the corre¬
sponding week of the previous four years was 171. The
mortality from scarlatina during the past week was very
great, no less than 21 deaths having resulted from this
disease. The average number of deaths from scarlatina
in the corresponding week of the last four years w as five.
Four deaths were ascribed to fever. Whooping-cough
proved fatal in two instances, and croup in a like number.
Seven deaths were referred to diarrhoea, and one to dysen¬
tery. Twelve children were carried off by convulsions.
Tweuty-six deaths were ascribed to bronchitis, six to
pneumonia or inflammation of the lungs, and two to
pleurisy. Phthisis or pulmonary consumption causedten
deaths; the average number of deaths from phthisis in
the corresponding week of the last four years was 19.
Six deaths were referred to heart disease. Four deaths
resulted from cancer, four from liver disease, and one
from nephria or Bright’s disease.
Over-Housing.
The caution lately administered by a veteran suigeon to
his junior brethren not to ocer-house themselves when
entering into practice was very forcibly illustrated by a
na'ice anecdote, narrated by Dr. McClintock, in his memoir
of the late Dr. Hardy, at the Dublin Obstretical Society.
Dr. McClintock, after narrating the success of Dr.
Hardy in a comparatively obscure street, told his hearers
that even although Dr. Hardy’s change of residence into a
more fashionable and public locality was not undertaken
until he had been for many years well established in prac¬
tice, when the time might have been supposed to have
arrived for the move ; nevertheless, it was the fact that
the change was not only not attended with an increase of
income commensurate to the greatly increased expense,
but in the first year afterwards there was an actual falling
off in Dr. Hardy’s professional receipts of .£77.
Perhaps the story is not new, though it may be the first
time the confession has been made.
Election to the Meath Hospital, Dublin.
The period of the Session at which the lamented death
of Dr. Stronge—announced in our last—took place, neces¬
sitated a very short interval before the appointment of his
successor. The medical officers in whom the appointment
is vested by Act of Parliament, proceeded to the choice of
a surgeon on Saturday last. Of the candidates whose
names were mentioned as competing for the office, Mr.
Ledwich, of the Ledwich School of Medicine; Dr.
Mapother, Professor of Anatomy and Physiology at the
Royal College of Surgeons; Dr. Robert Persse White,
surgeon to Jervis Street Hospital; and Dr. Mayne, were
the favourites. It was considered most probable that Mr.
Ledwich’a wide-spread connection with medical education
in Ireland would have entitled him to the preference, but
before the election he retired from the competition, and
Dr. R. P. White was chosen. Dr. White is at present
medical officer to the Roundtown Dispensary, and as it is
considered probable that he may vacate this position in
order to devote himself to his hospital duties, both that
appointment and the surgeoncy of Jervis Street Hospital
may be expected to be open to the competition of the pro¬
fession.
Medical Men in Parliament.
It is much to be regretted, when the great questions of
sanitary science are forcing themselves upon the attention
of the public, and must ere long occupy more consideration
in Parliament, that there is so little prospect of an increase
of the medical element in the House of Commons. True,
some of the medical candidates have been successful. Dr.
Brewer in Colchester, Mr. Vanderbyl in Bridgwater, Mr.
Clement in Shrewsbury. But, then, others have been re¬
jected. Dr. Sandwith at Marylebone, Sir D. J. Corrigan
at Dublin, Mr. Mitchell Henry at Manchester, and Mr.
Alfred Smee at Rochester. These are men whose attain¬
ments and eloquence would have given them a position in
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NOTES ON CURRENT TOPICS.
November 3d, 186g a 455
the Legislature, and their views on all subjects relating to
the public health would have had an authoritative bearing
upon the questions arising out of them.
At a meeting of the Town Council of Congleton, Dr.
Robert Beales was elected Mayor for the ensuing year.
His Royal Highness, the Prince Christian of Schleswig-
Holstein, has consented to preside at the annual festival
to be held in the spring on behalf of the funds of the
University College Hospital.
John Gillman Kisby, L.A.H.I., died on Nov. 17th,
at Rureton House, Shacock, Co. Cavan, aged 69 years,
sincerely and deeply regretted by his family and friends.
He was for twenty-five years Apothecary to the House of
Industry Hospitals.
Sir Roderick Mcrchison read a letter on Monday
week at the Geographical Society, just received from Dr.
Livingstone at the Foreign Office, dated Dec. 14th, 1867.
The accounts received from him are quite satisfactory.
He says he wants shoes more than anything else.
After what has occurred at St. Pancras, it is to l>e
hoped that something will be done to smooth the course
of the medical officer of this parish. Two candidates for
the appointment are in the field—Dr. Green, who is
acting as the substitute of the bite Dr. Hillier, and Mr. J.
Netten Radcliffe. The Vestry have decided to defer the
appointment uutil the temporary engagement of Dr.
Green has closed.
- ♦ -
MEDICO-SOCIAL PENCILLINGS OF LONDON
LIFE AND PRACTICE.
No. 1.
It is now many years since there assembled at my
modest and retired lodgings a “ bunch ” of class fellows
in order t-o celebrate, in the convivial student fashion
of the time, an event regarded by myself as unquestion¬
ably destined to ameliorate the physical condition of the
bodily afflicted section of the entire human family, and
considered by the " gushing ” units of the assembled
" bunch ” as a “ jolly good job indeed.” A few days
prior to that time I duly won the credentials which
legally entitled me to flap and to flounder—a qualified
Bird ; to attempt a step or two on the ladder of success—
a simple, plodding, medical machine ; or, better still, to
ambitiously try a flight above the common herd—nearer
to the bud, whence I could regard that luminary in its
burnished glow and magnificence, or look upon the broad
earth, its wonders and its wants, with the stoic placidity
of the physiologist and the philosopher.
Such on event usually called forth a large amount of
good nature and wild enthusiasm, and was celebrated, as
a rule, if not by “ sound of trumpet and beat of drum,”
by another process, nearly as loud, and certainly fully as
interesting. It consisted in a “ convivial spread,” and
not unfrequently the biliary derangement that sometimes
follows doings of the kind.
At the time of which I write, to be so much favoured
as to receive an invitation from a newly-fledged fellow
student—to form one of a select circle destined to close
the first act in his professional drama—was regarded of
more than mediocre importance ; for u " fellow ” might
stand with the meml>ers of his class on terms sufficiently
intimate to meet the common courtesies of every-day
life, and yet not be considered sufficiently M A 1 at
Lloyd’s ” to receive the cognomen of staunch friend—a
li fellow worthy of a fellow’s friendship, you know.”
It is true that I could boast the possession of the friend¬
ship of many to that degree which should have entitled
them to the honour of an invitation, but u monetary ex¬
haustion,” and total absence of available resources where¬
with to raise the wind just at that time, influenced my
selection. Consequently, the guests for the occasion were
limited to “ parties ” who, without the surmise of a doubt
being raised regarding their physical compactness, I might
compare to that pedal extremity of a late Earl of
Aldborough, celebrated in the ttaenlivening chronicles
of quack puffery—they were of “ long stauding !”
It was at the close of an evening in the u blithe and
merry month of May ” that the “ convivial spread ” took
place, and my lodgings being situated in “ quite a genteel
suburban district, within easy walking distance of town ’’
(vide my landlady’s card of terms), and as the majority of
my guests were partial to town and sojourned there, in con¬
sequence, a brisk walk in an easy and quiet sort of way,
coupled until a pardonable amount of speculative anxiety
to ascertain the full depth and extent and variety my bill
of fare would exhibit, evidently had the effect of
quickening the sensitive instincts of my guests—if such
was by any means possible—for they arrived in the
vicinity of the banquet table, punctually as to time, and
remarkably high as to feather.
The chair, by unanimous desire, was filled by Flexor
Longus, whose plumage had just received the finishing
touches. Consequently, he too being fully fledged, was
considered a personage of importance. Palmaris Brevis,
our stump orator, acted as croupier ; whilst Digitalis,
who never would understand how a femur could have
two necks, possessing, as it does, but one head, con¬
descended to undertake the arduous and responsible
duties of steward aud general “ chef.”
There were many amongst that select company of whom
especial mention might be made did time and space
permit it, which they don’t ; yet, for reasons to follow,
special allusion is made to the presence of Don Juan
noted for his curly ringlets, divided with geometric pre¬
cision in the mesian line from the vicinity of the occipital
protuberance to the frontal eminence, tended too with that
cherished fondling and lackadaisical care so remarkable
and distinguishing a feature in the habits and the customs
of the hirsute enthusiast; and of Pyramidalis, known for
his stateliness, greatness of soul—palpably displayed in
his love for the " newest things ” in tailoring—weakness
for blue-eyed, bee-bodied lady friends ; partiality for idle¬
ness, and lor the very decided preference he at all times
manifested—during ambulation particularly—for the com¬
panionship of the physically short.
There was a non-medical friend also present, a gentle¬
man from an agricultural district, with a steady head for
the management of live stock, and with an eye, it was
insinuated, ever fixed to guard the mercurial uncertainty
of Consols and New Three perCents. ; and although out
of the position in these papers, wherein it should form a
full chapter, an incident in connexion with this gentle¬
man occurred during the progress of the evening, the
relation here of which may serve as a warning to the
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456 The Medical Press ami Circular.
HOSPITAL REPORTS.
November 25,1808.
thoughtless anil gushing members of the body medical,
and certainly afford a lesson to the loquacious and to the
boastful—a lesson, indeed, such as few of us may desire to
learn, yet all of us may read with interest, if not with
advantage and with profit.
Qcn> Nunc.
SCOTLAND.
HEALTH OF SCOTLAND.
We select a few items from the monthly return of tli3
Scottish Registrar-General as to the eight principal towns.
It appears that the rate of the mortality is again high.
The deaths registered in the month of October last were
2,298, being 21G above the average in October for ten
years past, taking into account the increase of population,
which is now possibly rather more than 960,000. The
mortality of children under five years of age is as high as
46 per cent.; in Greenock it comes up to 61 per cent.
From zymotic diseases 31 deaths are recorded—an un¬
commonly high ratio for these maladies ; but it was
higher still in Edinburgh and Glasgow, where scarlatina
prevailed ; in Paisley, from scarlatina and fever ; and in
Greenock, where there was scarlatina and whooping-
cough. Scarlatina is making great ravages, as 325 deaths
have ensued from this epidemic—14*1 per cent, of the
mortality. From fevers 98 deaths have resulted ; from
cholera only 5 ; from diarrhoea 71; from diphtheria, 16 ;
whooping-cough caused 95 deaths, 'and croup 48. We
now come to chest diseases, of which inflammatory affec¬
tions of the organs of respiration are at the head of the
list, being the cause of no fewer than 364 deaths. From
consumption 235 are recorded; while of deaths from
violent causes, there are 6 from intemperance and de¬
lirium tremens, and 3 suicides, which close the list, no
deaths having occurred from small-pox during the past
month.
In the eight principal towns, we find from the Regis¬
trar-General’s return for the week ending Saturday, Nov.
14th, that the deaths amounted to 588, showing a surplus
of 157 on the corresponding week in 1867, the numbers in
the latter week being only 431. The proportions in the
present year were, Glasgow, 286; Edinburgh, 99; Dundee,
55; Aberdeen, 49; Paisley, 30; Greenock, 42; Leith,
17; Perth, 10.
EDINBURGH PHILOSOPHICAL INSTITUTE.
A lecture was delivered yesterday week in Queen street
Hall, by Mr. R. Carrutliers, of Inverness, to the mem¬
bers of the Philosophical Institution, The subject w-as
“ The Early Edinburgh Review .” He began by stating that
in 1801 there were a number of remarkable young men,
well educated, trained to literature, strongly attached to
each other, yet all poor and striving for distinction.
First on the list the lecturer placed Francis Jeffrey,
whose character and history he sketched at some length.
Next to him, he said, was Sidney Smith, the wittiest of
all English divines since Swift and Sterne. He alluded
to a statement of his—that it required a surgical operation
to get a joke into the head of a Scotchman—and parried
the thrust by'a reference to such men as Smollett, Burns,
and David Hume, whose familiar intercourse overflowed
with humour. The third member of the fraternity was
Francis Horner, who died comparatively young. The
others were John Allan, noted for his great attainments
in literature and science; Thomas Thompson, a distin¬
guished reviewer; Dr. Thomas Brown, the well-known
Lecturer on Mental Philosophy; and lastly, Henry
Brougham, who subsequently obtained the highest place
in the Senate of the United Kingdom. After paying a
merited tribute to the talents of tnese remarkable men,
he related the circumstances connected with the origin
and development of the Edinburgh Review , and concluded
by referring to the practice of preserving memorials of
men of genius in the places where they lived, and ex¬
pressed a wish to see a tablet placed on the respective
dwellings of David Hume, Henry Brougham, and Sir
Walter Scott; and “ another on the third flat of No. 18
Buccleuch place, where lived the remarkable Francis
Jeffrey, and where the Edinburgh Review was projected/ 1
Our recollection does not reach so far back as the days
of “ English Bards and Scotch Reviewers,” but it goes
far enough to enable us to bear testimony to the eagerness
with which the issue of the “Blue and Yellow” was in¬
variably received.
-♦-
ST. GEORGE’S HOSPITAL.
Dr. Ogle’s Cases of Abdominal Tumours.
( Continued.)
Case XXVIII .—Large tumour in the abdomen , thought to
be a fibrous tumour , which proved to be the uterus, pushed
up bg a fibrous tumour attached to its inner surface , and
filing up almost entirelg the pelvis .
Sarah F., act. thirty-eight, emaciated and of a sallow
complexion, was admitted July 14tli, 1845, having had
much vaginal discharge, aud clotted blood passed during
menstruation, which was too frequent. For the previous
four or five months she had felt a tumour at the lower
part of the abdomen, which she fancied moved from side
to side. Occasionally she had retention of urine. The
tumour gradually increased until admission, when an oval
elastic tumour could be felt occupying the vagina, and
very nearly filling the pelvis. An oval tumour could also
be felt above the pelvis ; and above this again , upon the
right side , and rather below the umbilicus , was another ir¬
regular tumour . This was supposed to be a second fibrous
tumour projecting from the peritoneal surface of the
uterus. The vaginal tumour was ligatured. Ulceration
of the walls of the vagina and neck of the bladder super¬
vened, and the patient died July 29th.
Post-mortem examination .—The fibrous tumour of the
uterus was found quite to spring from the fundus of the
cavity by a thick pedicle, aud the diseased mass filled the
S elvis. The tumour recognised within the abdomen
uring lile, reaching almost as high as the umbilicus,
turned out to be the uterus , which was pushed up by the
diseased mass above described. The peritoneum was
healthy ; the surface of the fibrous tumour was in a
sloughy state, and the vagina and neck of the bladder
much ulcerated. The rectum was misplaced, but healthy.
Case XXIX.— Tumour in the pelvis , formed bg blood ex-
travasated between the lagers of the broad ligament of the
uterus. Peritonitis ; perforation of the ileum, and cica¬
trix at another place . Peculiar sgmptoms.
Bridget T. was admitted February 4th, 1852, suffering
from a recent attack of what appeared to be local peri¬
tonitis, and with an anmmic aspect. The catamenia were
regular, but habitually scanty. In three weeks she left
the hospital, as being considered well; and as her health
appeared reestablished, she had married, but had not
become pregnant. She, however, always suffered from
constipation. On October 24th she was suddenly seized
with pain in the abdomeu during the night On the next
day she had a costive motion, and then no other for a
week, when she was greatly relieved by aperient medicine.
She then had no alvine evacuation for a fortnight, and
stercoraceous vomiting came on on the morning of admis¬
sion, in spite of purgatives, the use of leeches, &c. The
tongue was tolerably clean, the pulse 180, the abdomen
full and firm ; and every now and then large coils of in*
testinc could be distinctly felt rolling about under the
hand, accompanied by paroxysms of pain. As calomel
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TRANSACTIONS OF SOCIETIES.
November 25,1868. 457
and enemata did no good, opium was given at regular
intervals, with the effect of relieving the distressing
symptoms; and at length the obstruction gradually gave
icay, and a large amount of yeasty stone-coloured freces
passed. She appeared to recover rapidly; so much so as
to leave the hospital again, December 8th. On the 24th
she again returned, as sne was less well, and also suffering
from constipation, having had much abdominal pain,
which was now severe and constant. The pulse was
feeble and rapid, and the abdomen tense and full. After
a very restless and painful night, she was quite collapsed
the next day, and died in the afternoon.
Post-mortem examination .—The peritoneal cavity was
found to contain much recent lymph and turbid fluid,
mixed with foaces and fetid gas. Perforation of the ileum
about one foot from the caecum was detected. The aper¬
ture was thin and uneven, and the mucous membrane
around not inflamed but stained of a dark colour. Half¬
way between this perforation and the ileo-caecal valve the
intestine was constricted and presented an evident cica¬
trix; and this part adhered to another part of the intestine.
The stomach and kidneys were natural. Occupying the
right side of the pelvis, and rising into the iliac fossa,
was a large globular tumour of a dark purple colour and
of the size ol an orange, which proved to be a thick cyst
filled with coagulated blood, which was laminated in¬
distinctly and situated between the layers of the broad
ligament, being also closely adherent to the Fallopian
tul>e and ovary, which were separable from it, the former
of them terminating in a mass of fibrous material. Both
ovaries contained small cysts.
Case XXX. —Ovarian tumours on both sides of the ab¬
domen; peritonitis masking their presence.
A married woman, act twenty-six, admitted Nov. 23rd,
1854. Three months previously she had suffered much
from pain in the loins and abdomen, attended by diarrhoea.
The abdomen had begun to swell one month before
admission. Last child born twenty-two months pre¬
viously, and all that time she had been suckling it.
On admission, pulse quick and jerky, tongue dirty, ab¬
domen fluctuating, distended; urine contained litnates,
and a slight amount of albumen. She was treated under
the supposition that she suffered from peritonitis,—
slight ptyalism being produced,—and morphia was given,
as she had restless nights. She afterwards had a relapse,
and after that the abdomen was tapped. A quantity of
.reddish fluid, mixed with masses of fibrin, was drawn off.
Diarrhoea, and pain followed, checked by opium and
chalk. The abdomen again filling, she was again tapped,
with much relief; but she became weaker, Bank, and
died February 1st.
Post-mortem examination .—Excepting that the pleural
sac contained much reddish fluid, the lungs bein'* com¬
pressed and the general cavities encroached upon by the
abdominal contents, the thoracic organs were natural.
Abdomen. The parietal and visceral peritoneum was
thickened and opaque and vascular, and the cavity con¬
tained about two quarts of straw-coloured fluid. The
greater parts of the abdominal and pelvic cavities were
filled with a large ovarian tumour, which originated
apparently in the left ovary, displacing much the intes¬
tines. It was also connected with the left broad ligament
and Fallopian tube by a broad neck, and its surface was
indented, as it it had been composed of several cysts.
On section, it was found to consist at its circumference
chiefly of a whitish opaque substance, which was in some
parts tolerably firm and laminated, like the white fibrinous
clots of the heart; in other parts it was more diffluent.
The central part was more solid and rather vascular,
but evidently consisted of a lowly-organised fibrinous
product. Another tumour, of a similar character, con¬
sisting of a Bingle cyst filled with a moderately firm
whitish laminated fibrinous mass, was found also in the
place of the right ovary. The uterus was healthy and
very little displaced. The abdominal viscera were
healthy.
Case XXXI. —Fluctuating tumour of the abdomen , which
proved to be a distended and inflamed urinary bladder ,
the emptying of which was apparently prevented by pres¬
sure of a retroverted pregnant uterus on the urethra .
E. S., 031. forty-five, admitted May 10th, 1848, com¬
plaining of much pain in the abdomen, which was greatly
distended, and oi a rounded tumour, which was easily
to be felt, with a very defined border, just above the
pubes, rather to the right of the median line. This gave
very decided evidence of fluctuation, and a sensation as
of having very thin walls. It appeared to interfere much
with respiration. Behind the tumour, the bowels lay
distended with solid matter and gas. She was unable
either to evacuate the rectum or the bladder. The legs
were ccdematous, tongue furred, pulse feeble and frequent.
Had had a miscarriage twelve months before, since which
the catemenia had never returned ; but she had enjoyed
good health until three or four weeks before admission,
when she was suddenly seized (April 16) with cramp and
violent pain in the abdomen, and perceived a swelling in
the right side on the same evening, which had continued
to increase. She said she had passed neither urine nor
stool for four days.
When admitted, much dark-coloured alkaline offensive
urine was drawn off, and poppy fomentations applied
to the abdomen. The tumour remained, and the bowels
could only be relieved by medicines, and that with diffi¬
culty. At first the patient was better, but pain and
weakness increased, and, owing to excessive tenderness of
parts, no satisfactory examination of the vagina could be
made. The pulse became more frequent and weak, and
the tongue brown and dry, and sordes formed. The
oedema of the legs was removed, and the fluctuation of
the abdomen also, leaving a solid tumour to be felt over
the pubes. The urine contained albumen and a deposit
like altered blood-corpuscles. She lived entirely on wine,
brandy, and eggs ; on the 24th she had a miscarriage of
a foetus a few weeks old, and the next morning fifty
ounces of urine were drawn off, the usual quantity not
exceeding from fifteen to twenty. She sank, and died
May 25th.
Post-mortem examination .—The omentum and intestines
and bladder were adherent to each other, and offensive
pu3 existed between them. The bladder was greatly
dilated (capable of holding two or three quarts), and
reached as high as the umbilicus, being adherent to the
anterior walls of the abdomen by effused fibrin, which
easily gave way. Its mucous membrane was in a sloughy
state, and lined by effused lymph. The urethra was in
a still more sloughy state, and also the surrounding tissue,
so that it was impossible to distinguish the natural
passage. The uterus was four or five times larger than
natural, and had the appearance of one which had lately
parted with its contents. The fundus pressed back on
the rectum, so that the^ lower part might have pressed
on the urethra. The vagina contained a few ulcers.
The rectum was healthy. The kidneys were mottled and
inflamed, and their pelves dilated.
-♦-
faMrttas jof
MEDICAL SOCIETY OF LONDON.
Monday, Nov. 16, 1868. J
B. W. Richardson, Esq., F.R.S., President, in the Chair.
Dr. Sedgwick exhibited an adaptation of the mouth to the
uterine speculum.
Mr. Spencer Watson exhibited a case illustrating his treat¬
ment of wounds by the antiseptic method. The case was
that of a boy who had a wounded knee-joint. Mr. Watson in¬
jected into the joint a lotion of carbolic acid 3j to oz. Mr.
Watson also exhibited the comminuted bones and a bullet re¬
moved from a hand injured by a pistol-shot two years before
with good result.
Mr. CoorER exhibited a case of carcinoma about 10 x 6
inches, situated over the lower part of the sacrum.
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TRANSACTIONS OF SOCIETIES.
November 25, ISM.
Mr. Henry Smith exhibited a case of excision of the knee,
operated upon eighteen months ago; there was bony ankylosis,
a most useful limb, and the boy was in excellent health.
Mr. Hunt read a paper on the phases of physic in the 19th
century. He commenced by saying that the principles of
physic are not fixed ; he thought the beginning of the present
century was an heroic age in medicine. Bleeding ad deliquium,
and purging ad misericordiam were the order of the day. The
Apothecaries Act of 1815 had little effect for several years, but
as time passed anatomy and physiology formed the true basis
of medicine. Practitioners differed in their estimate of the
value of drugs, which depend on the quality of the drugs which
in 49 cases out of 50 were iu a state of adulteration. Purgatives
he thought had of late years been much neglected. He believed
that three-fourths of chronic disease depends upon constipa¬
tion ; purity of air and purity of aliment were essential to the
treatment of disease. The latter part of this century has been
marked by the first advance in diagnosis, resulting from the
proper use of the stethoscope, microscope, laryngoscope. The
author concluded his paper by expressing a hope that the
labours and researches of the president would throw great
light on many questions at present involved in great, obscurity.
A warm discussion then commenced. Dr. Camps, in referring
to cholera, said, that the treatment by purgatives was not
good. Dr. Cholmeley thought that if in the present day we do
not purge as formerly, we still have great regard for the healthy
alvinc evacuations.
Mr. Roger Harrison related cases showing the innocuous¬
ness of annual bleeding.
The President thought with regard to diet in certain cases,
that, for example, in diabetes treated without stout, he had
known the most disastrous consequences ensue ; he believed
the abuse of alcohol was terrible, and that the lancet never did
one tithe the harm. Mr. Royes Bell agreed in a judicious use
of stimulants. Mr. Hunt having replied, the meeting ad¬
journed.
ARMY MEDICO-CHIRURGICAL SOCIETY OF
PORTSMOUTH.
November 4 th, 1868.
Deputy Inspector-General Dr. C. A. Gordon, C.B., in
the Chair.
Surgeon Perry, Royal Artillery, brought before the Society
the details of two cases of
PLEUHO-PN EUMONI A,
followed by Hydrothorax and Empyema, which had occurred
in his practice, with the means of showing the importance of
resorting to surgical measures in such cases as a means of pro¬
longing life.
The first case was that of a soldier who was attacked with
pleuro-pneumonia, followed by great effusion, not yielding to
ordinary treatment. His symptoms became so urgent that
there was no hope of doing him good except by puncturing his
chest. This was accordingly done, and 44 oz. of pale green-
coloured pus evacuated with the greatest relief. In a week
from the date of the paracentisis being performed, the par¬
tially cicatrised wound opened during a fit of coughing, and
73 oz. of similar fluid flowed out. The wound was closed, but
in another month the operation had to be performed, when
50 oz. were withdrawn. The cicatrix subsequently broke up
again, giving exit to from 8 oz. to 10 oz. a-day. The man’s
life was prolonged for at least three months by the operation,
and during that time more than 300 oz. of pus were evacuated.
The second case was that also of an artilleryman, who suf¬
fered from the same disease, and whose chest was punctured
six times in as many months, the quantity evacuated at each
operation varying from 48 oz. to 84 oz., but at one time
amounting to as much as 210 oz.! Upon the last operation
being performed, a paroxysm of very severe coughing took
place, and, in spite of all endeavours to prevent it, a quantity of
air was sucked into the pleural cavity. Spontaneous breaking-
up of the freshly-formed cicatrix soon followed, but by careful
nursing he was kept alive for three months longer. During
this time from 10 oz. to 11 oz. of pus were secreted daily, and a
period of very nearly nine months elapsed between the first
evacuation of the fluid to the fatal termination of the case.
In that long period more than 1500 oz. of sero-purulent fluid
were secreted and evacuated!
The autopsy of the first case elicited no particular point of
pathological interest, except as regarded the pyogenic pleural
membrane and the collapsed and camified condition of the
lung ; but in the last, with these same conditions, there were
discovered miliary abscesses in the kidneys, spleen, and re¬
maining lung, whilst the interior of the mesenteric glands
were also full of puriform matter. These abscesses bore the
greatest resemblance to those of tubercle, but were evidently
due to py.Tmic poisoning from the affected pleura.
Assistant-Surgeon Maunsell, R.A, read a paper on
MORTALITY IN INDIA ACCORDING TO TEMPERAMENT.
In his experience the sanguine and bilious were the two
temperaments which came most prominently before the medi¬
cal officer in India. Fevers (intermittent and remittent},
dysentery and- hepatitis were seen among men of dark com¬
plexion, sallow face, or of bilious temperament ; bat
men of sanguine temperament (fresh complexion, light hair,
and blue eyes), though very liable to be attacked by the dis¬
eases of the country, the affections were in them less severe and
their effects more transient.
Europeans landing in India fresh from England bring with
them a stock of nervous force and vital energy which act as
protecting powers. The longer they remained in the country
the more their innate powers of resistance gave way, the
balance turned, diseases by which they are affected take on
an asthenic character.
He produced a list of sixty- two cases of hepatitis terminat¬
ing fatally. The patients had been admitted to the hospital
of the 10th regiment during fourteen years ; twenty-one of
these cases were of the bilious, and forty-one of the sanguine
ous temperament.
He considered the subject very interesting, as the choice of
men for foreigu service greatly affected the efficiency of a regi¬
ment on its going abroad.
Assistant-Surgeon O’Leary, Hon. Sec., read a paper by
Dr. Clarke, R.A., on a case of
MALINGERING,
the subject of which (a soldier in the battery under bis medi¬
cal charge) persistently continued in his endeavours to feign
disease, but was eventually, not only detected, but tried, con¬
victed, and punished for the offence, and was, at the date of
the report, in the performance of his duty.
. Dr. Lamprey, 67th regiment, gave the history of a case
which served to illustrate the liability of a mistake being made
in supposing a man to be feigning disease, though at the time
he might be labouring under most serious illness. The case
was that of a soldier of his regiment who had been for some
time under treatment for rheumatism, and as he persisted in
his inability to perform his duties, and no treatment had made
any improvement in his case, he was brought before a medical
board for invaliding, but was by it remanded for further treat¬
ment. While in hospital, after being rejected by the board,
the signs of aortic aneurism were first suspected, although
there was doubt as to the existence of this disease, the indica¬
tions being remarkably obscure. Death shortly occurred, and
the post-mortem examination revealed the existence of an
aneurism of the transverse, and commencement of the descend¬
ing portion of the arch of the aorta, with erosion of the bodies
of the last cervical and two first dorsal vertebras ; showing
evidently that the disease had been for some time in existence,
and, at the same time, pointed to the origin of the pains which
caused his disease to be classified under the head of rheu¬
matism.
-♦-
MEDICAL CLUB.
An adjourned general meeting was held at the Club on
Friday, Nov. 13th, 1868, Sir William Fergusson, Bart., in the
chair. The following report of the Committee and the new
and amended rules were unanimously adopted.
The Committee report that as the Club was originally started
on the express understanding that the members should not be
liable for any debts incurred in carrying it on, they are advised
that this principle cannot be departed from without entirely
changing the constitution of the Club, and they strongly
recommend that no alteration should be made in this respect.
New and Amended Rides .
1. That a general meeting of the members shall be held at
the Clubhouse, on the second Wednesday in October in every
year. Any member having a proposition to make at the said
meeting, must send in the same signed to the honorary secre¬
tary, twenty-one days prior to the day on which the meetingis
announced to be held, so that due notice thereof may be
given.
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The Modteal Prtts and Circular.
CORRESPONDENCE.
November 25, 1868. 459
2. The Committee may, whenever they think fit, and they
shall, upon a requisition made in writing by not lest* than ten
members, convene an extraordinary general meeting.
3. Any requisition made by the members shall express the
object of the meeting proposed to be called, and shall be left
at the Clubhouse, addressed to the honorary secretary.
4. Upon receipt of such requisition the Committee shall
forthwith proceed to convene an extraordinary general meet¬
ing, to be held at the Clubhouse. If they do not proceed
to convene the same within twenty-one days from the date
of the requisition, the requisitionists or any other members
amounting to the required number, may themselves convene an
extraordinary general meeting.
5. Seven days* notice at the least, specifying the day and
hour of holding any such extraordinary meeting, and the
nature of the business to be transacted thereat, shall be given
to each member by circular sent through the post, and such
notice shall be deemed to have been given when posted.
6. The Committee shall consist of eighteen members. The
present members shall continue in office until the next general
meeting. At the next and every subsequent general meeting,
one-third of the members of the Committee for the time being
shall retire in rotation, but be eligible for re-election. At the
first meeting after their election, the Committee shall appoint
one of their number as chairman.
7. The members at the general meeting shall elect by ballot
a like number of persons to fill up the vacancies caused by
such retirement as aforesaid.
8. Any casual vacancy occurring in the Committee may be
filled up by the remaining members thereof, if they so think
fit, but any person so chosen shall retain his office so long only
as the vacating committeeman would have retained the same
if no vacancy had occurred.
9. The Committee shall have power from time to time to
make such bye-laws as shall appear to them necessary for the
good government of the Club, the same to be confirmed at the
next general meeting.
To enable the Committee to make arrangements for the
continuance of the Club without increasing the subscriptions
of the original members, or rendering them liable for any debts
that might be incurred in carrying it on, it was decided to
establish a guarantee fund for the next two years to meet any
excess of expenditure over income that might arise. A list of the
subscribers to the guarantee fund was presented, and included
125 names, representing about £300.
Several members expressed a confident opinion in the con¬
tinued success and prosperity of the Club. It was unani¬
mously resolved to make it in every respect worthy of the
profession, and as soon as possible to place it upon a much
more enlarged basis, either on the principle of the ordinary
Committee clubs or under the provisions of the Joint Stock
Company’s Act.
A vote of thanks to the Chairman was carried by acclama¬
tion.
-♦-
MEDICAL REPRESENTATION IN PARLIAMENT.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir, —In the article from the Times , which you quote in
your leader last Wednesday, there are several errors, and as
they might mislead your readers I write to contradict them.
The writer states that the subscriptions to Sir D. Corrigan’s
election fund amounts only to £1,135 12s. That was then the
sum subscribed by the profession alone; in addition over
£3,000 were subscribed by the political supporters of Sir
Dominic. That the medical subscriptions exceeded £3,000
was never stated by any one except the Times' correspondent
himself, in his previous letter.
It iB next stated that the Council of the Irish Medical
Association “declined to convene a general meeting to pro¬
mote Sir Dominic's return, on the ground that the rules would
not warrant them in doing so. A form of resolution was
cleverly drawn up to avoid the objection, and it is said the
zealous friends of the baronet almost carried it by a surprise.
After some members, who thought the matter had been dis¬
posed of, had gone away, the motion was brought on in a new
shape, and was rejected on a division by a majority of only
one vote.” The errors in the above few sentences will be dis¬
played by the following relation of facts :—I proposed that the
Council should call a meeting for the purpose of aiding the
return of a medical representative (Sir D. Corrigan’s name
was erroneously introduced into the minutes). The Chairman
and Secretary informed me that the President only could
summon the Association, but that the Council could call to¬
gether the whole profession. I therefore substituted the word
“ Profession ’* for “ Association " in my resolution, which was
negatived by a large majority. No member left the room from
the moment I introduced the matter until the meeting broke
up. After an incorrect description of the meeting in the
Molesworth place Lecture Hall, the correspondent reports
that “ another meeting was held simultaneously in another
place to protest against it,” and this has been the only public
intimation that such an opposition meeting was to be, or was,
held.
The constituency of Dublin exceeds 12,000, yet so evenly
balanced are the opposite parties that it has happened that Sir
D. Corrigan wa3 defeated by just the number of votes which
certain of his professional brethren recorded against him for
one political reason.
However, nearly three hundred medical men laid aside
general politics, and by their influence and subscriptions strove
to return to the House of Commons that man, who, of all
others, would have been the ablest Advocate of their profession,
as well as of great sanitary reforms, which are most ineffi¬
ciently dealt with in that assembly.
The deep anxiety which was felt on the subject throughout
the entire country will be apparent from the letters of several
practitioners, which, together with a report of the public
meeting and the subscription list, will be this week published
in pamphlet form by the treasurers to the fund.
Yours faithfully,
E. D. Mapother, M.D.
125 Stephen’s green, Dublin.
TO THE EDITOR OF THE MEDICAL PRE88 AND CIRCULAR.
Sir, —A8 it is only right that honour should be given where
honour is due, I think it right to say that the method of
dividing the perineum in the last stage of labour, usually as¬
cribed to Dr. Beatty, is really the suggestion of Butignot , as
may be seen by reference to page 340, Year-book of the
Sydenham Society 1859, in which he recommends, in cases
where laceration is apprehended, incisions to be made on one
or both sides. The latter plan I tried lately with great success,
and think it preferable to dividing one side only. The head
was delivered almost as soon as the incisions were made.
I am, Sir,
Yours obediently,
J. M.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—Y ou would much oblige by inserting the following
remarks in the next issue of the Medical Press and Cir¬
cular :—
It is now full time that the case of Poor-law Medical Officers,
as to extra remuneration and retiring annuities, should be de¬
cided on ; and, in addition to such, I would say permanency of
appointment. At present the Poor-law Medical Officer in
Ireland may be compared to the farmer who holds land with¬
out a lease from a bad landlord ; or it may be from a good
one influenced by a bad agent. Their position is one of un¬
certainty, insomuch that, I say with regret, there are amongst
members of Boards of Guardians men without conscience,
without principles, who are turned as chaff before the wind
by other members more independent, or who may have control
over them. Such become from the start opponents to the
Medical Officer, and can worry him at their pleasure by issuing
tickets to trivial cases, at all hours and in all seasons. What,
therefore, is the means of defence for the Medical Officer ?
The only one is permanency of appointment. But it may be
said—If Poor-law Medical Officers’ appointments be made
permanent appointments, how are the poor to be guarded if
the Medical Officer chooses to neglect them in their illnesses ?
The remedy, 1 would say, and the course to be adopted ought
to be : at the appointment of any Poor-law Medical Officer it
should be distinctly agreed upon that he would be liable to a
fine of £10 or £5 for each neglect in the discharge of his duty
to the poor, which neglect be clearly proved before a full
meeting of the Board of Guardians of the union to which he is
attached.
Yours faithfully,
Ulysses Fitzmaurice, L.R.C.S.I., L.K.&Q.C.P.I., &c.,
Physician to the Listowel Dispensary.
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4 60 fffce Medical Ptms and Circular. NOTICES TO CORRESPONDENTS.
November tt, 186ft.
CHILBLAINS.
TO THE EDITOR OP THE MEDICAL PRESS AND CIRCULAR.
Sir, —This being the seasonable time for chilblains, I beg
to offer for insertion the following formula. It will be found
satisfactorily effectual in relieving the irritation, and, as far
as my experience has gone in its use, speedily curative. It
must be freely applied with a camel’s-hair brush.
A Liniment, aconiti, 5ii-
Add. carbolic, gtt iv.
Collodium flexile , B. P., 5iv. fll
I am, Sir,
Azygos.
- - ■+-
THE SOCIETY OF ARTS.
The One-Hundred*and-Fifteenth Session of the Sodety of
Arts commenced on Monday the 23rd of November, when
the opening Address was delivered by Lord Henry G. Lennox,
M.P., Chairman of the Council.
The following are the dates of the Wednesday evening meet¬
ings, the chair being taken at 8 o’clock :—
1868
November .
. _
_
23
25
tt
December .
. 2
9
16
23
_
1869
January
. —
—
20
27
it
February
3
10
17
24
ft
March .
. 3
10
17
—
31
ft
April .
. 7
14
21
28
tt
May .
. 5
12
19
26
tt
June .
. —
—
—
—
30
For the meetings previous to Christmas, the following ar¬
rangements have been made : —
November 25.—“A Glance at the Past and Present of the
Society of Arts, with some Suggestions as to the Future.” By
S. T. Davenport, Esq., Financial Officer of the Sodety.
December 2.—“ Further Notes on the Productive Industries
of Natal. * By Dr. Mann, Superintendent of Education and
Special Commissioner for the Colony.
December 9.—“ On the Theory of Boiling, in connection
with some Processes in the Useful Arts.” By Chas. Tomlinson,
Esq., F.R.S., F.C.S.
December 16.—“On Artificial Freezing.” By Dr. B. H.
PauL
December 23.—“ Description of the Electric Organ.” By
Henry Bryceson, Esq.
The first course of Cantor Lectures for the ensuing Session
will be “ On the Aniline or Coal Tar Colours,” by W. H. Per¬
kin, Esq., F.R.S.
♦
gptriral gfrfos.
University of London.— The following aie lists of Can¬
didates who passed the respective examinations indicated
Second MB. Examination.—Pass Examination.— First Division.—
Tempest Anderson, B.8c., Charles Dorrington Batt, Joseph Birt,
Reginald Eager, fcFrederick Harry Haynrs, Henry Charles Hilliard,
Daniel John Leech. Thomas Richarison Loy, John Makeus, George
; Vivian Poore, William Aslept Richards, John JamesRulge, B.A.,
B 8c.. Frederick Taylor. Second Division. — William Turbervtlle
Buckle, Edward Bowies Crowfoot, Alexander Panl Fid lian, George
Arthur Kenyon, John Wreford Langmore, Jeremiah McCarthy, M.A.,
Dublin, John Sanderson Wyman, Isaac Burney Yeo.
Chloroform. —Chloroform can best be preserved by the ad¬
dition of half to a whole part of alcohol. Light will then not
decompose it. If pure, it will not alter the colour of dampened
litmus paper. If free from chlorine, it will not blue paper
dampened with the iodide of starch. When mixed with one
part of alcohol, its specific gravity is 148° at 17.58 Cent.—
Rump, in Central-BlaU fiir die Mcdicini schcn IFisscnschaften.
We are requested by the Publishers of the Quarterly Jour¬
nal of Microscopical Science, to state that that Journal will
continue to be published as usual by the Messrs. Churchill,
and edited by Dr. Lankester and Mr. E. Ray Lankester. The
only change consequent upon Dr. Lankester and Professor
Busk ceasing to edit the Transactions of the Royal Micro¬
scopical Society will bo that the Transactions of that Society
will not be published separately in the pages of the Journal.
Hunterian Medical Society of Edinburgh—Intro¬
ductory Address by Thos. Grainger Stewart, Esq., M.D.,
F.R.S.E.—The introductory address for this session was
delivered in the Logic Class-room of the University, on the
evening of Friday last, by Dr. Stewart, Edinburgh. John
M‘Nab, Esq., M.D., F.R.C.S.E., occupied the chair, and in¬
troduced Dr. Stewart to the meeting, who delivered an
able address on the “Life and Labours of Edward Jenner,”
the discoverer of vaccination. There was a good attendance
of students and medical practitioners, and frequent cheers
were elicited from the audience during the delivery of
the address. Dr. Black, honorary president of the society,
intimated that two medals were offered, one from Dr. M‘Nab,
and another from Dr. Messer, for the two best dissertations
given in at the end of the session on medical subjects to be
announced at next meeting. Votes of thanks were awarded
to Dr. Stewart and the Chairman, which were heartily accor¬
ded, when the proceedings were brought to a close.
The number of medical students pursuing their studies at
the different schools in London and the provinces amounts,
according to a reliable return, to 1478. Of these 284 s rt
studying in the provinces—at Birmingham, 72 ; Manchester
63 ; Leeds 32 ; Liverpool, 80 ; Newcastle, 27 ; Bristol, 20 ;
Cambridge, 17 ; Sheffield, 13 ; and Hull, 10. — Standard.
Edinburgh University. —The polling for the two candi¬
dates nominated for the Lord Chancellorship of Edinburgh
University terminated on Friday, and the result was on Satur¬
day declared to be as follows :—For the Lord Jus tioe-General,
1,780 ; for the Right Hon. W. E. Gladstone, 1,570 ; majority
for the Lord Justice-General, 210. — Times.
- + -
NOTICES TO CORRESPONDENTS.
Da. Rumbey ok Public Health.—Out last issue contained, in the
form of a supplement, the first portion—revised by the author—of hi*
Address as President of the Health Department or the Social Science
Association at its recent Birmingham Congress. [It was followed by a
paragraph which had been accidentally omitted by the printer from the
concluding portion, published Nov. 11th. ] We adopted this plan in order
that our readers might be furnished with a complete verbatim report of
this important Allocution.
We shall be happy to forward copies of this journal for October 28th.
November 4th and 11th, containing the subsequent portions of the
Address, to those new subscribers who commenced after the first-named
date.
Dear Sib,—I n your next publication will you be good enough to ns me
a standard work on professional etiquette, and to advise the proper line
of conduct under the following circumstances.
A is called upon at a late hour to visit a patient living some miles dis¬
tant from his residence. After prescribing, Ac., for the patient, he is
told that B had boen sent for some hours previous, but that the messen¬
ger had returned, stating B was from home, and his return uncertain. As
A is leaving B arrives, having been sent for by his servant, who states he
was so dosTred by the messenger. B declines taking charge of the case,
but leaves it in A’s hands. Now, how should A act; should he resign
the case? I enclose my card, and am,
Yours obediently,
“ 8peuo”
V We are decidedly of opinion that inasmuch as A was placed—in
consequence of the absence from home of B—in charge of the case, and
undertook the responsibility without having been informed that B had been
sent for, he is not ealled upon to deliver over the ch&ige of the patient
to B. In large towns such contretemps are very u>nal, and we are not
aware that it is usual for the practitioner in attendance to retire in favour
of the surgeon who may have been first sent for. If tha case had been
previously in the charge of B, the circumstances would be altered, and
we think It would not be good taste for A to avail himself of the chance
of B’s absence to take the case out of his hands.— Ed. Medical Paisa
A Circular.
Dr. W. Grimshaw on a New Sphymografh.—W e have given the
illustration to the engraver; when this is exeented, a proof of the whole
shall be sent you.
Dr. Cameron.— 1 Thanks. In our next.
To Our Subscribers.—T hose gentlemen who have not paid their sub¬
scription for last year, are respectfully requested to do so without further
delay.
To Our Contributors.— In consequence of the great pressure upon
our space, we must ask the indulgence of those who have kindly forwarded
us papers for insertion. 1 n thanking them for these contributions, some
of which are of great practical vriuc, we beg to assure them of their ap¬
pearance in our columns as early as possible. The last few weeks we
have given four or eight pages extra, and we hope this will be accepted
as an earnest for the remainder.
APPOINTMENTS.
Holman, J. R., Esq.—Promoted to Staff-Surgeon in Her Majesty’s Fleet
Blake, C. Carter, Doct. es Sciences, F.G.8., Hon. F.A.8.L— Lactam?
on Comparative Anatomy and Zoology to Westminster Hospital
8chool of Medicine.
BOOKS, PAMPHLETS, Ac., RECEIVED.
Operations for Cicatrices after Burns. By J. H. James, F.R.CJ&.
London: John Churchill and Sons.
A Handbook of Uterine Therapeutics. Third Edition. By E. J.
Tilt, M.D. London : John Churchill and Sons.
Lectures on Surgery. By J. Spencer, F.R.8.E. Edinburgh : A sad
C. Black.
Address on Institutes of Medicine. By G. Aitken Meigs, K.D.
New York Medical Journal.
The Medical and Surgical Reporter.
Boston Medical Journal.
Journal de Medicine.
New York Medical Gazette, Ac., Ac.
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“SALUS POPULI 8UPREMA LEX.”
WEDNESDAY, DECEMBER 2 ,
1868 .
CONTENTS.
LECTURE.
Jervis street Hospital -
Lecture Introductory to the Course of
Medical and Strgical Clinical Instruc*
tion, 18 C 8 . By 8. M. MacSvrlney,
M.D., Physician to the Hospital.... 481
ORIGINAL COMMUNICATIONS.
On Heat Stroke. By C. Handheld Jones.
M.B. Cantab, F.R.S.. 484
Experiences of a Regimental Surgeon in
India. By C. A. Gordon, M.D., C ft,
Deputy Inspector-General of Hospitals 488
LEADING ARTICLES.
Educational Rxrosx . 472
Smoke Nuisance and Magisterial Jus¬
tice . 472
Report op the Army Medical Depart¬
ment for the Year 1866, Published
in 1868 . 478
PAQE
NOTES ON CURRENT TOPICS.
Death from Starvation. 474
Guardians versus Poor-law Board. 474
The Abergele Coroner. 474
H.M.8. “Ariadne”. 474
Death from Hydrophobia. 474
Hints on Quackery. 474
The New Pharmacy Act and the Dispen-
pensary Practitioners. 474
The Health of Dublin. 475
Thames Purification from the Sewage of
Oxford, Eton, Windsor, and Abingdon.. 475
Royal Medioo-Chiruigical Society. 475
Payment of Medical Officers. 475
Killed during the Elections. 476
8t Andrew’s Medical Graduates’ Associa¬
tion . 476
SCOTLAND.
University of Edinburgh. — Election of
Chancellor. 476
page
CORRESPONDENCE.
Statistics of 8carlatina. 477
8 r D. J. Corrigau’s Candidature. 477
Large Families and Public Health. 478
GLEANINGS.
Consumption and Dyspepsia. 479
Transfusion of Blood. 479
LITERATURE.
Notes on the Metals'. 479
Perpetual Almanack and Calendar for the
Investigation of Dates. 479
Medical News, Notices to Correspondents,
Ac. 479
$ n t ro buciorg gtclntt.
JERVIS STREET HOSPITAL.
LECTURE INTRODUCTORY TO THE COURSE
OF MEDICAL AND SURGICAL CLINICAL IN¬
STRUCTION, 1868 .
By 8. M. MacSWINEY, M.D.,
Physician to the Hospital.
Gentlemen, —To-day, when I am opening the Winter
Session of Clinical Instruction in this Hospital, I beg
leave, on behalf of my colleagues and myself, to offer to
all our young friends here who occupy the students’
benches—both those who now, for the first time, enter
upon the study of medicine, aa well as those who, after
an interval of repose, have resumed their labours in this
field of knowledge—our hearty welcome and good wishes
for their success. And I take the opportunity afforded
me when thus greeting them, to say that it shall ever be
our anxious desire here to give all friendly assistance in
our power to the beginner, to whom everything appertain¬
ing to his profession is, as yet, strange and unknown, as
well as to encourage and help on the more advanced
student, who is
“ Stepping from hindrance on to hindrance,
As a boy crosses, on the stones, the streams.”
But, gentlemen, I at once admit that Introductory
Lectures are at last going out of fashion ; it is no longer
possible to invest them with a pleasing novelty, and elo¬
quence itself would, for the most part, fail to add a fresh
charm to threadbare platitudes more than “decies repetita, .*
Still, I should regard the total abandonment of a time-
honoured custom, which periodically brought the teacher
and student face to face for friendly and familiar talk, as
an event to be regretted, and I would fain hope that the
preliminary discourse which, in former years, used to
usher in with changeless regularity the winter’s work for
the medical pupil, may—though doomed to final extinc¬
tion—yet awhile, with its pleasing accompaniments and
reminiscences, linger amongst us. And if, in coming for¬
ward to address you on this occasion, I distrust my own
powers, and lose confidence in the success of my under¬
taking, I may well be excused when it is remembered
how many great physicians and surgeons, the pride and
ornaments of the profession in this city, have spoken be¬
fore now to applauding audiences of students from the
very place where I stand. But a consciousness of the
generosity of my hearers sustaius me, and I feel em¬
boldened to speak out what I have to say, in howsoever
poor attire I may clothe my thoughts, from a knowledge
that the genial and friendly instincts of those who listen
to me will overlook the shortcomings of the speaker,
out of regard to the good faith and sincerity of his speech.
The study and practice of medicine to which you have
devoted yourselves, gentlemen, is oDe of the noblest and
most unselfish of human occupations upon which the intel¬
lect can be employed. It is, of all professions, that one in
which there never arises any question of class, creed,
country, or race—in which there is never to be found a
taint of distinction, in its beneficent application, regard¬
ing the subjects of its ministrations. Its sole end and
aim is to solace the anguish and relieve the physical pain
of suffering fellow-creatures. It has been Btyled a u God¬
like profession,” and Cicero, in the famous oration, when
pleading to Caesar for Ligarius, exclaims, “ Homines , enim,
ad Deot nulla re propriut accedunt quarn talutem honunibu*
dando .” Whilst adopting as our motto these imperishable
words of the great Roman Orator, we must still never
forget that the province of the medical profession is “ the
physical nature of man, and its object is the preservation
of that physical nature in its proper state, ana its restora¬
tion when it has lost it. It limits itself, by its veiy pro¬
fession, to the health of the body with the higher
science, affecting man’s moral and religious nature, it has
absolutely nothing to do. Employing itself alone, as a
science, about that which relates to the body, it has, in
our day, attained to a very eminent position. The diffi¬
culties which had to be overcome before medicine was
brought to its present proud state were enormous—some¬
thing commensurate with the greatness of the ends which
it aspired to accomplish. And though it has many con¬
quests yet to make, its triumphs have been numerous and
brilliant. I may be permitted to adduce a very few
examples confirmatory of this statement. Medical science
has, tnrough the agency of Edward Jenner, of deathless
fame, furnished us with the knowledge of the protective
power of vaccination, whereby, as has been computed,
three years have been added to the duration of human
life. It has discovered au agent by whose action the
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462 The Medical Press and Circular.
INTRODUCTORY LECTURE.
December % 1846.
living body is rendered insensible to pain during the per¬
formance of the most formidable surgical operation. It
has pointed out to us the means by which the spark of
life, well nigh extinguished in the recently drowned, or
suffocated, may be re-kindled—the lamp of life, as it
were, relit—and the breathing, which had for the time
been stopped, may, under its wise guidance, be re-estab¬
lished. Under its teaching, which occupies itself solely
with the physical nature of man, skill may now be ob¬
tained whereby, when well applied, to cause the lame to
walk, the blind to see—nay, even sometimes the deaf to
hear. And other triumphs, we may be sure, are still in
store for it—for medicine is ever progressive—ever
moving forward—surely and proudly to its goal. Pro¬
bably the question most frequently discussed respecting
the profession of medicine is, “ Is medicine an art
merely ? or is it a science, like mathematics or che¬
mistry V The correct answer I take to be that it par¬
takes somewhat of the properties of both—that it is no
longer exclusively the “ars conjecturalis” which Celsus
declared it to be, out that, in some respects, it nearly ap¬
proaches, and in others has actually attained to, the
proportions of a strict branch of knowledge. Take
chemistry, as a good example of a pure science. When
the chemist intentionally adds a certain reagent to a
known solution, he is aware that a definite, constant, and
infallible decomposition will take place; it always does so.
In like manner, whenever the physician treats a specific
disease with a specific remedy, and that a certain known
result, say the cure of the malady, invariably follows, (and
there are instances of this kind of case to be met with in
the practice of medicine,) his profession obeys, thus far,
the requirements of the definition of a science, and may
be stated to be one to that extent. For, in this supposed
case, an exact knowledge of the injury, and an exact
knowledge of the means whereby it may be cured,
is assumed. As examples, may be cited quirua in
intermittent fever; lemon-juice in sea scurvy; iodide
of potassium in certain specific states of the bony and
fibrous tissues; sulphur in scabies; opium in wakeful¬
ness } and some others of a like nature. But when, as is
ihuch more commonly the case, the physician is not
absolutely certain as to the cause of the malady, and,
moreover, is not acquainted with any one remedy which
will invariably cure the disease, then he can only claim,
on such an occasion as this—where diverse views may be
maintained—the character of an art for his profession.
And this art consists in the skilful use of all the means
at his disposal for arriving at a correct diagnosis of the
disease, and the expert and judicious use of the remedies
known to exercise a beneficial effect upon its progress.
It may well be your high ambition, gentlemen, to en¬
deavour, by discoveries the results of strict investigations,
to take from medicine some of its characters as a mere
art, and add to its claims to be considered a science. The
young recruit who desires to enrol himself in the ranks
of a profession wherein those who have preceded him
have achieved such successes as these just now briefly
indicated, may well feel proud of his adopted art, and
must, naturally, wish to know after what preparation,
and in what mood of mind, he should present himself for
reception as one of its votaries. Obviously the study, at
once so arduous, and so full of interest, of a profession
whose aim is so high, and whose ends are so sublime, as
are those of medicine, should be approached in the man¬
ner best calculated to fit the cultivator of this science for
the elevated position to which he aspires. And, there¬
fore, it is, gentlemen, that I propose now to make a few
observations directly bearing upon this particular pre¬
liminary preparation of the student of medicine.
The subject of the preliminary education of youths in¬
tending to study medicine has lately attracted an unusual
degree of attention, and attempts have been made to
render it more befitting the requirements of so important
a profession than heretofore it has been. The following
remarks express the opinion of a committee on prelimi¬
nary education, who have lately reported to the General
Medical Council:— .
u It is quite apparent that the defects which require to
be remedied in the education of students of medicine are
to be found less in the subjects of professional study than
in provision for that preliminary mental culture which
would enable the student to grasp, with vigour, the various
intricate and complicated sciences on which medicine is
founded, or with which it claims affinity.”
From all sides the opinion is expressed that the student
of medicine should not enter upon the acquisition of the
more strict knowledge of that profession until he had first
fitted himself in some measure for his task, by a far more
extensive and sound general knowledge than heretofore it
was the custom for him to possess. And this appears to
be pre-eminently reasonable and just, for surely it is not
too much to require that the student of medicine should
be equally well-cultivated in all the branches of know¬
ledge, ana have received as liberal an education, as the
lawyer, the diplomatist, the political economist, the
merchant. It cannot be denied that hitherto this has not
been the case, and the fact must be admitted that, up to
;he present time, the student of medicine has entered upon
iis studies from a lower intellectual stand-point than is
issumed by those who attach themselves to the other
irofessions. That a knowledge of the Greek and Latin
Classics should be acquired by the young man who intends
;o study medicine, I hold to be essential. On this account
t follows that an academical education would appear now
;o be indispensably necessary for him, for by this means
he mental faculties are disciplined, the reasoning powers
itrengthened, and a familiarity with the unrivalled bla¬
des of the classical tongues acquired. When we reflect
hat all knowledge formerly was locked up in Greek and
Latin stores ; that all scientific nomenclature is, as yet,
drawn from classic sources ; and that the physician still
directs the remedies that are to assuage the patient's suf¬
ferings in the noble Latin language, we cannot fail to be
Impressed with the conviction, derived from these and
other considerations, that an acquaintance with Latin and
Greek should still be insisted upon in the student of
medicine. But for the future, imdoubtedly, a greater pro¬
minence than ever before prevailed must be given in the
preliminary education of the student of medicine to the
cultivation of the sciences, in order that he may clearly
apprehend the scientific foundation on which alone the
art of healing now depends. In fact, a scientific know¬
ledge may be declared to be now a sine quA non to the
student of medicine. For example: an inspection of
many of the more recent medical works will serve to show
how necessarv to the pupil the knowledge of Elementary
Mathematics is, seeing that it is becoming daily more and
more the custom to express various physiological or patho¬
logical facts by Equations . Moreover, most, if not all, tha
appliances of the art of medicine are derived from,
or dependent upon, the physical sciences. Such are
the microscope , the ophthalmoscope , the endoscope, the
laryngoscope, and many more ; so that, in fact, he who has
a preliminary knowledge—that is, a knowledge acquired
previously to entering upon the strict study of medicine—
of natural history, natural philosophy, chemistry, botany,
will always possess great advantages over the student un¬
acquainted with these subjects, and may fairlv calculate
upon winning thereby high honour in his classes, and
future good position and fame. •
This much I deemed it right to say as to preliminary
education; I would now oner a few remarks upon the
actual commencement by the pupil of the study of medi¬
cine. The first act, according to the new rules, of the
young man about to enter now upon the difficult study of
medicine, is the very important one of placing his name
on the Register of the General Medical CounciL The fcet
of his name being found on the Register shows that he
'-as already passed a satisfactory preliminary exam ination ;
nd it serves, moreover, the highly important purpose of
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Th« Medical Press and Circular.
INTRODUCTORY LECTURE.
December 2,1868. 463
studies. His next act is to attend lectures, and also to
study disease at the bedside, in all its complex and won¬
derful varieties of form, as met with in tne wards of a
medical and surgical hospital. Now, with regard to lec¬
tures, there are many signs that a change respecting their
number and position in the medical curriculum is immi¬
nent. There is a growing tendency to reduce the number
of lectures. For tne most part, ordinary medical lectures
are only useful, and only used, for the purpose of enun¬
ciating the general principles of the subject to which they
relate ; whilst to practical or demonstrative studies, is
committed the working out of the several and varied de¬
tails of these different subjects. This being so, it is easily
conceivable that the lectures required to be attended may
be so numerous as not to leave time enough for the acqui¬
sition of the more practical and more important know-
ledge. And this is actually what is alleged to maintain.
It is said—and to me the statement seems reasonable—
that it is nnjust and objectionable to demand of the
student duplicate certificates for any course of lectures
whatsoever ; and it is proposed that he be no longer re¬
quired to attend more than one course of the same lectures
on the same subject. For the lectures thus suggested to
be reduced, it is recommended to substitute practical
teaching; such, for example, as may be found in the
wards, and in the out-patient department of a hospital.
And here the question rests at present; nothing has been
finally determined upom but we may fully expect that in
the future legislation affecting the professional education
of medical men, some considerable alteration of the pre¬
sent requirements will be made in the direction I have
indicated.
But the final examination is the point of chief interest
to the medical student; in this, as at present conducted,
clinical examinations in medicine and surgery occupy a
new and very important place. These examinations are
real and undoubted tests of knowledge, and in order to
acquit himself creditably in them, tho student will now
require to pay greater attention than ever before to the
observation of disease at the bedside, to the acquisition of
the elements of diagnosis, and of the knowledge of the
correct treatment of disease. Here it is that clinical
teaching in a medical and surgical hospital renders such
invaluable service. The other methods of instruction of
the medical pupil are comparatively elementary. Clinical
teaching is the summing up and practical application
of all knowledge previously acquired at lectures.
Clinical teaching, properly conducted and trustingly
received, is the method by which medicine is best
studied; it is, indeed, that one mode which is at
the same time most calculated to advance the knowledge
of the physician, and most likely to result in tne
amelioration of the patient. This method of instruction
will also impart to the student a sound practical medical
knowledge, and will alone afford him the certain means
of recognising and treating disease when suddenly con¬
fronted with it. This is the kind of knowledge, gentlemen,
which we undertake to communicate to you here, if only
you be willing to receive it; a knowledge which in medi¬
cal and surgical clinical teaching, is like that which ex¬
perimental courses in the sciences afford. The first duty
of the hospital physician or surgeon is to minister to the
suffering poor ; out he has to perform another and scarcely
less important function in advancing—through the means
afforded by his institution—the cause of medical science
and education. This is the view which for years has
governed the medical staff of this hospital in its delations
with the medical scholars who have been in the habit of
attending the practice of the hospital. By the faithful
carrying out of this plan great advantages have resulted to
the public, from the valuable practical teaching communi¬
cated to the pupils by the maty eminent medical men
Who from time to time have been attached to this hospital.
The hospital has long enjoyed a high repute as a school
ox medicine and surgery; its class of students has always
been a numerous, often a large one. A considerable num¬
ber of those former students are now scattered over
different parts of the globe engaged in practice, some of
whom have acquired well-merited distinction and eminent
success, and all of whom apply to the relief of suffering
humanity the sound and practical lessons which they
learned in this institution.
I will not here follow a plan often adopted on occasions
like the present, the habit, namely, of stringing together
a number of suggestions and recommendations to the
pupil as to the mode in which he should conduct his
studies, and the demeanour which he should observe in
his general conduct. Your own instincts, and the exercise
of your reasoning and perceptive powers, will soon make
clear to most of you. how alone, with chance of profit or
credit, the science of medicine is to be wooed and won.
A just appreciation ot the nobility and dignity of the
profession you have selected will canse you to estimate it
correctly, and serve it honestly, even though it may not
bring great wealth or high worldly honour to its cultiva¬
tors. Whilst, therefore, I would express an earnest hope
that yon will act all through your studies as becomes good
Christians and true gentlemen, I do not believe that any
benefit would result from a detailed enumeration of the
several rules of good conduct which the student should
follow, of the dangers which he should shun, of the dis¬
positions with which he should be animated. All advice
respecting inode of work, care of health, cboioe of
companions, is, at this time of your day, old and
stale ; you have, most of you at least, heard it all
before; to the well-disposed and industrious student
its re-incnlcation is unnecessary; whilst on the idle,
the mischievous, or the indifferent, it would fall,
howsoever eloquently or forcibly propounded, with¬
out any effect. You have cast in your lot with those
who cultivate medicine in a high and worthy spirit, and
you propose to practise a profession by which, if followed
honestly and conscientiously, though no great worldly prises
may be grasped, at least signal benefit may be conferred
upon the health and happiness of those patients who
may be entrusted to your care. Would that my weak
words could arouse and confirm in your minds a noble
determination to so hear yourselves as to become truly
worthy of so great, so exalted a profession. For success
in this profession, the possession of certain qualities is
essential. Amongst these are honour, truth, high principle,
energy, industry, quick and cultivated intellect. You
Will require to worn hard, for in order that your future
labours may be fruitful of good, your present work must
be severe and true. Medicine is peculiarly the profession
where emergencies arise. A medical man has, usually, no
time for reflection or for reference to authorities on those
occasions when his services, medical or surgical; ore
called into requisition. Hence it is that he has pre¬
eminently the most urgent need of- a highly cultivated
condition of his various sensed, and a well-ordered state
of his reasoning powers.
sable, if he would carry out efficiently all the behests of
his high calling. I would impress upon you, gentlemen,
and reiterate even to tediousness, tne advice to follow
closely, and to observe well, the cases of sickness to be met
with in the hospital beds. To understand the symptoms
he will observe, and all their significance, the stndent re¬
quires to be a good anatomist; for to him who is well
informed in anatomy the body is, as it were, transparentr
he knows to a nicety the situation of the various internal
organs, hidden though they be from the natural eye. He
who aspires to be a sound practitioner should have first
studied tho natural appearance and healthy action of the
various parts and organs of the body, before he applies
himself to the comprehension of its pathological states.
For it is by a perfect acquaintance with the condition of
the healthy structures that he can best hope to recognise
the deviations induced by disease, I recommend you to
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464 The Medical Press and Circular. ORIGINAL COMMUNICATIONS.
December % IMS.
note the cases of unusual interest that you may meet in the
wards. I by no means desire to advise you to make volu*
minous histories of each patient’s condition. This would
be but to encumber yourselves with a greater load of
material than you could carry. What I inculcate is that
you should make short, clear, and precise “ memoranda 71
of the salient points in the more remarkable cases by way
of records , to be afterwards referred to. This is what I
mean by “ note-taking.” It is a useful custom, approved
both by reason and experience; and the knowledge ac¬
quired by the habit of committing to writing the parti¬
culars of cases, and one’s own ideas, or the remarks of the
teacher upon them, is, you may be well assured, both
valuable and durable.
Finally, I would urge upon every true student to follow,
as often as the opportunity is afforded him, to the dead-
house the bodies of those who have succumbed to disease.
In this way alone can the diagnosis be tested, the history
of the case rendered complete, and an accurate and
durable impression be left, through the unerring eye,
upon the mind.
In conclusion, gentlemen, 1 beg leave to say to you,
before we part, that upon yourselves will mainly depend
the amount of advantage you shall derive from your at¬
tendance on the practice of this hospital. In the pursuit
of one’s medical studies, as in all the concerns of life, the
one true way by which success, prosperity, and fame are
to be obtained is narrow, uninviting, and beset with many
difficulties. You must be prepared to apply your own
reason and thought to the observation and study of the
objects and work you are engaged upon, not relying alto-
? ether or too much upon the teachings of any master.
Jut, above all, you must ever preserve, in a high state of
integrity, the healthy tone of yoor moral nature. As
medical men you may often, in your after career through
life, be the ministers of more than mere corporeal conso¬
lation ; and you may have good reason to know the value
of the “ word in season 77 —
“ Sunt verba et voces quibus hunc lenire dolorem
Possia; et magnarn morbi deponere partem. 77
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Original
ON HEAT-STROKE. 1
By C. Handfield Jones, M.B., Cantab., F.R.S.
(Continued from page 466.)
Our next topic is Etiology. It might be thought that
this admitted of no discussion, regard being had to the
nomenclature, but we soon find that this is not the case.
Mr. Marcus Hill argues with much plausibility against
heat being the sole and essential cause of the malady,
from the very numerous instances in which sjldiers and
labourers have been exposed to extreme heat, solar or
artificial, without suffering in this way. As an instance
he cites a passage from Dr. Henderson’s report, which
states that a body of sappers and soldiers marched 75
miles, from Candahar to Yerhkh, and back again, after
a halt of seven days, enduring intense heat and great
fatigue, without having one man struck down by coup
de soleil . The thermometer during the march stood at
130° ; at Candahar, in the shade, it varied from 100° to
109°. Dr. Maclean also remarks that British sportsmen
in India often pursue their exciting amusement in the
hottest weather, but by using reasonable precautions they
seldom suffer. He is fully alive to the influence exerted
by other concurrent conditions, but says “ that it cannot
be doubted that heat, and speaking generally, heat long
l Read before the Harvelan Society, 16th October, 1S6S.
continued, is the true exciting cause of this formidable
affection. 77 This opinion we can scarcely hesitate to accept;
nevertheless we ought not to leave unnoticed the strong
resemblance which seems to exist between the operation
of heat and malaria, as this has strongly impressed more
than one able observer. Mr. M. Hill writes:—“ It seems
to me, as I have attempted to show, that there is probably
a very close connexion between these attacks of heat-
apoplexy and remittent fever, and there are indeed many
good and substantive reasons for the assumption that it
(heat-apoplexy) depends primarily ujpon a cause similar, if
not identical with that which excites remittent fever."
Mr. Bonnymau, writing nine years later than Mr. Hill,
expresses his belief that further investigation will pro¬
bably show that malarious fevers and heat-apoplexy are
due to the same or to closely allied causes. He regards
heat as the essential cause of the latter (differing herein
from Mr. Hill), but thinks that the same is also often
productive of periodic fevers. The facts which have
arrested the attention of these observers may probably be
accounted for on these grounds. Heat generates malaria
—as a rule, the more heat the more malaria—it cannot
therefore surprise us that the two influences should be
commonly in operation together. Even where the soil is
thoroughly dry, at least on its surface, malaria may be
abundantly generated by heat, so that there are few
places of which one can positively affirm that the gene¬
ration of malaria is impossible. Again, heat, while
generating malaria enables it to act at an advantage by
enfeebling the resisting power of the body. Lastly, it
seems scarcely doubtful that both these agents primarily
affect the nervous system, and that in the same way, and
operate on the other organs in great measure through its
medium. Putting together these facts, it does not appear
to me difficult to account for the views which I have
above noticed.
The following history, cited by Dr. Maclean, may be
referred to here as probably an illustration of the con¬
joined effects of heat and malaria.
On July 8th, 1853, a body of men, 1,200 strong,
marched from Bevarloo to Hassell (about 10 miles).
They started at 8 a.m. Only 500 reached Hassell in the
evening ; 19 perished en route , and a great number in a
state of furious delirium were taken to hospital. It is a
remarkable thing that the temperature on this occasion
did not exceed 91° or 95°. Nothing so disastrous, Dr.
Maclean says, occurred under an Indian sun during the
time of the mutiny. In connection with this, M. Boudin
observes that two well-known Egyptian astronomers,
MM. Mahmoud and Ismail, who were in Brussels on
that day, assured M. Quetelet that they suffered as much
from a temperature of 87-2 in that city as from a tem¬
perature of nearly 122° in Cairo,—a fresh proof of the
necessity of taking count of the qualitv of temperature.
—Reynolds’s “ System of Medicine, 77 voL ii., p. 160.
Over the other causes, whose influence however is often
most important, we may pass more lightly. They are in
general the predisposing causes of fevers and many other
oiseases. Fatigue, foul air, intemperance, unsuitable dress,
have all in various well-known instances manifested their
fatal influence. They bear the same relation to the special
cause, heat, as they do to the special miasm of typhoid or
typhus fever. Certain other conditions of a less definite
kind seem to contribute materially to the destructive effects
of heat. Calm, sultry, oppressive weather appears to be
more pernicious than bright and clear, though perhaps
somewhat hotter. The beneficial effect of a thunderstorm
has been several times observed. In the Report of the
American Army, 1863, it is stated that cases of insola¬
tion were of very common occurrence during op¬
pressively hot weather, the men being heavily laden
with arms, ammunition, rations, Ac., but a heavy
thunderstorm swept across the face of the country,
leaving behind it an invigorating coolness, which banished
sunstroke from the ranks of the army for the rest of the
season. Sir R. Martin alludes to the time when the strong
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S. W. monsoon ceases, and the sky becomes obscured by
a film of dark, heavy, negatively electrified clouds, and
the atmosphere hangs like a weight on the mind atid body
of the soldier, as that which is most favourable to the oc¬
currence of epileptic seizures in India, and I presume of
heatstroke also.
The pathology of this malady, if a single malady it is,
Is surely of exceeding interest So much does it seem to
link itself with many classical forms of morbid action, with
various neuroses, fevers, and inflammatory congestion, that
it is not too much to assert that if a full comprehension of
the modus operttndi of the morbid agents concerned in
heat-stroke could bo obtained, a flood of light would be
shed over the whole field of acute disease. There are but
two theories which seem to call for special notice. One is
that advocated by M. Hill and Bonnyman, to the effect
that the symptoms are the result of the poisonous action of
retained C 02 , the elimination of which by the lungs is ma¬
terially less in hot weather, while In heat-apoplexy not
only do the other emunctories not make up by an increase
in their functions for the deficient respiratory changes, but
they themselves cease also in great measure to perform
their depuratory offices. “ When it is borne in mind how
absolutely necessary for the welfare of the body, and even
for the existence of life, the proper performance of the func¬
tions is, it cannot be matter of surprise that on the inter¬
ruption of function of so many important organs as the
lungs, kidneys, skin, and intestines, disease of a grave
character should result.” He dwells on the coincidence of
the symptoms, as well as of the post-mortem appearances
in slow poisoning by Co a , with those met with in heat-
apoplexy. I feel it difficult to give my assent to this View
except to a limited extent, for the following reasons If
the accumulation of Co 2 in the blood were the cause of the
pulmonary engorgement which is so often met with, the
causal condition being supposed essential, the engorged
state of the lungs ought to be constant too, which we have
seen It is not. It must also be remarked that very com¬
monly the elimination of Co 2 from the system must be
most materially checked, as when one lung is compressed
bv effusion, or both are locked up in asthma ; yet nothing
like heat-stroke results. Slow poisoning by Co* does not
seem capable of accounting for the event in such cases as
Sir R. Martin mentions, where men riding in the open air
fell off their horses vomiting, convulsed, cold, and covered
with profuse clammy sweat; nor, indeed, for .any of the
cases which run an acute course, whether of the cerebral or
cardiac variety. It does not seem easily explained how the
arrest of the elimination of Co a from the lungs (supposing it
the primary alteration) is brought about. If it is in conse
quence of the air being rarefied by the heat, this ought to
affect all alike, and besides ought to be much more felt by
those who ascend high mountains or go up in balloons, who
yet rarely, if ever, suffer as the heat-struck do. This argu¬
ment seems to me to have the more weight because the
elimination of Co a from the blood is essentially a physical
process, not dependent on vito-chemical action os is the
case with most secretions.
While not accepting this theory as giving an adequate
explanation of the primary morbid changes, I think it
nevertheless contains a modicum of truth, and I cannot
doubt that the presence of retained excreta in the blood
must tend materially to lessen the resisting power to mor¬
bific agents, and to intensify their injurious influence.
Blood-poisoning may well occupy a subordinate and secon¬
dary place, though I cannot assign it the first in pathologic
precedency. The theory which seems to me most to accord
with all the facts, and to explain them best, starts from
the undoubted premises—(1), that heat, when it becomes
at all excessive, is enfeebling to nerve power; and (2),
that persons endued with much nerve force resist heat
much better than those more feebly constituted. As to
the influence of heat upon the heart, it is notorious that it
often proves paralysing. Syncope, even fatal, has not un¬
commonly been produced by the hot bath, and the Turkish
^Iso commonly affects novices to some extent in the same
way. That the vaso-motor nerves and their centres art
enfeebled and relaxed by heat cannot be questioned ; it is
a matter of the commonest experience. This seems to be
true of the vaso-raotor nerves of internal organs, as well as
of the external. Were it otherwise, how should diarrhesa
be so common a disorder in hot climates and in hot
weather at the very time when blood is determined most
freely to the cutaneous surface. That motor nerves and
centres are commonly enfeebled by heat is surely proved
by the great difference in our capability for bodily exertion
on a cold and on a hot day. The very same I find true in
my own case, as regards the intellectual centres. At a
time when I have felt extremely brain-feeble, when study
was almost impossible except for a short time, the weather
being mild and damp, a change to dry and cold has re¬
stored ray vigour in a few hours. A man of much larger
calibre tells us something to the same effect. Professor
Tvndal, in his work on the “ Glaciers of the Alps,” says—
“'Whether my exercise be mental or bodily, I am always
most vigorous when cool.” Most of us, I think, during
the recent heats must have been conscious of diminishea
capacity for any mental effort. Mr. M. Hill dwells on
“ the listlessness, lassitude, want of physical energy and of
mental vigour, which so much troubles us in hot weather,
and also the extraordinary tendency to somnolence, which
exhibits itself so frequently in persons recently arrived in
this country (India), and whose brains have been habitu¬
ated to the stimulus of purer blood whilst resident in A
colder climate.”—(“ Indian Annals,” 1855, Oct., p. 221.)
Such instances of failing power are, it is true, but minia¬
ture maladies, yet they seem to me well worth noting as
marking the gradual transition from perfect health to
actual disorder, and showing how even in its lesser de¬
grees, the operation of heat is depressing to the in¬
tellectual centres. It must be remarked that cerebral
enfeeblement does not necessarily show itself in an
approach to stupor, but often by an apparently opposite
state, marked by restlessness, fidgetyness, and more or less
insomnia. A further stage of tnis is delirium, just as a
further degree of the former is coma. The two conditions
of the brain are (as I have tried to show elsewhere) the
exact analogues of the hyperesthesia and numbness which
are common disorders of sensory nerves, and occur under
very much the same circumstances. As I have, in my
Lumleian Lectures, argued that pain is a mode of paralysis
of sensory nerves, it seems to me particularly interesting
to find it present here in association with so many other
pareses. Very much the same view as I take was pro¬
pounded many years ago by Sir Thomas Watson. He re¬
marks, in his Lectures, that he conjectures the affection
termed sunstroke is more akin to the state we call concus¬
sion than to true apoplexy. “It would appear,” he pro¬
ceeds, “ that the sun’s rays act upon the brain like a shock.
The nervous system is suddenly and extensively influenced,
and the heart’s movements arrested as in syncope.” The
apparent suddenness of the seizure in many cases may be
attributed, I believe, to the circumstance that the cause
acts primarily and principally on the nervous system. It
is notorious how often the derangements of this part of our
vital machinery declare themselves by a sudden outbreak.
In my work on “ Functional Nerve Disorders,” I have
offered some evidence to shew that a paralysing shock,
acting through vaso-motor nerves on the capillaries, may
give rise to solution of their walls and extravasation.
Beauprt’s case is so appropriate to our present subject
that I may be excused for repeating it here. The subject
of it was a soldier, previously in perfect health, who was
suddenly stricken down senseless by sunstroke, and died
in six hours. During life, black, dissolved, scorbutic-like
blood flowed from the nares; the cavity of the mouth was
filled with blood, and all tho lining membrane was
chequered with livid, scorbutic-like spots. A litre and
a-half of black blood mixed with urine was drawn off by
the catheter. On dissection, spots of extravasation were
found throughout the whole extent of the mucous lining
of the alimentary canal, as well ns in that of the nas^l foss®
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and of the bladder. Something of this kind probably oc¬
curs in the pulmonary capillaries of those cases where the
lungs are found in a state of intense congestion, with
patches of partial or complete apoplexy, or with sub-pleural
extravasation, or even in the pleural cavity. A less con¬
siderable but similar result of the relaxing effect of heat
was noticed in a voung male, whose perspiration in the
axillae stained his flannel red while he was exposed to tro¬
pical or semi-tropical heat I have little doubt that blood
globules escaped from his capillaries, as they have been
round by the microscope in “bloody sweat.” It does not
appear to me very difficult to understand why the lungs
are so often found intensely congested if we consider that
the blood is in a fluid state, and probably gravitates into
the chest in large amount even after death ; that the
capillary network of the air-cells is extremely close; and,
what is of particular moment, that the vessels are, unlike
any others in the body, almost entirely unsupported by
solid tissue; that their normal texture is more or less
altered by the nervous shock ; and that the mode of death
in many, perhaps most, instances occurs in the way of
coma. These considerations go far to account for the phe¬
nomena ; but I will not affirm that they explain them
completely. To do this, however, does not appear to me
in anywise necessary to my theory, as the condition in
question is by no means constant, and cannot therefore be
regarded as essential. The cerebral hypereemia which is
of very frequent occurrence depends, I conceive, like the
pulmonary, mainly on paralysis of the nerves of its afferent
vessels. The increased temperature is a very important
phenomenon which completely harmonises with the theory
I advocate, and is not observed in intoxication by carbonic
acid when the surface is universally cold and the pulse
slow (G. Bird). Its dependence on the same cause that
we believe to be operative in fever—viz., paralysis of the
sympathetic system—can hardly be questioned, especially
when we note the co-existence of sundry other signs of
vasal paralysis, such as hypersemias and effusions. I can¬
not conclude this part of my subject better than by the
following quotation from a recent communication of Dr.
H. Weber to the Clinical Society. His views appear to
me well substantiated, and have a most interesting con¬
nection with the subject before us. The two cases on
which his communication is founded are summarised as
follows:—
“ Case I.— Summary. —Injury to the neck, with at first
only transitory loss of consciousness ; excessive micturition
ana diarrhoea; contraction of pupils; rapid rise of tem¬
perature, and development of intense pyrexia, with coma ;
death eight hours after injury, with a temperature of
111*2° F. (44° C.). Post-mortem Examination. —Fracture
and dislocation of third, fourth, and fifth cervical vertebrae;
considerable laceration of the corresponding portion of the
spinal marrow; softness and moistness of the brain ; in¬
tense congestion of the lungs; fluidity of the blood in the
diastolic heart; ecchymotic spots under pericardium and
endocardium.
“ Ca8B II,— Summary. —Injury to the neck ; at firsfcjno
perfect loss of consciousness or of motion ; afterwards
coma, with development of intense pyrexia ; death nine¬
teen hours after the accident.
“ Post-mortem. —Fracture and dislocation of the third and
fourth cervical vertebrae, lesion of the corresponding por¬
tion of the spinal marrow ; brain soft; intense congestions
of the lungs ; heart distended with fluid blood ; minute
ecchymotic patches on its surface.
“ The fact taught by these cases, that the most intense
pyrexia can be developed by lesion of certain portions of
the nerve centres alone, without the previous existence
of any morbid poison, or any other change in the blood, is
in favour of the view that the phenomena of fever or
pyrexia are referable to nerve influence, that they are in
tact nerve symptoms, and that the blood changes insepar¬
able from fever are, to a great degree, effected by an
altered nerve action, even in those processes where the
admixture of a poison to the blood is the first link in the
chain of morbid conditions.
“ The great analogy in the symptoms during life, and in
the post-mortem appearances between these cases and cases
of heat-stroke, as described by Longmore, Maclean, and
others, and also the cases of rapid death from rheumatic
fever and other diseases, accompanied by excessive ante¬
mortem rise of temperature, leads us to the inference that
the vital condition of the nerve-centres is the same in all
of them, and if it were allowed to use hypothetical expres¬
sions, we would designate this condition as paralysis of
certain portions of the nerve centres, and especially of
the regulating centre, or centres of the chemical processes.
The observations before us are already sufficient to show
that this paralysis may be produced in various ways, as
by exhaustion, owing to continued overstraining of
the regulatory apparatuses of temperature in protracted
exposure to high temperature under unfavourable cir¬
cumstances (ordinary heat-stroke), or in acute diseases
accompanied by high degrees of pyrexia, by pain, by sleep¬
lessness, convulsions, (acute rheumatism, tetanus, &c.) ; by
mechanical injury to certain parts of the nerve centres, as in
the cases just related; ana it is not improbable that
severe shock to the nervous system alone, mechanical or
physical, may, under peculiar circumstances, suffice to pro¬
duce the same effect.”
These interesting observations of Dr. Weber cannot foil
to remind us that it has been found necessary, by expe¬
rience, to protect the upper part of the spine from the heat
as much as the head, ana that in some cases of heat-stroke
the sufferers have felt as if they had received a blow oil
this part. We also see that intense congestion of the
lungs and ecchymotic spots are produced uDder the very
conditions which I oonoeive to exist in heat-stroke ; viz.,
prostration of nerve power and elevated temperature
without any poison being present in the blood.
The great dryness of the skin is probably produced in
the same way as in the hot stage of fever (however that
may be).; it is not of constant occurrence, and is met with
in cases of long-continued exposure to heat where no
serious malady has ever oocurrea, as in the Bengal pilots
mentioned by Sir R. Martin, p. 47, and p. 392.
Were any further evidenoe necessary as to the essential
concernment of the nervous system in heat-stroke, it
would be found, I think, in consideration of the chronic
seauel®.
While I cannot but believe that the primary nerve dis¬
order in heat-stroke is of a functional kind, and that all
the grave symptoms which ensue may be independent of
any structural lesion(at least any demonstrable), I am auite
ready to admit that secondary effusion of serum or blood
within the cranium, or obstruction of the pulmonary blood
vessels, may contribute more or less to the gravity of the
disorder in many instances, and in fatal ones may even
prove the principal cause of death.
I must now ask your attention for a few minutes to
what may be termed the associated pathology of host-
stroke, i.e.y to the affinities which the disorder manifests
to others which differ from it considerably in outside show.
Sir H. Holland thinks that we have not yet drawn
sufficiently from this source of knowledge. “ It is pro¬
bable,” he continues, “ that we may hereafter learn from it
the virtual identity of many diseases hitherto placed
asunder by distinctions which have foundation only in sab-
ordinate symptoms, thereby disguising from us what is
most important both in pathology and practice.” Dr.
Pirne, in his recent excellent little work on “flay
Asthma,” has well stated and supported the view that
many cases which are often imagined to be dependent on
odorous emanations, are really the results soLelv of in¬
creased temperature, and he proposes for such the name
“ summer fever f I am convinced that he is right. During
three or four years successively I have suffered in my own
person with a more or less severe catarrhal fever, which
commences about the middle of July, and lasts about a
month. The symptoms are great debility and prostration,
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anorexia, inability for brain work, or almost any other,
cutaneous hyperesthesia, so that I shrink from the summer
breeze as too chilling, and pretty severe nasal and pharyn¬
geal catarrh, with expectoration of heavy, ill-looking
mueo-pus. I have not the least asthmatic tendency, nor am
I the least intolerant of hay or other odorous substances.
On one occasion, after eighteen or twenty days of the
catarrhal symptoms, I got smart rigors, followed by
pyrexia ana sweating, with very great prostration. Tonics
are beneficial, and all such means as recreate nerve-
power. I have no doubt of the intimate connexion of the
disorder with atmospheric heat acting on a not over-robust
system. - My friend. Dr. Palmer, learnt from an intelligent
practitioner, whom he met in Yorkshire this year, that he
often had cases of slight sunstroke in children, in whom,
after a semi-comatose condition, with a feeble pulse and
cool skin, had lasted for some hours, reaction usually fol¬
lowed, and was succeeded frequently by catarrhal symp¬
toms, or sore throat, &c. Two or three years ago an
elderly lady, an habitual bronchitic, was returning to her
home in London on a very hot day, and sat during a
journey of more than 100 miles in a first-class carriage ex¬
posed to the heat of the sun’s rays, which distressed her a
good deal. When she reached her house she was in a state
of fever, and three days later I was called to attend her in a
dangerous condition. The usually moderate bronchial catarrh
was increased to great intensity; she suffered very great
dyspnoea, and was very prostrate. So peat was the nerve
prostration that when she recovered she told me that she
had been quite unconscious of all that had been going on
around her, at least she remembered nothing about it ;
moreover, for weeks after, she had great difficulty in
writing, she could not recollect the right words, nor remem¬
ber how to spell them correctly. In this instance we have
nerve paresis and inflammatory congestion as results of
heat, and it seems only reasonable to believe that the latter
was dependent on the former. I have already alluded to
the probability that most cases of summer diarrhoea are
produced in the same way. So it was, I think, in the
following instance, which is by no means uncommon, and
often runs into English cholera. J. W., set. forty-one, a
robust, strong, perfectly temperate labourer, was taken ill
July 8th of this year, about two p.m., with diarrhoea and sevei e
flatulence, and great pain all over the body. When I saw
him about four p.m. he could hardly speak at all, and was
eructing continually. His pulse was 69, weak, skin oool
and damp. He was so ill that he was taken into the wards.
With ether, sal volatile, and opium his disorder rapidly
subsided. It did not appear that he had taken anything
to disagree with him. My reading of the case was heat
affection of the solar plexus conditionating pain in the
related plexuses and paralysis of the vessels of the
mucous surface of the intestine. It will be remembered
that in Dr. Palmer’s case of heat-stroke there was unilateral
pain and catarrhal flux on the same side. In India Sir R.
Martin says we are familiar with dysenteries, hepatic in¬
flammations and congestions as acute sequelae to sun-stroke.
Is not the pathognesis of these such as I have above sug¬
gested, viz. paresis of vaso-motor nerves determining
hyperemia, which in states of debility passes into actual
inflammation.
Another malady which seems to be allied to heat-stroke
is roseola aestiva, of which I have seen several instances.
In one particularly the patient’s surface was very exten¬
sively red, and the hyperemia issued in a copious serous
discharge ; in fact, he had an external diarrhoea. In this
case there were no notable symptoms of cerebral affection,
the vaso-motor nerves of the surface were alone involved;
but in Cazenave’s description mention is made of shiverings,
depression, headache, sometimes agitation, slight delirium,
and even convulsions, with hot skin, thirst, anorexia, and
constipation, or diarrhoea ; so that it is evident that the
nervous derangement may be very extensive. Sore throat
is often present, and it is remarkable that, as Dr. Broadbent
states, it has been remarkably prevalent this hot summer.
JSczema is sometimes evidently the result of heat (eczema
solare). Some time ago I saw a young officer who had re*
cently been sent home as an invalid from a tropical country
in consequence of an intractable eczema of the face. Since
his arrival at home considerable improvement had taken
place. His general health was good, although he had suf¬
fered from ague, and there was no other apparent cause for
the malady tnan the injurious influences to which he had
been exposed. The skin of his face was unduly red, and
on the least excitement of the circulation, or exposure to
heat, it became very flushed. Serous effusion occasionally
took place even at home—in the tropics it had been copious.
His cutaneous vessels and their nerves (in the face) were
evidently toneless and feeble.
My remarks on treatment must be very brief. The
essential indications are to restore nervous power, to sus¬
tain the action of the heart, and to relieve congestions.
The cold douche has approved itself as a useful remedy,
and an Indian officer has informed me that it is best ap¬
plied to the epigastrium, which is painfully hot Drs.
Levick and Darrach, in America, have found it a successful
proceeding to rub the surface of the body with pieces of
ice. Out of seven cases of severe sunstroke, which were
treated in this way, six recovered, and among them two
whose temperature in the axilla had risen to 109°. The
one who died was a man of sixty-five. In one of these
cases the rubbing with the ice had to be continued for
one hour and-a-quarter before the patient began to recover
his consciousness. Out of twelve other cases admitted
previously to these, but in the same month, and treated
with stimulants, cold affusions, or the full bath, seven died.
Useful as cold douching may be in many cases, I think it
should not be employed indiscriminately. When the action
of the heart was very feeble, there would be danger of its
being arrested altogether. Brown-S4quard warns us that
death may be produced in this way. He has seen, he
says, asphyxiated puppies, whose hearts were still beating
fifteen or twenty times in a minute, killed at once by being
dipped into cold water, the heart stopping by a reflex
action. In the convulsive form of the malady, attended
with extreme nervous irritability, Dr. Barclay says the
douche is inadmissible, from the agony it occasions,
and in such he has found chloroform inhalation useful,
sometimes availing even to the preservation of life.
Recently, I believe the use of the warm bath has been re¬
commended, and I can quite understand that in such cases
as those last mentioned it might be serviceable. Mr.
Wrench has lately (British Medical Journal , August 15,
1868) spoken very highly of the use of opium in cases of
predominant cerebral affection tending to issue in coma o t
convulsions, and preceded by sleeplessness. He uses it as
a calmative, aiming especially at procuring sleep. I think,
however, that it might be given with advantage in small
repeated doses, combined with ether or ammonia in cases
of a mixed kind, where, together with more or less col¬
lapse, there were signs of cerebral exhaustion and irrita¬
bility. Effervescing ammonia ted saline, with excess of
ammonia, would probably be a good form, and the opium
might either be added to it, or given in combination with
camphor, in a pill. Sir R. Martin advocates this practice,
comDined, in suitable cases, with local blood-letting. In
those instances where the cerebral hyperesthesia persists
for several days, attended with more or less prostration,
bromide of potassium will probably render great service.
At the same time, wine or other restoratives may be ad¬
ministered. In all cases, absolute quiet, repose of mind
and body, and coolness of the atmosphere, must be en¬
sured as far as possible. Purgatives should not be neg¬
lected ; one mercurial cholagogue dose at least should be
given as soon as it may be safe, and may be repeated if it
seem advisable. Much, of course, must depend on the
constitution with which we have to do. A weakly, anaemic
woman, and a robust, full-blooded man, are not, of course,
to be dealt with alike. Many of the worst cases will pro¬
bably prove fatal, do what we may ; the nervous energy is
too deeply sunk to render recovery possible. Two remedies
may, however, be named which would be worth trial, in
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ORIGINAL COMMUNICATIONS.
December 3,1888.
addition to those already noticed. Where the chief peril
was from asthenia, the pulse evidently foiling, I should
give- tinct. digitalis in quickly repeated doses of IT^x,
which might be injected subcutaneously if the patient
were unable to swallow. This drug has been found by
t)r. Murray of great use in typhus fever in sustaining the
heart’s action, and other testimony is not wanting to show
that its primary action on the heart is stimulating. Where,
on the other hand, the peril was from coma, besides the
arousing application of sinapisms or blisters to the nucha,
I should administer strychnia, a drug which I am sure acts
often with good effect in recreating depressed nerve power,
and approves itself in my hands quite as much a tonic to
the brain as to the cord. Having regard to the defibri-
nised condition of the blood, it seems not improbable that
acids, vegetable or mineral, might be beneficial. Lemon-
juice, or nitric acid, diluted, would form agreeable drinks.
Dr. T. G. Glover, writing of the use of dilute sulphuric
acid in hot weather, says it is often extremely toning in its
effects. Together with half a glass of sherry daily it put a
stop to attacks of semi-syncope in a boy eight years old.
With respect to blood-letting, I am disposed to think
tliat, timely employed (on which Sir R. Martin justly in¬
sists that its success depends), it may occasionally be ser¬
viceable, either in the form of v. s. to relieve an oppressed
right heart, or as a local depletion to lessen congestion of
the brain. In the discussion which ensued, one of the
Speakers, Dr. T. Ballard, stated that he had in several in¬
stances found the application of leeches to the head very
beneficial.
In the management of the sequela) we must bear in
mind that the great object is to restore the tone of the
nervous system. This will in most cases require great
patience and perseverance on the part of the patient and
his adviser. Relapses must be expected, and we must be
satisfied if we gain ground decidedly, though slowly. A
bracing air, sufficient rest, freedom from anxiety, interest¬
ing occupation, varied with plenty of out-door recreation,
and a tolerably generous diet, are almost essential. Ex¬
posure to a hot sun should be avoided as much .as may be,
as well as hot rooms, late hours, dissipation, and so-called
gay life. As medicines, cod-liver oil, strychnia, quinine,
iron, valerianates of zinc, iron, and ammonia, nitromuriatic
and sulphuric acid, hypophosphites may be mentioned as
likely to render good service. The doses of cod-liver oil
need not be large, £ij. a day may suffice. Small doses of
opium with iron, or quinine, or camphor, Indian hemp,
tannin, and nitrate of silver, may in particular instances be
employed very beneficially. The two latter are appropriate
to conditions where the stronger tonics cannot be borne.
Nitrate of silver is, I think, really useful in vertigo and
certain other cerebral disorders, and if given in Jgr. doses,
ter die , for three weeks at a time with sufficiently long in¬
tervals, there need be little fear of discoloration. The cold
douche to the head once or twice a day should not be for¬
gotten. In many instances I have no doubt residence at
a prudently conducted water cure establishment, such as
Dr. Grindrod’s at Malvern, would be beneficial.
I subjoin a tabular representation of the causal relation
which I conceive to exist between heat and the various
morbid phenomena, which are attributable to it. For a
tolerably full account of the true nature of pain, hyper-
jesthesia, and sundry other disorders of sensation, motion,
and consciousness, I refer to ray third Lumleian Lecture,
Medical Times and Oazett Vol. II., 1865.
Heat causes nerve weakness.
Serve Weakness causes hyper-excitability or prostration.
Either or both of these conditions may be met with in
the same person, one centre may be hyper-excitable,
another prostrated, both alike being enfeebled.
Ilyper-excitability appears as delirium, mania, anxiety,
insomnia, tinnitus aurium, quasi-hysteria, convulsions,
palpitation, formication, dryness of surface.
Prostration appears as coma, drowsiness, giddiness, inca¬
pacity for mental exertion or attention to business,
impairment of sight and hearing, numbness, pain,
paralysis, syncope, fever, erytliemata, local hyper-
aemias, extravasations, diarrhoea, incontinence of urine.
The above symptoms, or modifications of them, variously
grouped, are often combined with more or less hyperaemia
of the head, but are not dependent on it, at least in the
majority of cases. This is a capital point.
In concluding this tedious paper, which I would have
made briefer had I had more time, I have only to add,
that in this malady, as in all others, routine treatment is
wholly objectionable, and that every case has its special
peculiarities, which must be regarded, and the remedies
adjusted to their requirements. We start with a causal
diagnosis , and there can be no question that the of>eration
of the same cause acts on different individuals so as to pro¬
duce very various results. The mode of operation is indeed
the same in all, but the phenomena are different, because
the same nervous centres do not suffer in all, nor do they
suffer exactly alike, nor to the same relative extent Hence
the morbid picture must be continually changing. Sound
principles or action remain, however, sure guides.
EXPERIENCES OF A REGIMENTAL SURGEON
IN INDIA.
By C. A. GORDON, M. D., C.B.,
Deputy Inspector-General of Hospitals.
(Continued from page 430.)
Captain Cator, 10th Foot, was, on 14th March, 1858,
during the operations connected with the capture of Luck¬
now, wounded in the left arm by a musket bullet, which
entered about the middle of the limb, between the biceps
and the humerus, passed backwards, and making its escape
posteriorly by a very large and ragged opening, the hu¬
merus being fractured in its progress. When seen, imme¬
diately on the receipt of the wound, the front opening was
wide; the haemorrhage from the posterior was considerable;
sensation and motion were destroyed in the ring and little
finger, and partially so in the middle one.
This officer having been so unfortunate as to have had
tho power of flexing the right elbow destroyed by a wound
received in the Crimea, it was deemed advisable to hold
a consultation on his case, the result of which was that, in
accordance with the principles laid down by Guthrie, an
attempt should be made to save the limb. On the 16th,
irritative fever set in, and was treated by diaphoretics;
cold water dressing was applied to the wound, and he was
transferred to the field hospital, where the wound ultimately
healed ; the fracture in the humerus reunited, but the loss
of power and sensation in the fingers remained permanently
destroyed.
Shoulder. —Taylor, 37th Foot, received a bullet which
entered near the acromial end of the right scapula, and
was cut out posteriorly opposite the head of the humerus.
The part of the scapula through which the missile passed
was comminuted ; but no spicula came away at the time.
The discharge became very fetid, and partial sloughing
occurred of the parts around the posterior opening. Modi
pain was complained of along the whole arm, and consi¬
derable swelling of the hand supervened: Slight irritative
fever made its appearance, but was soon checked by febri¬
fuges. The local applications consisted only of poultices
and cold water dressing, used alternatively as each seemed
to be indicated; afterwards solution of lead and opium
during the day; ointment of the same at night. Thirty
days after admission, and thirty-one after the receipt of
the wound, two small spiculae came away from the posterior
wound, after a night of unusual suffering along the median
nerve by the patient. Other small pieces, evidently of
the scapula, subsequently came away, and the opening of
exit was then the first to heal. The history of the csss
contains a remark to the effect that the attack of pyrexia,
under which the patient laboured, seems to have been in¬
duced by the tainted atmosphere of the hospital. It would
seem, however, that on its being subdued recovery pro-
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ORIGINAL COMMUNICATIONS.
December 2,1868 . 469
gressed favourably; the man, although deprived of the use the extensive nature of the injury. The greater part of
of the ami, retained good health, and at the expiration of the wound granulated steadily, although at one point the
eighty-two days from the injury was invalided. dead bone could still be seen. By the 16th of September
1(7 * eck.— Swift, 10 th Foot, was wounded by a he had taken on flesh, and was walking about the ward,
bullet which entered at the root of the neck on the left It was then found that suppuration had taken place under
side, passed backwards and downwards, and escaped at the scalp, in a direction towards the occiput. The pus was
the left side of the spinal column, having traversea close then regularly pressed up towards the wound, where it
to the outside of the stemo-inastoid muscle, through the escaped, and poultices applied. On the 11 th October, a
trapezius, and escaping just above the superior angle of the counter opening had, however, to be made. The dead
scapula. He was reported to have expectorated or vomited portion of bone gradually became loosened ; and on 6 th
about a pint of blood, and for some days afterwards to December, a ragged piece, consisting of both tables, two
have spat up small quantities. Extensive ecchymosis inches and a-halflong and one inch broad, was extracted,
occurred around the wound, but there was no constitutional the long axis being across the occiput in the track of the
disturbance. The progress of the case under cold water wound.
dressing was satisfactory; both wounds healed favourably, The patient did well, and was sent to England with the
that of ingress first. Some stiffness of the neck remained; invalids of the season.
but as hospital gangrene had appeared in hospital, he was Allen, 10 th Foot, was, at Sooltanpore, struck by a grape-
sent to barracks, and made a complete recovery. shot at the junction of the occipital with the two parietal
the Face. —Nolan, 10th Foot, was wounded by a bones, the injury chiefly affecting the left side of the head,
bullet in the left cheek. It entered directly over the left A portion of bone nearly two inches square was depressed
stemo-mastoid, injured slightly the lower jaw, and de- by the missile as it glanced off, and the man when picked
stroyed several of the posterior teeth; then lodged and up laboured under all the ordinary symptoms of compressed
was cut out behind the parotid duct. Extensive inflam- brain. No trephine was at the time available, but by
raation and suppuration followed; the matter burrowed means of a free incision through the scalp, and a small
down the neck, but was given egress by a counter opening, saw, a triangular piece of skull was removed, so as to admit
Seventeen days after the wound small spiculae of bone from an elevator ; and thus, within half an hour of the wound
the injured jaw came away; others continued to do so being inflicted, the depressed and comminuted portions
for some time afterwards. Under cold water applications, were removed. The scalp was drawn together, and cold
and then simple dressing, the case progressed favourably, water dressing applied. On the succeeding day he spoke,
The wound of entrance was the first to heal; the others and manifested other signs of returning sensibility. The
granulated favourably, and on the sixty-fifth day of the pupils were natural as to size, but contracted sluggishly,
injury he returned to barracks. ana there was ptosis of the right eyelid. On the 25tn,
O'Neal, 37th Foot, was wounded by a bullet which after an unusually long march, he was found evidently
entered at the lower part of the back of the head, below worse. He had during the night and earlier part of the
and close to the right mastoid process, passed directly for- day been picking the bedclothes in his dooly, but when
wards, knocking out the two posterior molar teeth of the seen towards afternoon lay supine. There was no stertor ;
upper iaw, and lodged in the mouth, from which, together pulse was small and rapid; skin moist, and of natural tem-
with the teeth, it was spat out. The man was stunned by perature ; the features contracted. On the following day
the shot. He fell, and on attempting to rise, fell again he died, and then examination revealed the fact that the
several times before assistance reached him. On being fracture had extended through the,parietal bone down
brought to hospital, cold water dressing was applied, and towards the base of the skull. The exterior of the dura
from that time forward not a bad symptom appeared. In mater was covered with clotted matter, and softened. The
twenty-two days after the receipt of the wound that in the surface of the brain within the arachnoid, over the occipital
mouth had healed; on the 27th of the same month that of region, was covered with effused blood, and in some parts
entrance had closed, and on the thirty-first day of the in- the cortical part had already become softened,
jury he returned to duty. No other application than cold I. Of the Chest.— Superficial.— Andrews, 37 th Foot, was
water, and then simple dressing, is noted as having been struck by a bullet immediately below the right nipple,
used ; and no medicine was given internally. The missile passed backwards, and escaped at tLe angle of
H.—Of the Shull. —Giffard, 37th Foot, was, on 29th the fifth rib without inflicting a fracture. The “ shock”
July, 1857, shot in the head. The bullet struck over the of the injury was severe. The seat of the wound became
apex of the lambdoid suture, made in the scalp a ragged, very irritable, and considerable constitutional irritation
irregular opening of two inches and a-half in length, laying supervened. Poultices to the wound, with Dover's powder,
bare and denuding the outer table of periosteum, but appa- quinine, and cinchona bark internally, subdued those
rently causing no fracture. From that date to 7 th August symptoms ; simple dressing and lead lotion were alter-
the man complained of inability to sleep, but had no con- nately applied to the wounds, and recovery was completed
stitutional disturbance. A profuse discharge occurred, iu fifty-one days.
and severe pain in the wound was from time to time com- Complicated. —Cleary, 10 th Foot, was, during the action
plained of. Up to the 11 th cold water dressing was alone at Sooltanpore, struck oy a grape-shot over the region of the
applied. On that day leeches were applied around the seat breast. The missile, having penetrated the skin, slipped
of injury, inflammation having run somewhat high, and down to near the ensiform cartilage of the sternum, from
being only for the time relieved by them. During the which point it was extracted by incision. Immediately on
few ensuing days he was drowsy; the pulse laborious; the receiving the wound, the man expectorated blood to a con-
pupils dilated. On the 16th maggots appeared in the siderable extent ; but it did not appear that any rib was
wound, but were destroyed by the application of turpen- fractured. At the time he was treated by tartrate of anti-
tine. Calomel, in combination with James's powder or mony internally, and by application of cold water to the
Dover's powder, was given at short intervals, and in small wound. On the following day, his symptoms were favour-
doses ; poultices, cold water, and simple dressing being able; expectoration had decreased ; he was therefore
applied as indicated. On the 20 th, the first decided im- ordered calomel and opium to guard against probable
provement was apparent, the inflammation around the inflammation, and the treatment was continued for some
wound having moderated. On the 27th, his expression days. On the tenth after receiving the injury, he suffered
was much improved ; he was cool ; wound discharging severely from pain at a point a little lower than that where
freely ,* the pus healthy ; a piece of dead bone was percep- the bullet had been extracted. There was much oppression
tibie at the bottom of the wound ; and for the first time a of breathing ; pulse was small and quick ; expectoration
desire for food was expressed. not copious, clear and [frothy. He was at this time dis-
The notes of the case record that from this date a steady tinctly under the influence of the calomel that had been
improvement took place, it being remarkable, considering administered. On the thirteenth day, while the regiment
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was on the march, profuse bleeding suddenly took place
from the wound, which was accordingly enlarged with a
view to secure any arterial opening that might be found ;
none was discovered, but it was then found that the
sternal portion of the seventh rib had been fractured.
Pressure and styptic applications were employed, but for
some days the haemorrhage continued to recur. A consul¬
tation was held, but the point could not be determined
whether the bleeding proceeded from the internal mam¬
mary or from the intercostal artery. The alternative of
passing a ligature round the portion of the rib, in the hope
of thus securing the latter, was had recourse to ; but as
our after movements necessitated his transfer to a field
hospital, the subsequent history of the case is not forth¬
coming. Notwithstanding that it is incomplete, however,
it is deemed interesting in its way, as illustrating a particu¬
lar kind of injury met with on service ; and it may be ob¬
served that somewhat similar ones are related in Ranking's
Half-Yearly Abstract to December, 1856, and in the
Edinburgh Medical Journal for May, 1856. Guthrie, in
his Commentaries, page 519, edition of 1855, acknowledges
the great difficulty there is in treating wounds of this
nature.
K. —Through the Sacrum. —Walker, 10th Foot, while
swimming a nullah at Arrah, received a gunshot wound.
The bullet entered the centre of the sacrum ; and on his
being brought to hospital two days afterwards, the left
lower extremity was found to be paralysed, and he unable
to void urine. A large opening indicated the entrance of
-he bullet; the finger discovered the sacrum bare and
rough, but the further progress of the missile could not be
traced There seemed at first to be very little constitutional
disturbance, but during the night after his admission he
sank into a low state, requiring the very free administra¬
tion of stimulants. This condition was but temporary,
however; he rallied, and up to the thirteenth day after
the injury he seemed remarkably well. From that time,
however, the powers gradually succumbed; a profuse fetid
discharge toot place from the wound; he became ema¬
ciated; bed-sores appeared on the prominent parts; the
penis, from having been so long a time resting in the
urinal, became excoriated, and existence became a burthen.
Yet it was not imtil the thirty-third day after the injury
that he died. Post-mortem examination revealed the fact
that the anterior part of the sacrum was shattered and
comminuted in a frightful manner. The bullet had formed
a canal for itself, and rested on the body of the fourth
lumbar vertebra in front. The lumbar muscles were sepa¬
rated from their attachments by quantities of suppuration;
and the origin of the vesical twigs of the lumbar plexus
being destroyed accounted for the paralysis of the viscus.
L. — Penetrating the Intestine. —Macartney, 10th Foot,
was, on 12th May, 1858, wounded in action at Chitowrah.
The bullet made its entrance between the 10th and 11th
ribs, in a line above the anterior spine of the ilium, and
seems to have passed downwards and backwards, escaping
an inch and a-half to the left of the spinous processes of
the first and second lumbar vertebrae, close to the crest of
the ilium. At the same time he received a wound from a
second bullet, which, entering on the outer aspect of the
left arm about its middle, passed inwards completely
through it. He was struck down insensible by these in¬
juries, remained in that state some time, and when brought
to hospital was suffering from a considerable degree of
“ shock.” On the following day, symptoms of peritonitis
set in, attended by severe vomiting of bilious matter, and
the contents of the large intestine were discovered to be
escaping from the wound posteriorly. On the 14th, these
symptoms had already begun to moderate, and some faeces
were voided per anum. On the morning of the 15th, there
was a very free faecal discharge from the posterior wound;
considerable tympanitis; skin moist, and of natural tempe¬
rature ; face free from anxiety; pulse soft, small, and slow.
He complained much of thirst, vomited much bile, but
was not restless. Tongue coated with bilious coloured fur;
bowels not moved naturally since the previous day, but
very profuse faecal discha
dark, and offensive. He had from the first occurrence of
peritonitis been treated with mercurials. The gums were
now tender; he had, however, calomel in quarter-grain-
doses every three hours, the diet being restricted to tea
and bread. The notes of the case, taken at the time, state
that it was remarkable how little he suffered. All the
symptoms of peritonitis had disappeared by the 19th, but
he still continued ‘to vomit bilious matter. The greater
part of the faeces were voided by the wound, but some also
by the natural passage. The skin and pulse were natural
On the 21st he was moved from the field to Arrah, where
a temporary hospital had been established; and when
again seen, eight days afterwards, the faeces had ceased to
flow from the posterior opening, and the anterior was heal¬
ing favourably. From this time till the 19th of June the
progress of the case was in all respects favourable. By
that time the anterior opening had completely healed; the
posterior remained a granulating surface. He was then
carried with the regiment towards Dinapore, a distance of
about twenty-five miles, and which he reached on the 20th
Soon afterwards he was attacked with slight pyrexia, which
however was speedily subdued under treatment ; the state
of the bowels continued variable, but they were generally
relaxed. On the 21st July, the posterior opening, which
had for some days been healed, presented an ulcerated
spot, and on the same afternoon some faeces came away;
there was no pyrexia; no pain was complained of, and the
state of the bowels was natural. He seems to have re¬
mained in much the same state till towards the end of
September, when the mornings and evenings having begun
to become slightly cool, his health began to improve. The
posterior wound at times gave exit to the contents of the
bowel, and he was at times troubled with pain in the ab¬
domen. On the 11th October, he proceeded as an invalid
en route to England.
Ounshot Wound of Uncertain Nature .—It is scarcely to
be anticipated that a wound inflicted by a bullet should in
any case l>e so dubious in its nature as to set diagnosis at
defiance. All writers on injuries of this nature relate in¬
stances in which the course of bullets has been extremely
eccentric ; but in that about to be related, although the
course of the missile was to a certain extent sufficiently
apparent, the actual degree of injury, and all the tissues
affected by it, remained undiscovered!
Teehan, 10th Foot, was, at Lucknow, wounded by a
bullet in the loins. The missile entered a little to the
right of the first lumbar vertebra, but its course could not
be traced, although a free opening was made with that
view; the right lower extremity was powerless as regards
motion, but sensation was unaffected. After a few days
the slough which formed in the wound separated, leaving
a dean opening, and then there seemed reason to believe
that the bullet had not lodged, as was at first suspected.
He had to be sent to a field hospital afterwards, owing to
the regiment having to pursue the rebels, and when, five
months afterwards, he rejoined it was found that although
the power over the limb was considerably restored, and
the wound had completely healed, he was totally unfit for
the duties of a soldier, and he was accordingly invalided.
Bums .—Some general remarks having already been
made on this class of injuries os met with on service in
India, I submit an illustrative case.
Akers, whose name has been already mentioned, was, at
Lucknow, blown up by the explosion of gunpowder. When
brought to the hospital tents shortly after the aocident, the
cuticle was found destroyed over the whole face and front of
the neck, the eyes being uninjured save that they were con¬
siderably suffused with blood. The cuticle of the hands and
wrists hvmg in shreds, curled up and shrivelled; that of the
feet, entire lower extremities, nates, genitals, and pubis was
in a similar state—thus much more than one-third of his en¬
tire surface was implicated. When first seen in hospital
he was shivering, and complained of feeling cold; the poke
was small, and he was suffering from intense pais. The
injured parts were dressed with Canon oO, and a large
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ORIGINAL COMMUNICATIONS.
December 2,1868. 471
dose of brandy with opium was administered. It was
soon afterwards discovered that the parts where the in¬
juries were most extensive were completely destitute of
sensation ; those less so being stitl intensely painful.
Great irritability of the stomach and continual vomiting
speedily set in, and continued till he died, exhausted, on
the fourth day after receiving his injuries.
This is a type of other cases of severe bum that came
under observation, in all of which the persons injured
suffered from sensation of great cold ; some had intense
thirst, others expressed a desire to sleep; but all were
speedily seized with frequent vomiting and great irrita¬
bility of the stomach.
Hospital Gangrene .—The following cases rather illustrate
the measures by which this terrible malady may be checked
at its onset than its own destructive progress ; they are
however, it is hoped, not the less interesting on this
account.
Acres, 10th Foot, was wounded by a bullet which passed
through the right thigh, from without inwards, entering
about the midale and escaping near Hunter’s canal, but
apparently not penetrating the limb below the fascia.
Little constitutional disturbance occurred, and for fifteen
days after the receipt of the wound it progressed favourably
under the application of cold water and poultices alternately.
From that time his state was reported as not having been
so satisfactory, and the wound not to have continued to
progress. On the twenty-third day after the injury he
was found restless, feverish, and irritable. The openings
of entrance and exit had become deep, cupped, and pain¬
ful ; the neighbouring parts were red, swollen, and very
irritable ; a dear serous liquid oozed from both wounds.
Opium was now applied to the wounds, calomel in two-
grain doses combined with one grain of. opium was ad¬
ministered every three hours ; the bedding was changed ;
the vicinity of the bed in which he lay thoroughly
cleaned and whitewashed. In two days the characters of
the sores had undergone a favourable change; the local
and constitutional symptoms had given way; the phagedenic
action was checked at its commencement. On the twenty-
ninth day the administration of calomel and opium was
omitted ; an ointment of acetate of lead and opium was
applied to the sores, the appearance of which w r as that of
tardy ulcers. Under great attention to diet, cleanliness,
nourishing food, and stimulating applications, he gradually
recovered, to be subsequently killed by a bum at
Lucknow.
Kenny, 10th Foot, was shot by a bullet, which passed
through and through the muscular tissues of the middle
of the thigh without inflicting any other injury. He had
to walk eight miles after receiving the wound, and when
admitted into hospital manifested little or no disturbance
of the system. Under cold-water dressing the wound did
well, and continued so till the twenty-fifth day after the
injury, when the wound of entrance suddenly assumed a
cup-shaped form, became excessively irritable, the sur¬
rounding parts swollen and painful, and the patient him¬
self attacked by pyrexia. The surface of both wounds was
at once covered with opium ; calomel and opium were
given in small doses every three hours ; great attention
was paid to cleanliness. The phagedenic action did not
from that time advance ; the sores at once began to im¬
prove in appearance, and under the application of lead and
opium lotion they healed ; the man being sent to duty
sixty-one days after receiving his wound.
Mortification. —The case about to be related under this
head is one of extremelv rare occurrence. Sloughing of
the parts directly injured by bullets is common enough,
and in fact forms an ordinary stage in the progress of such
cases ; so also is gangrene of the distal portion of a limb in
cases of destruction of the principal vessels, but the fol¬
lowing is in its nature very different from either of these.
Mr. Venables, a civilian, forty-five years of age, and
twenty-seven years in India, was, on the 15th April, 1858,
wounded during an attack on the Sepoys, near Azimghur.
A bullet struck the outer aspect of the lower extremity of
the left ulna, fractured the bone without entering the joint,
ran up the side of the forearm, and was cut out near the
elbow. There was at the time nothing in the injury to
occasion anxiety, and the medical officer by whom he was
attended therefore merely put the arm in a splint, and
loosely bandaged it. On the morning of the 17th Mr.
Venables had a shivering fit, succeeded by the different
stages of what seemed an ordinary attack of intermittent
fever, to which for years he had at intervals been subject.
While the pyrexia lasted he was therefore treated by
diaphoretics and effervescents. On the evening of that day
he complained of feeling that the rings which he wore on
the fingers of the injured hand were tight; they were
accordingly taken off. He also * complained of diffused
pain in the left shoulder, but somehow or other no further
notice seems to have been taken of the state of the arm
till the morning of the 18th, when it was discovered to be
cold, black, ana covered with phlyctenae ; the arm, from
the elbow-joint to the shoulder, was swollen, and presenting
all the modifications of green, yellow, and blue ; under
the clavicle distinct emphysema was detected; the pulse
was rapid and hard ; face flushed, general manner excited,
and he was generally delirious, although still capable at times
of collecting his ideas. It was obviously too late to do any¬
thing effective in this case. Brandy and opium were given,
and at three a.m. of 19th he died. The heat of the weather
was at the time very great, and although his body was
interred the same afternoon, the state to which decom¬
position had advanced was horrible to look at. His habits
nad been free, but his general health what was in India
considered good, intermittent fever being held as of no
acoount. With reference to this case, my object is not to
remark upon the treatment pursued, but to bring it for¬
ward as illustrating a complication which, although by no
means common, at times accompanies gunshot wounds in
India.
Traumatic Tetanus .—This terrible complication is
fortunately of comparatively rare occurrence after wounds
on service in India. The following is, however, a very
illustrative case of its progress and termination :—
Byrnes, 10th Foot, on 28th July, 1857, received a gun¬
shot wound which passed through the upper part of the left
thigh, without injuring the femur. Hearrivedat theregimen-
tal hospital the following day, and by that time considerable
inflammation had set in. Leeches were applied around the
wound ; their bites bled very freely, ana for some days
thereafter he seemed free from constitutional disturbance.
On the 4th August the pain and sense of tension at the
wound were described as very great. On the following
day these symptoms were increased, a thin bloody
discharge oozed from the wound, restlessness was
great, skin was hot, pulse rapid and tongue white ;
at four p.m. of that date he suffered from pain and
stiffness in the jaws, which were nearly closed ; he could
with an effort swallow; pain was complained of in the
back of the neck; the head was bent backwards, and
the features were distorted. Towards evening accessions
of spasms occurred in distinct paroxysms, at intervals of ten
to twenty minutes ; the body on each occasion was drawn
violently backwards, the sufferer uttering loud screams
from agony. Deglutition soon became almost impossible ;
the abdomen felt distended, hard, and painful; pulse 100,
full; surface warm and dry; urine was voided naturally.
On the 6th, the conditions continued with little alteration;
surface had become cool, and pulse sank to 90. In the
afternoon of that day an aggravation of the symptoms took
place, and injury of the sciatic nerve was suspected. The
tetanic spasms increased in severity and frequency. Chlo¬
roform was liberally administered, in addition to the other
remedies usual in such cases; no benefit was obtained
however. He gradually became unable to expectorate the
phlegm that rapidly accumulated in his bronchii, and
during the evening he died in great agony. No post¬
mortem examination seems to have been performed.
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“salus populi suprema lex.’*
WEDNESDAY, DECEMBER 2, 1868.
- + -
EDUCATIONAL REFORM.
If we set aside the questions which concern our Consti¬
tution on Church and State, the question of Education is
the question of the day. The great increase of the con¬
stituencies effected by the Reform Acts of the last two
years, has drawn the attention of some of our leading
statesmen (among whom Mr. Lowe may be especially men"
tioned), to the necessity of diffusing information among
the people, in order to fit them for the exercise of the pri¬
vileges which they now so largely enjoy. As to the ne¬
cessity for more schools, for better instruction, and for
bringing the young Arabs of our great cities within the,
influence of those “ noble arts which soften the manners
and do not suffer them to be brutal,” all parties are agreed.
But the end being conceded, there is the greatest difference
of opinion about the means. Some say education should
be entirely free, and some that the pence of the poor should
help to defray the expenditure. A hot fight rages between
the upholders of the voluntary principle and the upholders
of the compulsory principle, and no slight degree of heat
is evolved out of the question of the class of persons from
which pupil teachers should be selected. There is a close
analogy between the position of Parliament with reference
to the education of the masses and the position of medical
politicians with reference to the education of the rank and
file of the profession. Great divergence of opinion may
exist in regard to the relative importance of books, lec¬
tures, and examinations, but no one Bingle independent
medical man has ever been heard to express his satisfac¬
tion at the state of medical education ; and.no one single
medical student in either of the three kingdoms believes
that the present system is not weighted with absurd and
inconvenient regulations which interfere with his acquire¬
ment of a truly practical and useful knowledge of his pro¬
fession. The only persons who regard the system in a
favourable light are those who profit by its continuance.
But the “ hoary head ” which appears to be “ a crown of
glory ” at the examining boards ha3 not sufficient capacity
to devise the means by which the path, of progress can be
seriously obstructed. Strong views on education are be*
ginning to prevail in the profession, and the utterance and
enforcement of these opinions cannot be prevented. Even
the Medical Council, which exhibits a concentration of
corporate Conservatism, is obliged to take educational
questions into consideration, and to constitute committees
upon them for the purpose of displaying the appearance
of activity. Fortunately, we are not left wholly to the
originative endowments of the Medical Council. In April,
1867, an Association of Medical Teachers was formed in
London, and is now earnestly engaged in the considera¬
tion of a report on education emanating nominally from
the Council of the Association, but in reality proceeding
from the pen of the late eminent President, Mr. John
Simon. This report is a valuable one, and does great credit
to the judgment of its author. It will be seen that he has
taken the edge off the sweeping views which he enunciated
in his well-known address to the Association at the be¬
ginning of the present year, and we are glad to observe a
considerable coincidence in his views with those which
Mr. Rivington expressed in March, and to which we called
attention at the time. Indeed, it is to the latter gentleman
that we are indebted for this report on education.
The session of the Association was about to close without
any other than mere outlying questions being touched when
Mr. Rivington had the courage to propose six resolutions
on educational reform, and to make a speech of half-an-
houFs duration, to about a dozen members of the Associa¬
tion, ranged against the wall of the room in Soho square.
But for this the Association might still have been dis¬
cussing the number of lectures to be required from the
student, for the purchase of autographs, the supply of
anatomical subjects, or the utilization of the out-patient
departments. Now it is doing real business, and is going
to the root of the evils from which we suffer. Let it
steadily pursue this course, amend and pass its report, lay
it before the constituted authorities, insist on a direct reply
to its suggestions, and it will be achieving a useful work,
for which it will earn the gratitude and confidence of all
the thinking politicians within the ranks of the profession.
SMOKE NUISANCE AND MAGISTERIAL
JUSTICE.
A clause in the " Sanitary Act ” is specially directed
against what is very properly termed the smoke nuisance.
It renders liable to a penalty the owners of chimneys—
except those of dwelling-houses—from which black smoke
is permitted to issue, unless that said owner clearly proves
that he has adopted every precaution to mitigate the nui¬
sance complained of. In Manchester, which may be de¬
scribed as a city of factories, hundreds of persons have
been convicted for allowing black smoke to issue from their
chimneys; and it is stated that the evolution of black
smoke from the chimneys of that city has been greatly
lessened. In London, a few days ago, Messrs. Barclay and
Perkins, the eminent brewers, and several other well-
known porter manufacturers, were convicted under the
smoke nuisance prevention clause of the Sanitary Act, or
rather they submitted to a conviction, and promised that
the nuisance complained of would be promptly abated.
In Dublin the first attempt to abate the smoke nuisance
was made on the 14th ult. by the municipal authorities.
Messrs. Brennen and Rogerson, proprietors of the Phoenix
Brewery, Great James street, were summoned before Mr.
Allen, Divisional Magistrate, for a breach of one of the
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LEADING ARTICLES.
December 2,1868. 473
clauses of the Sanitary Act. It was alleged, on the part
of the prosecution, that enormous volumes of black smoke
issued during long periods from the chimneys of the de¬
fendants ; that their chimneys were little more than those
attached to ordinary dwelluig-houses; and that they were
not more elevated than the roofs of the surroundiug houses.
In support of these allegations the very strongest testimony
was given by Dr. Mapother, Medical Officer of Health for
the City; Dr. Cameron, City Analyst and Professor of
Hygiene in the Royal College of Surgeons; and Mr. James
Boyle, C.E. On the part of the defendants, Alderman
Plunkett (a member of the Corporation who were plain¬
tiffs in the case!) and some other of their neighbours
stated that they were not in the least annoyed by the
smoke from the brewery, nor did it in any way injuriously
affect their health. It was not denied that the chimney
was of insufficient height; that it emitted black smoke ;
that no improved furnaces—such as Jucke’s chain furnace
—was employed. In short, the facts stated by the prose¬
cution remained perfectly uncontradicted.
If such a case as this had been brought before a London
or Manchester magistrate an instant conviction would have
been obtained; but the Dublin Justice could not be
brought to perceive that enormous clouds of black smoke,
and the other and more dangerous products of imperfect
combustion, were injurious to the health of the community,
and accordingly dismissed the complaint.
After such a decision as this, it would be perfectly ab¬
surd to bring any case of smoke nuisance before this in¬
telligent magistrate. It would be utterly impossible to
prove more than was alleged against the Phcenix Brewery,
which indeed, we believe, was selected as one of the very
worst cases in the city. If therefore Mr. Allen's colleagues
on the magisterial bench take this view of what constitutes
a smoke nuisance—which, we hope, may not prove to be
the case—one clause, at least, of the Sanitary Act will
prove a dead letter in the City of Dublin.
In all chemical and gas manufactories the workmen
have a notion that the vapours given off during the various
operations protect them from cholera and other epidemics.
This idea is carried to an absurd extent, for even butchers
affirm that the abominable atmosphere of their slaughter¬
houses ensures immunity during epidemic outbreaks. No
doubt the vapours and gases from chemical works are
powerful disinfectants, and perhaps the same may be said
of the hydro-carbons evolved from gas works. Like many
other popular notions, there is some truth in the opinion that
in certain kinds of factories the workmen are protected from
contagious diseases; but the proprietors of these works
often encourage and perhaps originate the idea, in order to
obtain more toleration for the nuisances which they create.
REPORT OF THE ARMY MEDICAL DEPART¬
MENT FOR THE YEAR 1866, PUBLISHED IN
1868. Pp. 647.
The subject of the health of our troops ought to be
of the deepest interest to every citizen of this wide¬
spread empire. No nation can at the present moment be
so deeply responsible for the care of its “ national police ”
as ourselves, since no nation sends its troops into such a
variety of climates.
To analyse all the information contained in the carefully
collected statistics before us, would be a task beyond our
strength. We can merely attempt to give a few phases of
the subject, as it strikes our own mind in perusing this
work, which to the student of hygiene, whether English or
foreigner, is one of the most important volumes that he
can be referred to. The first forty pages of this “blue-
book ” is devoted to the health-statistics of our home troops.
The average strength of non-commissioned officers and
men serving in the United Kingdom during the fifty-two
weeks ending December 1866, amounted to 70,292; the
admissions into hospital to 59,966 ; deaths 676 ; and there
were, of constantly sick, 2,942. This death-rate—namely,
9 62 per 1,000, is by no means high, and the figures show
that our home-troops are healthier than perhaps those of
any other nation. In the entry of enthetic diseases (vene¬
real diseases), we find, however, that there was a very
marked excess in 1866 in the amount of venereal cases at
Canterbury, Colchester, and Dover, and other army sta¬
tions, the number of men constantly in hospital for venereal
diseases amounting to 1,138, or 1619 in 1,000 of strength.
The loss of service during the year 1866 from these dis¬
eases was equal to that of the whole force in the United
Kingdom for 5*91 days. Doubtless the next report will
show the benefit caused by the introduction of the Con¬
tagious Diseases Act, 1866.
Tubercular disease caused in 1866 an admission into
hospital in the proportion of 16*9 per 1,000, and there were
2*96 deaths in the same number of troops. Continued
fevers are much on the decrease, owing, it is said, to im¬
proved barracks.
Re-vaccination .—This has been applied on 383 soldiers
and 12,210 recruits. In the soldiers the operation gave
rise to a perfect vaccine pustule in 201 out of 1,000 cases ;
to a modified pustule in 376 in 1,000 ; to a failure in 423
cases. Among the recruits re-vaccination gave rise to a
perfect pustule in 341 in 1,000 ; to a modified one in 311
in 1,000 ; and to a failure in 347 in 1,000 cases. Among
the recruits found fit for service at the head-quarters of the
recruiting districts in 1866, the numbers bearing marks of
small-pox and vaccination, or not bearing these were,—In
England, 73 in 1,000 bore marks of small-pox ; 889 in
1,000 marks of vaccination ; and 37*3 in 1,000 had no
satisfactory marks. In Scotland their numbers were 126*3
small-pox ; 788*6 vaccination ; and 85*2 no marks.
Some of the details of the subject are as follows :—The
health at Aldershot has been very good. Venereal dis¬
eases, indeed, seem to have constituted a great proportion
(one-third) of all the admissions into hospital there in 1866.
There is a hospital for soldiers' wives and children well
spoken of. At Plymouth and Devonport, at the Curragh,
and in other military stations, we read of improved statistics
of the health of our troops, all of which are most cheering,
with the exception of the universal complaint as to the pre¬
valence of enthetic disease.
Page 29 is devoted to a description of the Contagious
Diseases Act, 1866, from which the following is an ex¬
tract :—“ Persons out of the army can form but little idea
of the amount of disease, and the modifications of health
induced by syphilis. Military hospitals in many garrisons
of various parts of the world would be comparatively
empty were it not for diseases of this and a similar nature.
The number of Lock Hospitals in this country, and the
means for the treatment of diseases so highly contagious,
are very small and inadequate.It would be
incompatible with the nature of his occupation for every
soldier to be married, even were it practicable to find suffi¬
cient barrack accommodation.”
Of the Recruiting of the Army .
The health of the labouring classes of our large towns is
by no means ill-judged of by the results of rejections of
recruits. We know that London has a less death-rate than
that of Liverpool, Leeds, Edinburgh, Glasgow, Dublin, or
Belfast We are not then surprised to find that the number
of rejections for physical defects are, in London, 469 ; in
Liverpool, 580 ; in Leeds, 777; in Edinburgh, 507 ; in
Glasgow, 613 ; and in Belfast 714 in 1,000. In the whole
of England there were 365*9 per thousand inspected not
admitted; in Wales, 416*1 per 1,000 ; in Scotland, 416*0
per 1,000 ; and in Ireland, 415*0 per 1,000. Thus statistics
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474 Tha Medical Press and Circular.
NOTES ON CURRENT TOPICS.
December % 1868.
speak eloquently as to the deteriorating effects caused by
our present large town system on the health of our citizens.
Under the height of 5ft. 3in., 140 recruits were admitted ;
2,069 were of the height of 5ft. 6in. to 5ft. 7in. ; and 104
were upwards of 6ft. Ninety-nine recruits weighed less
than 1001b.; 2,411 weighed from 1301b. to 1401b.; and 34
weighed more than 1701b. Of 1,000 recruits examined,
206 were unable to read or write ; 87 were only able to
read ; and 707 to write and read. As to the occupations
of the recruits, we find that 364*6 in 1,000, labourers, hus¬
bandmen, and servants, who applied, were rejected, whilst
400*1 in 1,000 manufacturing artizans (clothworkers,
weavers, lace-makers, &c.), were rejected, and 419*3 me¬
chanics (carpenters, smiths, masons), were rejected per
1 , 000 .
-♦-
ghrks 0W famtl ffspcs.
Death from Starvation.
Our workhouse officials seem to be culpably neglectful
at certain times. What amount of suffering and mortality
they may be accountable for it is impossible to tell, but
every now and then a case crops up—and latterly it has
not been a solitary one—which shows that our Poor-law
system as at present administered is sadly defective.
Some days ago an inquest was held at Bethnal Green on
the body of a poor man fifty-one years of age. He had a
wife and three children, and could only earn five shillings
a week. The wife applied to the workhouse for relief as
they had no food, and was told by an official “ to go and
work, as they had plenty of such tales.” The consequence
was the man died. It may be that in the thickly-populated
parts of our metropolis, where poverty and destitution
abound, every such catastrophe can never be entirely pre¬
vented. At the same time it is plain, notwithstanding our
civilization and benevolence, that the best method of
doing so has not yet been adopted.
Guardians versus Poor-law Board.
The Poor-law guardians of Clerkcnwell refuse to form
a sick asylum district for Finsbury as ordered by the
Poor-law Board, and have formed with Holbom and St.
Luke's a defensive alliance in order to strengthen their
opposition.
The Abergele Coroner.
Dr. Evans Pierce has again been chosen to fill the
office of mayor at Denbigh, a circumstance which must be
highly gratifying to himself and to his professional
brethren, when we remember the vile attacks made upon
his professional capacity as coroner during the long and
painfully arduous inquiry over which he presided, inves¬
tigating the causes of the melancholy railway disaster of
last summer.
H.M.S. “Ariadne.”
The screw frigate “ Ariadne,” which is being fitted out
at Portsmouth, with every sanitary improvement the
authorities can suggest for the use of their Royal High¬
nesses the Prince and Princess of Wales during their im¬
pending tour to the East, will be in charge of Staff-Surgeon
J. Rnddall Holman, M.D., M.R.G.S., Ac., late surgeon to
H.M. Dockyard, Chatham, and Assistant-Surgeon Henry
Hadlow, M.R.C.S., late Assistant-Surgeon to H.M.S.
“ Conqueror,” and R. S. P. Griffith, M.R.C.S.
Death from Hydrophobia.
Mr. Jesse Greenwood, the landlord of the Wool-
sorters’ Arms, Halifax, has died of this terrible disease.
This is the third case in Halifax within a few weeks. He
was bitten on the mouth by his pointer dog eight weeks
ago, and, though he applied caustic to the part at that
time, last Wednesday he became ill, and died with all the
marked symptoms of hydrophobia.
Hints on Quackery.
Advice on the art of humbug from one of its most suc¬
cessful adepts—hints on quackery from one of the most
ineffable clerical quacks which even America can boast—
is worthy of record. Henry Ward Beecher has recently
published an amusing piece of advice to young doctors,
and as an instruction what to avoid, and a literary curiosity,
we transfer it to our columns. The quack clerical thus ad¬
vises the quack medical :—
It is nature that cures. The less a doctor does, the better
for his patient. It is the doctor’s business to take the credit
of what nature does. Cultivate a look of mystery. Every
mother of a sick child studies the doctor’s face. Come in
softly, but with the air of a mild conqueror. Look piercingly
at the patient. Then look from one to another of the persons
present. Say to the nurse in a low tone, “I think you have
a right view of the case ; ” and, before you leave, say to the
mother, “ I could not have done bettor for tho case myself
than you have done.” If the child gets well, as it will, nine
times in ten, if you let it alone, you will have the credit in
that family of extraordinary skill. If it dies, it will only
bring out the moral view, “We must all die. When one’s
time comes no skill can cure,” &c. But if you really mean to
try the medicine dodge, you must choose your school. If yoa
are to be an allopathic yon need but three things : opium,
calomel, and antimony. Anything that cannot be reached by
them ought not to be cured. With these three swords yon
can slay all diseases or all the patients ; and, iu either case,
there is an end of suffering. If you select the homoeopathic
treatment, you have only to buy a manual and a box, about as
large as a cigar box, of pilules or tinctures. After a little
time, you can pul pill to symptom as rapidly as the post-office
clerk can distribute to names and boxes. If silence and
mystery are not your forts, you may have equal success by
judicious talking. Many people can he talked out of anything.
If laudatory words do not abate symptoms, they may iucrease
reputation. The patient may die, but, if those that still live
think that you ore “ the most knowing doctor they ever 0161”
(and it’s your fault if they do not), then you are sure of
being called again. Always have an eye to the future. Who¬
ever dies, see that the living like you. Dead men furnish bo
practice.
The New Pharmacy Act and the Dispensary
Practitioners.
We called attention lately to the operation of the new
Pharmacy Act, which by an alteration of the word “Apothe¬
cary ” for <* Medical Practitioner” had been made to include
all medical men who dispense medicines to their own
patients in the prohibition against the sale of poisons. Mr
Sandford, the president of the Pharmaceutical Society,
has lately addressed a letter to the Express in refuta¬
tion of this view. He thinks that the dispensing of
medicines to private patients could hardly be held to be
a “sale” of poison within the meaning of the Act He
“There are in London and many large towns medical
practitioners who are not licentiates of the Societv of
Apothecaries, keeping open chemists’ shops, and in
Scotland, there being no such licentiates, such men are
numerous. Now how will these men be affected f Are
they not apothecaries as much as if their diplomas bore
the seal of Apothecaries’ Hall ? Section 31 of the Medical
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December 9, 1868. 475
Act gives all persons licensed to practise medicine power
to recover payment for their attendance, and the cost of
snch medicine and surgical appliances as they may supply
to their patients ; the diploma of the University of London
authorises an M.D. to practise * Pharmacy’; or a licen¬
tiate of the College of Physicians can do so ; and within
the last few days the Lord Advocate, after searching the
charter of the Edinburgh College of Surgeons, has an¬
nounced that ‘pharmacy 9 is one branch of medical science
therein enumerated, and that according to his opinion
men graduating under that charter must be regarded as
the apothecaries of Scotland, and consequently entitled to
all the exemptions accorded in the Pharmacy Act to the
apothecaries in Great Britain. It is quite certain, as you
state, that the promoters of the new act intended to leave
all duly qualified medical practitioners in full possession
of their privileges, and the bill when it left the House ot
Lords was worded accordingly ; therefore the Pharma¬
ceutical Society must be acquitted of any wish to grasp
all the right to deal in poisons/
The profession is, we are confident, perfectly confident,
that the Pharmaceutical Society, which has merited the
public thanks for their efforts to pass the new measure, were
entirely innocent of any desire for a monopoly of the trade
in poisons. It is unfortunate that the phraseology of so im¬
portant a measure should be ambiguous in so important
a respect, but the probability of its wording being inter¬
preted as a restriction on medical men would appear so
remote that it need excite no anxiety within the profession.
The Health of Dublin.
The deaths registered during the week were 152—81
males and 71 females. The average number in the cor¬
responding week of the previous four years was 159. Nine
deaths resulted from fever. Eight deaths were caused by
scarlatina, showing a decrease of 13 as compared with the
preceding week. The mortality from croup amounted to
7. Convulsions proved fatal in 15 instances. Twenty-
four deaths were referred to bronchitis, and one to pneu¬
monia or inflammation of the lungs. Six deaths were
ascribed to heart disease and one to aneurism. Sixteen
deaths resulted from phthisis or pulmonary consumption.
Cancer was the cause of three deaths. Five deaths were
attributed to apoplexy, and a like number resulted from
paralysis. Old age was the assigned cause of eleven
deaths.
Thames Purification from the Sewage of
Oxford, Eton, Windsor, and Abingdon.
The up-river towns which have been for all these years
sending their decoctions and excreta through the channels
of their London friends lower down have been brought
to an account by the Thames Navigation Act of 1866,
which has peremptorily told them to get rid of their sewage
by other means, and gives them only thirteen months to
do it in. In their dilemma they went to Government for
advice, and Lieutenant-Colonel Ewart was sent down to
settle the difficulty. It seems that these towns are all close
to the water’s edge, and have had, therefore, no fall to help
them in distributing their sewage, and the very remedy
which they did not want to pay for is that which Colonel
Ewart advises them to try. In his report, which has been
just issued, the Colonel recommends that the sewage shall
be kept separate and utilised by irrigation, while the rain¬
fall may be discharged into the river.
We published in our issue for the 21st of August, 1867,
the very important evidence of Dr. Letheby on this point,
which goes very strongly to controvert the necessity (as
far as Londoners are concerned) for this sewage diver¬
sion scheme at all. Dr. Letheby, in his evidence before
the Select Committee, deposed as follows:—
u Firstly, he is of opinion that the peaty water is not ob¬
jectionable in any respect but colour, which, however, will
prevent its use for drinking purposes ; secondly, that the most
sparkling and agreeable waters which have been drunk with
avidity, in spite of all remonstrance, are generally the most
dangerous ; thirdly, that there is no evidence whatever that
the present London supply is any way objectionable ; fourthly,
that water contaminated with one-twentieth of its weight of
ordinary sewage, becomes, after twelve miles transit in a river
bed, as far as can be ascertained, perfectly innocuous; lastly,
that the outbreak of cholera in the east end of London was
totally irrespective of the water supply.”
Dr. Letheby is no mean authority, and his facts and
figures, of which we have now only space for a summary,
referring our readers to the date named, are so decisive that
it would appear unreasonable to force these towns into
an enormous expenditure, if nothing or only a chemically
inappreciable gain in the purity of the water is to be ob¬
tained.
If, however, the sewage is to be utilised by irrigation
(and this is incomparably the best possible means of dis¬
posing of it), it would seem to the ^engineering mind
that his proposal of a double system of sewerage for the
separate accommodation of the soil and the rainfall must
he inordinately expensive and very immense.
To save a cost of about a farthing a ton for pumping this
intricate system is proposed, and this, although the rain
water itself would almost pay, in the fertility which it
gives the land, for the cost of raising it to the necessary
level. We speak with much diffidence on a subject not
within our scope ; but the principles which we enunciate
are quite within the medical comprehension and the com¬
monest degree of knowledge.
Royal Medico-Chirurgical Society.
At the meeting of this Society on November 24th, a
most interesting paper, by Dr. Althaus, was read, giving
an account of a case of complete paralysis of the fifth nerve
on both sides. The patient had been a large sheep farmer
in Australia, and the affection arose from exposure to
severe cold wind. The paralysis, for a time, extended
even to the motor branches of the fifth, so that the mas-
seter and pterygoid muscles last their power, and the jaw
dropped like that of a corpse. The loss of sensation in the
tongue was so entire that this organ had been bitten in all
directions during the mastication of the food. During the
period of paralysis of the muscles of the jaw, just alluded
to, the patient was fed, for as long as sixteen months, on
minced food, which he swallowed as well as he could.
For numerous other matters of the greatest interest in
connection with this remarkable case, we must refer our
readers to a more detailed account of the case. Under the
influence of treatment with the continuous current for
three months very great improvement was reported to have
taken place, so much that the patient had become able to
follow a light employment.
The author was complimented most highly upon his
paper by the President, Mr. Savory, Dr. Reynolds, and
others who joined in the subsequent discussion.
Payment of Medical Officers.
At the annual meeting of the Newark Improvement
Committee, Dr. Welby was elected honorary officer of
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fceceittber % lS«8.
health, but at the last monthly meeting he declined to
accept the office. He gave as his reason that the question
whether or not the commissioners would pay a salary had
not been fully considered and determined upon, and
if they decided to pay a salary he would not stand in the
way of any medical man who was willing to undertake the
office. It was decided to make the next meeting special
for the purpose of considering the whole question.
Killed During the Elections.
Monday, Nov. 16th.—C. Tettmar, thrown down and
crushed at the nomination for the Tower Hamlets. Nov.
17th.—Thomas Whittaker murdered at Blackburn by an
infuriated mob of opposite political views. Mrs. Grant,
death from bayonet thrust whilst the military were
clearing the streets at Newport. Also on same day, at
Cambridge, the University College porter, named Lofts ;
death a few days after from concussion of the brain,
caused by a large piece of granite thrown by the mob
through the college gates. Nov. 20th.—During the riots
at Sligo, Captain King shot dead ; also a man named
Hill, death from fracture of skull ; and on same day, at
Drogheda, a man named Woods died from gunshot wound
received during the riot. Nov. 23rd and 24th.—Donovan
shot by a police constable during an affray at Kilbrittain,
near Bandon ; also the steward to Colonel Bernard,
during a riot at Cork; and Mr. Clarke, of Monaghan, who
was shot by a man named McKenna for an expression
used by deceased which annoyed him ; and on the 25th,
Mr. Edmund Miles, a medical student in Dublin, who
received a thrust with a stick, during an altercation,
through the eye, which lacerated the brain, causing
almost instantaneous death. These are all we have been
able to glean to the time of our going to press. There are
still several dangerous cases which may yet be added to
the records of death. Moreover, the elections have not
yet been concluded, but we hope that the publication of
this formidable list of killed may exercise a deterrent
influence upon those who are disposed to stimulate the
angry passions of the mob in times of political or party
excitement.
St. Andrew's Medical Graduates' Association.
Thk second anniversary session of the Association will
be held in London, at Willis’s Rooms, King street, St.
James’s, this day and to-morrow (Thursday). The pro¬
gramme for the session is as follows :—Wednesday, De¬
cember 2.— 7 p.m.: Election of new members ; election
of officers ; report of Council; discussion on restriction of
number of M.D.’s to ten annually. 8 p.m. : Report on
the Parasitic Theory of Disease, by Dr. Sedgwick; and
such other papers as time will allow. Thursday, De¬
cember 3.—2 p.m.: Report on the Criminal Responsibility
of the Insane, by Dr. Harrington Tuke, F.R.C.P. ; On the
Influence of a Moist Atmosphere in the Production of
Phthisis, by Dr. Edwards Crisp ; On the Relative Value
of Symptoms in the Diagnosis and Treatment of Disease,
by Dr. W. H. Day ; On a Case of Imperforate Anus, by
Dr. Lloyd Roberts; On Strychnia in Diphtheritic Paralysis,
by Dr. Maund ; On Fracture of the Sternum, by Dr.
Beverley Bogg, R.N.; On the Physiological Effects of
Chloroform, by Mr. Whitehead ; with other papers by Drs.
Bower, Harrison, Hugklings-Jackson, Wynn Williams,
O’Connor, Spencer Thompson, &c. p.m.: The Annual
Address, “ On the World of Physic and the World,” by
the President. 7 p.m.: Anniversary Dinner.
Intelligence was received at St. Petersburg on the
23rd from Persia, which states that cholera has broken
out at Astrabad.
A few days ago a hairdresser at Salisbury poisoned
himself accidentally by taking strychnine. It had been
ignorantly recommended as a tonic, and he took it “ to
steady his hand.” The amount taken was three grains.
The Western Morning News remarks that if the medical
men sitting in the next Parliament can make their voices
heard “ amidst the roar of railway directors, merchants,
and lawyers,” it will be so much the better for national
interests.
A telegram respecting the health of the Prince Royal
of Belgium, whose life has for some weeks been despaired
of, states that several serious symptoms have diminished
during the week, and that the general state of health of
his Royal Highness is more satisfactory.
On the day of our present issue, Sir W. Jenner, Bart.,
M.D., is announced to preside at the second annual meet¬
ing of the Victoria Hospital for Sick Children, to be held
at Willis’s Rooms at three o'clock. Ladies and gentle¬
men interested in the welfare of this valuable institution
are invited to attend.
Dr. Lush, M.D., St. Andrew’s, has been elected
M.P. for Salisbury. He is to be proposed for member of
the St. Andrew’s Medical Graduates’ Association at their
next session, and is going to dine with them as a guest
Dr. Lush is the first M.D. of St. Andrew’s who will have
a seat in Parliament.
We refer our readers to a letter in our correspondence
of to-day from Dr. Heame, of Southampton, in reference
to the Royal South Hants Infirmary. It appears that
there has been a series of mismanagement there for years,
which we have before noticed, and shall notice again
when we have more time and space at command.
A new medical society has been formed for Salisbury
and its neighbourhood, and the following officers have
been appointed for the first year :—President: J. A
Lush, M.D., M.P. Vice-Presidents: J. M. Cardell,
F.R.C.S. Eng. ; W. G. Davis, M.R.C.S., L.S.A. Com¬
mittee of Management: W. Martin Coates, M.R.C.S.,
L.S.A. ; J. Winzar, M.R.C.S., L.S.A. ; E. Young, M.D.
Treasurer: F. R. P. Darke, M.R.C.S., L.S.A. Hon.
Secretary : H. J. Manning, B.A. Lond., M.R.C.S.
-»■
SCOTLAND.
UNIVERSITY OF EDINBURGH.
ELECTION OF CHANCELLOR.
By a majority of 210 for the Lord Justice-General, Mr.
Gladstone’s election to the Chancellorship of the above
University has been defeated—a circumstance, in one view
of the subject, much to be regretted. He has been the
Rector for six years, and as a scholar and statesman noons
can deny his claims to the office held by the late Lord
Brougham. On the other hand, Mr. Injdia has exerted
himself greatly on behalf of the Scottish UniversitieB, and
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CORRESPONDENCE.
December 2, 1868. 477
may be considered as the author of the Medical Reform
Act of 1858. The result is, that the University of Edin¬
burgh has thought fit to show its appreciation of the ser¬
vices he has rendered them by making him Chancellor.
A meeting of the students of St Andrew’s University
was held on Thursday forenoon, when Mr. J. A. Fronde
was chosen Rector by a majority of fourteen over those
who voted for Mr. Disraeli.
The election of Member of Parliament for the Univer¬
sities of Edinburgh and St Andrews commenced on Mon¬
day. The result will not be known soon enough for our
present issue. That for Glasgow and Aberdeen, we under¬
stand, will commence to-morrow.
-♦-
STATISTICS OF SCARLATINA.
TO THE EDITOR 07 THE MEDICAL PRESS AND CIRCULAR.
Sir,— In the existing prevalence of Scarlatina the following
official returns, taken from the published reports of the Board
of Superintendence of Dublin Hospital, may be of some bene¬
fit, or must be matter of some medical curiosity. The returns
from the Hardwicko Fever hospital, the Cork street Fever
hospital, and the fever wards of the Meath hospital, show that
from March, 1858, to March, 1867, 336 cases of scarlatina
were admitted into the Hardwicke, 226 into the Cork street,
and 103 into the Meath, and that 36, or 10*71 percent., died
in the Hardwicko, 45, or 20 per cent., died in the Cork
street, and that none died in the Meath.
Assuming, as wo must, that all the ph}*sicians of these hos¬
pitals are equally capablo to attend scarlatina patients, and
that the same medical and nursing attention is paid in each
hospital, this difference in the results appears to be unaccount¬
able, that none should die in one institution, when 10 per
cent, and 20 per cent, die in others in the same city. In the
London fever hospital 793 cases of scarlatina were admitted in
four late years, and 84, or 10*66 per cent., died.
This difference in the resalts would seem to imply that the
medical officers of the Meath possess some mode of treatment
which is not known to any others (in which case it is to be
hoped they will publish it), or that the disease is year after
year milder in the district from whence patients are admitted
(which district is nearly the same as that from which the Cork
street hospital admits). As these returns are made by the
hospital authorities, their accuracy may bo relied or..
26th November, 1869. D. Phklak.
■ - -♦---
SIR D. J. CORRIGAN’S CANDIDATURE.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sib,—I must take exception to a statement made by Dr.
Mapother in his letter, published in your last issue, as calcu¬
lated to lead to a very erroneous impression of the feelings and
sentiments which actuated those who refused to support Sir
Dominic Corrigan at the late election. Dr. Mapother alludes
to “ votes which were recorded against him for one political
reason.” Now, I deny that the reason for the votes having
been thus recorded was a political reason. We would have
gladly waived any one or all of our political views for the pro¬
mised advantages to the profession ; but we were not prepared
to sacrifice our religious convictions, and join in a bigoted
raid on the church whose principles we have learned to syl¬
lable with our infant breath mid revere with our matured
reason. Faithfully yours,
A Medical Elector but no Politician.
-»-
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
In a recent issue you gave prominence to the vacancies in
connection with the physicianship of the Royal South Hants
Infirmary. Some of our professional brethren at a distance
will probably expect further information relative to vacant
offices which should unquestionably be associated with every¬
thing that can be regarded as honourable.
I might content myself with referring to the numerous
leading articles published in the Medical Circular over a
series of years, as well as to two articles honestly written in
the Lancet, dated respectively December 18th, 1858, and
January 8th, 1859, for a truthful record of the proceedings of
this so-called Royal institution. The facts therein adduced
are so strong and equivocal that I venture to urge on my pro¬
fessional brethren who take the smallest interest in the reform
of medical charities the propriety of consulting the articles
named. So far as my own inclinations are concerned the past
would be buried in oblivion, coold it have been shown that a
genuine endeavour to improve had been even attempted. Un¬
fortunately, the present position of the institution in question
demonstrates that the opposite policy continues all powerful,
so much so, that this, conjoined with other accomplished facts,
causes Southampton to be universally regarded as the pool of
obstruction, for, whilst many other plaoes have accepted the
broad principles on medical questions which a few pioneers stood
nearly alone in advocating more than twenty years ago, my
adopted home has even retrograded in that as well as in
almost everything else, and dearly has it already expiated its
wretched shortcomings by the most marked degeneration and
stagnation in everything which characterised a once thriving
community.
Charity of all things should be above suspicion, yet, in
fallen Southampton, with the exception of that noble work
the ragged school, evil influences have largely operated in
counteracting the benevolent efforts of our philanthropic an¬
cestors, which only the vigorous use of the probe and knife
will effectually eradicate.
The institution I have specially referred to, has long been
denounced as a sink of corruption, for have not the destitute
been compelled to accept the services of infirm physicians !
whilst those of men with unimpaired senses, and proved equality
in mental power, could have been provided for them ?
Let some of our interested, liberals who have so warmly
supported this abominable hotbed of impurity, tell us frankly
what they now think of favouritisms, plurality of votes, and
the securing of special efficiency in a professional staff by
necessitating a three years’ residence on the muddy banks of
the Southampton water ?
The named of such men as doggedly persist in refusing to
exclaim peccavi , should be engraved on the hardest stone, and
transmitted to the latest ages, as a protest against cant and
hypocrisy. We are living in stirring times, and you as one of
the safeguards of the profession, must be outspoken if you deter¬
mine on increasing your power, and doing all that can be done
to deserve the confidence of the majority of its members.
Such questions as I am about to suggest would have been
irrelevant when men of my own age commenced their
medical studies ; consequently, as a body, we have not kept
pace with the advancing spirit of our age, but, in many res¬
pects, have undoubtedly receded, and, therefore, have afforded
grounds for the designation of the ‘Tory Medical weekly,’
“ That we are a disorganised rabble.” The medical men of
Southampton especially merit this rebuke, for yon. are aware
that even in our degraded town a few active spirits, stirred by
the efforts of the Medico-political Association, have within a
comparatively short period exerted themselves strenuously to
secure a fair remuneration for medical club labour, and that
those disinterested exertions, attended by many sacrifices,
were mainly defeated by charity-mongers, by those self-de¬
nying creatures who affect to give their gratuitous services
to the helpless poor! by one of the physicians, and two of
the surgeons who adorn our renowned institution ! One of
the blessed fraternity is an extraordinary surgeon, and I be¬
lieve they denominate him surgeon extraordinary!
I appeal to my brethren throughout the world, and I know
that, through the medium of your excellent periodical, the
appeal will reach them, whether it is not worse than degrada¬
tion for physicians and surgeons to (Royal) medical charities
to accept IDs. 6d., and even less, for midwifery fees, in addi¬
tion to underbidding their brethren, and thereby obtaining
club practice appointments at from 7 *d. to Is. per member a
quarter. This is the position of distinguished medical men at
Southampton, as recently demonstrated by the untiring efforts
of well-wishers to the community; and a larger revelation of a
like character would have been made did I not feel that I
had 'already trespassed enough on your space. Yet permit
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478 The Medical Press and Circular.
CORRESPONDENCE.
December 2,1868.
me to add that the archives of this, we may hope, incompar¬
able Royal charity will hand down to posterity some of the
most glaring absurdities and blunders, elicited by special
public inquiries, and endorsed by local obstructives, which the
most flighty imagination could have conceived, although in
thorough accord with the whole history of this unfortunate
and misapplied establishment.
I am, Sir, yours faithfully,
Edwin Hearne, M.B., F.R.C.S.Eng.
Southampton, Nov. 27th, 1868.
- ♦-
LARGE FAMILIES AND PUBLIC HEALTH.
TO THB EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,—I f Lord Amberley and others were wrong in attribut¬
ing poverty and overcrowding in great measure to large
Mr. Stuart Mill, the greatest economist of this day,
is also in error. In that error, if error it be, I also humbly
share. Will you favour me greatly by giving the following
a place in your columns, and believe me, yours most faithfully,
C. R. Drtsdale, MJD., M.R.C.P., F.R.C.S,
London, Oct. 28th, 1868.
“Principles of Political Economy. By John Stuart Mill.
Ed. 1866, pp. 691 (cheap or people’s edition).
“Chapter XIII.
“ The Remedies for low Wages further considered.
“ 1. By what means, then, is poverty to be contended
against ? How is the evil of low wages to be remedied! If
the expedients usually recommended for the purpose are not
adapted to it, can no others be thought of ? Can political
economy do nothing, but only object to everything, and de¬
monstrate that nothing can be done ?
“ If this were so, political economy might have a needful,
but would have a melancholy and a thankless task. If the
bulk of the human race are always to remain as at present,
slaves to toil in which they have no interest, and therefore feel
no interest—drudging from early morning till late at night for
bare necessaries, and with all the intellectual and moral defi¬
ciencies which that implies—without resources either in mind
or feelings—untaught, for they cannot be better taught than
fed ; selfish, for all their thoughts are required for themselves;
without interests or sentiments as citizens and members of
society, and with a sense of injustice rankling in their minds,
equally for what they have not, and for what others have; I
know not what there is that should make a person with any
capacity for reason, concern himself about the destinies of the
human race. There would be no wisdom for any one but in
extracting from life, with epicurean indifference, as much
practical satisfaction to himself, and those with whom he sym¬
pathises, as it can yield without injury to anyone, and letting
the unmeaning bustle of so-called civilised existence roll by
unheeded. But there is no ground for such a view of human
affairs. Poverty, like most social evils, exists because men
follow their brute instincts without due consideration. But
society is possible, precisely because man is not necessarily a
brute. Civilisation in every one of its aspects is a struggle
against the animal instincts. Over some even of the strongest
of them it has shown itself capable of acquiring abundant con¬
trol It has artffidaliaed large portions of mankind to such an
extent, that of many of their most natural inclinations they
have scarcely a vestige or a remembrance left. If it has not
brought the instinct of population under as much restraint as
is needful, we must remember that it has never seriously
tried. What efforts it has made have usually been in the con¬
trary direction. Religion, morality, and statesmanship have
vied with one another in incitements to marriage, and to the
multiplication of the species, so it be but in wedlock. Religion
has not even yet discontinued its encouragements. The Roman
Catholic clergy (of any other clergy it is unnecessary to speak,
since no other have any very considerable influence over the
poorer classes) everywhere think it their duty to promote
marriage, in order to prevent fornication. There is still in
many minds a strong religious prejudice against the true doc¬
trine. The rich, provided the consequences do not touch them¬
selves, think it impugns the wisdom of Providence to suppose
that misery can result from the operation of a natural propen¬
sity; the poor think that ‘ God never sends mouths but he sends
meat.’ No one would guess from the language of either that man
had any voice or choice in the matter. So complete is the con¬
fusion of ideas on the whole subject, owing in a great degree to
the mystery in which it is shrouded by a spurious delicacy,
which prefers that right and wrong should be mismeasured and
confounded in one of the subjects most momentous to human
welfare, rather than that the subject should be freely spoken of
and discussed. People are little aware of the oost to mankind
of this scrupulosity of speech. The diseases of society can, no
more than corporal maladies, be prevented or cured without,
being spoken about in plain language. All experience shows
that the mass of mankind never judge of moral questions far
themselves, never see anything to be right or wrong until they
have been frequently told it; and who tells them that they
have any duties in the matter in question, while they keep
within matrimonial limits ? Who meets with the smallest con¬
demnation, or rather who does not meet with sympathy and
benevolenoe, for any amount of evil which he may have
brought upon himself and those dependent on him, by this
species of incontinence ? While a man who is intemperate in
drink is discountenanced and despised by all who profess to be
moral people, it is one of the chief grounds made use of in
appeals to the benevolent, that the applicant has a large
family and is unable to maintain them. Little improvement
can be expected in morality until the producing large families
is regarded with the same feelings as drunkenness, or any
other physical excess. But while the aristocracy and clergy
are foremost to set the example of this kind of incontinence,
what can be expected from the poor ?
“ One cannot wonder that silence on this great department
of human duty should produce unconsciousness of moral obli¬
gations, when it produces oblivion of physical facts. That it is
possible to delay marriage, and to live in abstinence when un¬
married, most people are willing to allow; but when persons
are onoe married, the idea, in this country, never seems to enter
into Anyone's mind that having or not having a family, or the
number of which it shall consist, is amenable to their own
control. One would imagine that children were rained down
upon married people, direct from heaven, without their being
art or part in it; that it was really, as the common phrases
have it, God’s will, and not their own, which decided the num¬
ber of their offspring. Let ns see what is a Continental philo¬
sopher's opinion on this point—a man among the most bene¬
volent of his time, and the happiness of whose married life has
been celebrated.
“ ‘ When dangerous prejudices,’ says Sismondi (‘ New Prin¬
ciples of Political Economy,’ Book vii.. Chap. 6) ‘ have not
become accredited, when a morality contrary to our true duties
towards others, and especially towards those to whom we have
given life, is not inculcated in the name of the most sacred
authority; no prudent man contracts matrimony before he b
in a condition which gives him an assured means of living, and
no married man has a greater number of children than he can
properly bring up. The head of a family thinks, with reaso n ,
that his children may be contented with the condition in which
he himself has lived; and his desire will be that the rising
generation should represent exactly the departing one : that
one son and daughter, arrived at the marriageable age, should
replace his own father and mother; that the children of hb
children should in their turn replace himself and his wife; that
his daughter should find in another family the precise equiva¬
lent of the lot which will be given in his own family to the
daughter of another, and that the imoome which sufficed for
the parents will suffice for the children.' In a coon far in¬
creasing in wealth, some increase of numbers would be affinis-
sible, but that is a question of detail, not of principle. * When¬
ever this family has been formed, justice and humanity require
that he should impose on himself the same restraint which b
submitted to by the unmarried. When we consider how small,
in every oountry, is the number of natural children, we must
admit that this restraint is on the whole sufficiently effeetasl
In a country where population has no room to increase, or in
which its progress must be so slow as to be hardly p er c ep t i ble,
where there are no places vacant for new establishments, a
father who has eight children must expect, either that six of
them will die in childhood, or that three men and three wom en
among his cotemporaries, and in the next generation three of
his sons and three of his daughters, will remain unmarried on
his account. ’ ’*
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The Medical Press and Circular.
LITERATURE.
[December 2 , 1868, 479
At the Stamford petty sessions, on Saturday last, Dr. New¬
man introduced the subject of earth closets. He Baid there
had been considerable doubt of the practicability of dealing
with these closets, on the ground that they had been found to
fail in some places. He, therefore, suggested that the scheme
should be adopted for the Stamford gaol, where it would be of
sanitary benefit to the prisoners, ana afford an easy opportu¬
nity for any one sceptical on the point to see that the system
was not only feasible but practicable. Earth closets had been
introduced into several gaols with the greatest success, and he
had letters from Mr. Voules, inspector of prisons, and the
governors of goals in which the closets had been adopted, all of
whom spoke in the highest terms of the nuisances prevented
by their use. The expense, Dr. Newman said, would be com¬
paratively trifling of adopting them in the Stamford gaol. Mr.
Simpson said the scheme had not been found to answer in the
Stamford Union. Dr. Newman was not at all surprised at
anything not answering there. After some further discussion
it was decided to bring the subject before the Town Council.
—Lincolnshire Chronicle.
Consumption and Dyspepsia. —At a late sitting of the Im¬
perial Academy of Medicine, Dr. Marrotte read a paper in
which he advocated the use of neutral acetate of potash in
gastro intestinal affections, such as mucous fevers, dyspepsia,
&c. It ought, he said, to be prescribed in the shape of a solu¬
tion in distilled water of a given strength, to be afterwards
diluted as occasion might require. As it has a disagreeable
taste, it should be administered in separate doses four or five
times a day, rather than as a continuous drink. At the same
sitting, Dr. Herard read a report on the therapeutic effects of
arsenic in consumption, as described by Dr. Moutard-Martin.
It appears that its efficacy was recognised by the ancients, and
has been formally confirmed by some modern practitioners.
Dr. Moutard shows that nearly all his patients subjected to
the arsenical treatment experience considerable relief after a
few days. In the course of three weeks they begin to lose
their extreme leanness. The happy effects of this substance
are chiefly perceptible in a kind of cousumption unaccompanied
by fever or very serious digestive disturbances. One of the
first phenomena, observed after a while, is a return of appetite.
The author of the report stated it, moreover, as his opinion
that arsenic exercises a direct action on the lungs.— Express.
Transfusion of Blood. —We find it stated in the Amico
del Popolo of Palermo, that Dr. Enrico Albanese a few days
ago performed the operation of transfusion of the blood with
success at the Hospital della Concezione of that city. A
youth, aged 17, named Giuseppe Ginazzo, of Cinisi, was re¬
ceived at that establishment on the 29th of September last,
with a bad humour in his leg, which in the end rendered am¬
putation accessary, the patient being very much emaciated,
and labouring under fever. The operation reduced him to a
worse state than ever, and it became apparent that he was
fast sinking, the pulse being imperceptible, the eyes dull, and
the body cold. In this emergency Dr. Albanese had recourse
to the transfusion of blood as the only remedy that had not
yet been tried. Two assistants of the hospital offered to have
their veins opened for the purpose, and thus, at two different
intervals, 220 gins, of blood were introduced into the system.
After the first time he recovered the faculty of speech, and
stated that, before, he could neither see nor hear, but felt as if
he were flying through the air. He is now in a fair state of
recovery.
University of London.— The following are Lists of Can¬
didates who passed the Examinations indicated :—
Second M.B. Examination — Examine'Ion for Honours — Medicine .—
First Class .—George Vivian Poore, Scholarship and Gold Medal; Wm.
Alsept Richards/ Gold Medal; Tempest AndersonB.Sc., Frederick
Taylor,* equal; John James Ridge. B.A., B.Sc,; Reginald Eager, Fred.
Harry Haynes, equal. Midwifery —First Clast —Frederick Taylor,
Scholarship and Gold Medal; William Aslept Richards,* Gold Medal ;
Reginald Eager*; Tempest Anderson,* B.Sc.; Daniel John Leech.
.Second Class. —John James Ridge, B.A., B.Sc. ; Georgo Vivian Fooro.
Forensic Medicine —First Class.— Frederick Taylor, Scholarship and
G Id Medal; Reginald Eager/Gold Medal; Charles Dorrington Batt/
Third CUj>»s .—Temp st Anerson, B.Sc.; George Vivian Poore M.D.
Examination.—Thomas Cole, Arthur Wellesley Edis, John Wickham
Legg. Thomas Michael; Charles William PhlIpot,B.8c. ; Robert Shinglc-
ton Smith, B.Sc., Gold Medal; J bn Kent Spender. M.S. Examination.
—Marcus Beck, Edward Lloyd Harries Fox,t M.D., Henry Green way,
Howse.t B.S. Examination.—Pass Examination.—Tempest Anderson,
E8&, John Wreford Langmore, George Vivian Poore, John James
Ridge, B.A., B.Sc.
* Worthy of Scholarship. t Worthy of Medal.
Notes on the Metals.— ify Thouias Woods, Ph.D ., <Cr.
Longman, Green and Co., London, 1868.
Dr. Woods has issued a second series of chemical notes,
which we have no doubt will be found most useful for the
purposes for which they are intended. The author takes
some credit for the fact that he has not used the term acid in
these notes. The writer’s views are, “1. The term acid is
not necessary in teaching chemistry. 2. Clearer and more
accurate views on chemical subjects will be instilled into the
minds of beginners without it than by using it as is done
at present in most class-books and classes. 3. Its em¬
ployment, even in the most limited degree, without assign¬
ing it a definite meaning, is improper, since it leaves only a
hazy idea of what is intended, where clearness is one of the
first objects to be, if possible, attained.*’ There are now many
points, which like the term acid ” are so used in the practical
demonstration of the science that it becomes a consideration of
technical convenience. The expurgation of this word, how¬
ever, entails some little inconvenience. The formation of a
lecture note-book is rather a thankless task, and certainly not an
easy one. To place in a clear condensed form all the salient
points of the science would be much more advantageously per¬
formed by each individual pupil for his own use, providing that
they are correctly noted. There is a kind of mental short-hand,
which however convenient to ourselves cannot be made graphic
to others. This is the true ideal of a lecture note-book.
As it is, the author has succeeded in giving a connected
history of the metals, shorn of as much descriptive matter as
possible.
As it is intended as a text-book for a school, we would
rather see gold, platinum, palladium, &c., taken out of the
catalogue of common metals and put in their old place amongst
the rare. Gold is certainly still our ideal of a rare metal, and
although sovereigns are every day in our hands and we seo
diamonds by the hundred in every well-dressed company, the
first is, with some isolated exceptions, the most valuable metal
(from its scarcity), and the latter our most uncommon
mineral.
Perpetual Almanack and Calendar for the Investi¬
gation of Dates. By John Gairdner, M.D., E.R.C.S.,
Edin., 2nd Edition, Edmonston and Douglas, Edinburgh, E.
Ponsonby, Dublin.
The superficial extent of the Calendar very inadequately
represents the labour expended upon its construction. It is
pleasing to find a medical man devoting his leisure time to the
amelioration of his fellow-mortals by tending to their mental
as well as their bodily wants. The principal objects to be ob¬
tained by the use of the “ Perpetual Almanack ” is conveyed
in its name. By virtue of a sliding diagram called “ Table 3,”
the almanack for any year retrospective, present, or future can
be at once constructed. The movable table representing the
unknown dates is arranged according to two other tables, one
of which represents centuries, and the other years. Again,
a doubtful date may be determined by the use of this diagram,
as the author says “ a matter of no small importance to the
student”
This almanack should be in the study of every man of lite¬
rary taste, and therefore must interest the profession, indepen¬
dently of the fact that it is the offspring of one of ouraelves.
NOTICES TO CORRESPONDENTS.
Dr. J.— Thanks for drawing our att ntion to tbs paragraph. The
statement is a palpable falsehood, and like many others which have pre¬
ceded it in the columns of the journal in question. Trie Medical
Press and Circular is now folded and cut by new and improved
machinery, at th rate of 5,00> per hour. In proof of tliU. 6,(*00 cop cs
were printed, folded, stitched, cut, and posted in nine hours, on Tues¬
day. file 17tli ult As the periodical in which tb s gross mistitemenl
appears only boasts of a little over half this number, “the cutting of
so large an impression as theirs would involve & delay of at least twenty-
lou’ hours,” needs no further comment
Mr. Steele is thanked for his complimentary letter.
Dr. D. Basil Hewitt.—T herapeutic Application of Heat and Cold,
will appear shorriy.
Mr. R*wdon Macxamara. — The whole of your Address shall be
published m our next h« per request
Dr. McCormac oh Ventilation published in our la't issue. At tho
end of the first paragraph, for tender, read reader, and at the end of
second paragraph instead of are concerned, read is concerned.
Communications with enclosures received from Dr. Edward Crisp,
London ; C. J. M adows, Ksq.. Ipswich ; Mr. Brooks, Dr Sharp, Rugby;
Dr. Elliot, Carlisle; L. W. Banks, Esq., Dr. Richiud, Northampton;
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480 December 2,1868.
&fee ^ttetlirat %tm and <Simitar ^dvertiiger.
Dr. Haslctt, Lakey ; Dr. S»gewick, London ; Dr. Duncan, Glasgow ; Dr.
Lory Marsh, Nottingham ; Dr. 8cott, Dr. Rumaey, Cheltenham ; Mr.
Treuchard, Taunton ; Mr. Morgan, Dublin ; Dr. Grimshaw, Dublin ; Dr.
Cameron, Dublin; Dr. Mapother, Dublin ; Mr. Nelson, Leeds; Dr.
Mitchell, London; Dr. Croft, London ; Mr. Bennett, London ; Barnard
Holt. Esq., London; A. Holman, Esq., London; W. Tyler, Esq.,
London ; Henry Steele, Esq., London ; Mr. Sargcant, Mr. Squ’re, Dr.
Carpenter, T. Hodson, Esq., Mr. Short, W. H. Snndhani, Esq., Coik ;
B. Godfrey, Esq., Enfl-ld ; Mr. Wilson, Mr. Whitford, London; Dr.
McCall Anderson, Glasgow ; Dr. Lane, Bishops Castle ; Mr. Owen; Dr.
Llaue ; Dr. Martin, Blackwaterstown; Dr. Waters, Tramare; Dr. Saunder-
son. Edenderry ;Dr.Leeper, Longhall; Dr Williams, Dingle; Dr. MeGurty,
Dclany, Kilkenny; Dr. Knotts, Castlebar; Dr. Swayne, Eallena;
Dr. Lyster, Kilkenny; Dr. Stobart, Cork ; Dr. Sharkey, Ballinasloe ; Dr.
•Stadden, Skibbereen; Dr. Reardon, Kiltarmer, Dr. Russell, Fermoy;
Dr. Crennian, Monasteraboice; Dr. Davidson, Dromara ; Dr. Gausscn,
Belfast; Dr. Mulvany, Dundalk : Mr. Stalden, Liverpool; Dr. Stand-
held Jones, Dr. Johnson, Dr. Tidy, Dr. Gordon, Dr. Wolfe, Glasgow ;
D- Phelan, Esq., 4c., Ac.
BOOKS, PAMPHLETS, &c., RECEIVED.
Economy of Life. By OeoTge Miles. London: Trubner A C >.
Half-yearly Compendium of Medical Science. Philadelphia : L. W.
Butler.
Diseases of the Urinary Organ . By Sir Henry Thompson. London :
John Churchill and Sons.
\ Dictionary of Materia Medica and Therapeutics. By Adolphe
Wahlsuch, M D. London: John Churchill and Sons.
Manual of Skin Diseases. Second Edition. By Tilbury Fox, M.D.
London: Henry Ren«haw.
Comparative Auatomy and Physiology of Vertebrates. Vol. III. By
Professor Owen, F.R.8. London : Longmans, Green. & Co.
Established 1848.
PROFESSIONAL AGENCY AND MEDICAL TRANSFER OFFICE.
60, Lincoln’s-inn-fields, W.C.
TUTR. J. BAXTER LANGLEY, M.R.C.S., E.L.S.,
^ &c. (Kino's Coll.), has always' upon his books a hugs
number of desirable investments and available opening* for Medical
Men commencing their professional career. Gentlemen wishing to re¬
linquish practice can be introduced without delay to competent succes¬
sors with means at their disposal.
Mr. Langley devotes his prompt personal attention to the negotiations
entrusted to him, and treats confidentially and with care all matters re¬
lating to professional business. The strictest reserve will be practised ia
all the preliminary arrangements and no expense incurred (except ia
special cases) unless a negotiation be completed.
The business of the Professional Agency is based upon the general
principle that no charge is made unless work has been done and services
rendered.
A prompt and just system secured a large measure of success to the
General Partnership and Commercial Agency Business formerly con¬
ducted by him at his City offices: this has for some yean been trans¬
ferred to Lincoln’s-inn-fidds, and he has invariably adopted the sane
equitable policy in the more professional matters placed in his hands.
Thus his experience in the management of Urge commercial under¬
takings, combined with his medical, scientific, and literary acquire-
JUtoertiseiumts.
NOTICE TO ADVEBTISEBS.
%\t IpMntl frrss wh Similar
OFFERS UNUSUAL ADVANTAGES
F OR the Insertion of announcements from its extensive
and largely increasing circulation in each of the three
divisions of the United Kingdom and the Colonies. Being also
supplied to the Hospital Libraries, &c., it will be found a most
valuable medium for Advertisements of Books, Vacancies and
Appointments, Sales, and Transfers of Practices,8orgical Instruments,
Chemicals, and Trades generally.
The scale of charges is as follows
Sevenlines and under. £0 8s. 6d.
Per line afterwards. 0 Os. 6d.
One-quarter page?. 1 6s. Od.
Half „ . 2 5s. Od.
One „ . 4 Os. Od.
The average of words per line is twelve.
When advertisements are given for a series of insertions, a very con¬
siderable reduction from the above scale is made.
^-Advertisements for Insertion in this Journal must be at the
Office, on Saturday, by Two o’clock.
HEALING POWDER.
FOR BURNS, ULCERS, ERUPTION8, EXCORIATIONS, AND
TENDER SKINS.
table regard to the int erests of all the parties concerned. As sa
Arbitrator on matters of dispute between professional men, Mr. Lansky
has had great experience, and he can refer to numerous cases in whim
he has been the means of preventing expensive and tedious litigation,
and in which his awards have been made roles of her Majesty's Oomts
at Westminster.
Mr. Langley can also refer to the Professors of his College, Members
of Parliament, Clergy, Merchants, Bankers and others, as a guarantee
of his integrity and honour in all negotiations entrusted to him.
Full information as to terms, Ac., sent free on application.
__Office Hours from 11 till 4; Saturdays from 11 till t.
M R. LANGLEY’S Quarterly Liat ot Selected P radices and
Partnerships for Transfer, In town and country, is now ready.
Free by post for two stamps. Address ah above. _
P HYSICIAN’S PR ACT ICE.— The succession to to
excellent Consulting and Visiting PR\CTICK in one of the be»t
country towns is open to negotiation. A valuable Hospital Appoint¬
ment is associated with the practice, and could be transferred to a suit*
a^le successor. Application to be made Immediately to X 425, Mr,
Langley, as ahov*. _
Ol QAA A-YEAR.—In a very fashionable and lanre
Xr1 jOl/V Water ng place in Yorkshire, a good Family PRACTICE,
forTuANSFBR. Recdpts steadily increasing each year. An intro¬
duction as}Partner will be given. The residence is beautifully situated,
and the practice is easily worked. Address X 321, Mr. Lan-jley, a>above.
I N a lnrgo town, with great scope for increase, a PRACTICE
for TRANSFER. Receipts £300 a-year; Appointments £25. IB-
Ileal (h the cause of retirement Terms, a year * purchase. AddrwN
X 428, Mr. Langley, as al>ovc._
P LEASANT country PRACTICE for TRANSFER.—
Actual receipts about £5 *0 a-year, including an easily-worked
Union Appointment. The investment is saf.*, as the whole connection is
transferable to a suitable man. Comfortable house, with garden and
orchard, situate in the centre of the practice. No opposition within four
and a-half miles Patients consist of clergy, gentry, fanners, die. Good
fishing and hunting. Books open for investigation. Address, X 4.7
Mr. La n gley, as above. _ ,
F irst-class partnership for negotiation.-
A very old-established connection in an improving country tow*.
Clubs and Union hsve been declined. Patients of the best class. Pre¬
sent income £800 a-year, but capable of great increase by the co-ope¬
ration of a suitable partner. The junior partner could reside in th-. horns
of the senior if {.desired. A local Hospital is about to be established.
Terras moderate. Address, X 428, Mr. Langley, as above.
A W KLL-ESTABLISHED PRACTICE in a HidES
District for TRANSFER. The present average receipts are about
£800 a-year, but capable of great increase. The patients are of a good
cla^s, and there are educational opportunities in the viciuity. The boa<e
is commodious, with garden, greenhouse, stabliug, and laud. An acci¬
dent compels the vendor to retire. - Reasonable terms would be con¬
ceded, and the whole connexion is believed to be transferable. Address,
X 422, Mr. Iangley, as above.
PASHA,
A PREPARATION which has for years 6tood the
test of Medical experience, as possessing Healing
Fbofeeties of a most Marked and rapid character.
Price 6s. per lb.
CempotUion
Ubdical §?tr $$ & Circular,
tl SALtJS POPULI SUPREMA LEX.”
WEDNESDAY, DECEMBER 9, 1 86 8.
CONTENTS.
LECTURE. paob
Introductory Address deliver, d at the
Meath Hospital, Dublin, by Rawdon
Macnamara, F.RC.S,, Ac. 481
ORIGINAL COMMUNICATIONS.
On a New Sphygmograpb. Invented b:
ML Longuet. Translated by Thomas \V.
Oriniahaw . 485
HOSPITAL REPORTS.
Mrrckr’s Hospital—
Calcnlus in the Bladder—Lithotritjr—
Successful Issue. By Mr. Morgan. 4S6
Cases from Melbourne. By Mr. Henry
Lee, of St. George's Hospital. 487
Cork strict Fkvei Hospital—
Under the care of Dr. Grimshaw. 488
KTiro's Collkob Hospital—
Cases under the care of Dr. Beale, F.R. 8 .
(From Notes by Dr. Tonge). 488
SCOTLAND.
Scottish Hospital in London. 4S9
Scottish Registers. 489
PAGE
The Universities of Edinburgh and St.
I Andrew's. 489
j Glasgow and Aberdeen Universiti-s. 489
LEADING ARTICLES.
Educational Reform — No. II. 490
Homeopathy in thb Edinburgh Rotal
Infirmary. 491
Army Medical Department for thk
1 Year 188*5. 491
NOTES ON CURRENT TOPICS.
New Examination in Operative Surgery
in the Ro)al Co lege of Surgeons in Ire¬
land. 492
Superannuation of Irish Poor-law Medical
Officers . 493
Sir Dominic Corrigan. 492
J unior Surgical 8 ociet.y. 498
The last Appointment of the late Govern¬
ment . 498
Medical Evidence . 493
French Medical Bibliography. 49 S
The Manslaughter of a Medical Student in
Dublin. 493
Goodair’s Anatomical Works. 494
Public Heal tli. 494
PAOB
Inquests in St. Pancras. 494
Te>timoni»l to Dr. Chowne. 494
Bridewell and Bethlehem Hospitals. 491
Fever in London. 494
Civic Honours to Medical Men. 495
A New Principle of Medical Editorship.. 495
1 lie Preservation of Meat. 49 $
Medico-Social Pencillings of London Life
and Practice. No. if. 496
CORRESPONDENCE.
Griffith on Dr. MacCormac's Plan of Ven¬
tilation . 497
Drysdale on the Fellowship of the College
of Physicians. 497
Hyne 00 Medical Represontaion in Parlia¬
ment . 497
LITERATURE.
Barton on the Nature and Treatment of
Syphilis. 498
Obituary. Gleaning*, Notices to Corre-
spondente ... 499
Introductory Address
DELIVERED AT
THE MEATH HOSPITAL, DUBLIN,
By RAWDON MACNAMARA, F.RC.S.;
Vic.-President Royal College of Surgeons In Ireland.
Mr. President and Gentlemen,—At the request of my
colleagues I have undertaken the duty of opening our
winter session here this year by what is generally termed
an introductory address; and at the very outset, like a
greedy schoolboy, I rush at what should, perhaps, be re¬
served as my bonne Louche, and in their name, as well as
on my own part, discharge by far the most pleasing por¬
tion of my task in bidding old and young, one and all, a j
right hearty welcome within these the time-honoured
portals of our good old Meath Hospital and County of
Dublin Infirmary. Lectures such as these have latterly
been decried as being trite and of but little interest, inas¬
much as they must of necessity be but the repetition, not
of a thrice told, but of a frequently told tale—a tale which
from frequent repetition must have lost all point and
zest, and to which more honour would be paid in the
breach than in the observance. I am not, however, of
those who think so, else I should not be here before you
this morning; but I can readily conceive that such should
be the sentiments of the veterans of our art—men who in
their youth and manhood have borne the heat and brunt
of the battle, and who in their old age yearn for repose—
forgetful of the fact that an eager phalanx of raw recruits
are pressing on in their rear, who must in the natural
course of events, more or less worthily as the case may
be, occupy their places, and to whom such lectures would
present all the charms that novelty can impart them.
Trite and worn out, then, as lectures such as these must
be to the distinguished visitors who honour me this morn¬
ing with their attendance, the young student may well
ask himself the cause of their presence, and wonder why,
by their gracious attendance, they inflict upon themselves
the tedium of listening to such crude remarks as must of
necessity be comprised in an address, in my opinion
seated for an occasion such as this. To such a question’
gentlemen, the answer mult he two-fold. The first rea
eon, and that for which I now tender them my grateftu
thanks, is, I flatter myself, some anxiety on their parts to
pay your lecturer every compliment in their power, and
by their presence to cheer me on in the discharge of my
duty towards you. The second, and by far the most im¬
portant, is to read you a practical lesson, to prove to you
by personal demonstration the successes, the nonours, the
dignities, that may await each one and all of you, should
you merit them by a diligent and conscientious discharge of
the duties which, doubtless, many of you have undertaken
here this day for the first time. Not one of the gentle¬
men present here this day, who by their labours and re¬
searches have enriched the literature of our profession,
and who have won for themselves social and professional
distinction, that did not as students, and that in many in¬
stances at no very remote period either, occupy seats upon
benches such as you fill here this morning. Is there, then,
gentlemen, no word of encouragement to you in their pre¬
sence here to-day 1 Can you fail in hearing the c< God
speed w which their very attendance here, as it were, wishes
you. In your name, then, gentlemen, as in my own, I thank
these visitors for the inconvenience to which they have put
themselves by coming amongst us this morning, and I
feel that I am but expressing their sentiments when I
assure you that the best tribute you can pay them, the
very best thanks you can return them, will be that here¬
after they shall witness or hear of your success, a success
which can only be insured by following the bright ex¬
amples they in their studious and laborious lives have set
you.
Such of you, gentlemen, as were in attendance upon
this hospital in the past session must recognise, and recog¬
nise with pleasure, some important changes in its present
appearance. The most striking of these changes are the
greatly improved means of access afforded you by ottr
new carriage drive, the enlargement of our grounds, the
vastly improved appearance of our entrance hall, the in¬
creased size of our previously miserably small accident
wards, the new entrance to the very lecture theatre in
which we are at present assembled, together with many
other minoT alterations to which it is unnecessary upon
the present occasion more particularly to allude. For
these alterations and improvements we are mainly indebted
to the exertions of our Standing Committee, who, without
fee or reward, exert themselves indefatigably for the best
interests of the institution ; and I think, gentlemen, I
may add, without fear of exciting invidious comparison,
that no member of that committee has worked more
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INTRODUCTORY ADDRESS.
December 9, 1668.
earnestly in carrying out these improvements than my
valued colleague, Mr. Collis. I understand that our
Standing Committee were much encouraged in their
efforts to carry out these improvements by the liberal
addition made to our annual income by the Corporation
of our city, for which they are entitled to the best thanks
of all who feel for suffering humanity, and who, at the
same time, interest themselves in the progress of our pro¬
fession ; but in an especial degree are we, to whom the
prosperity of this hospital must be so dear, deeply and
earnestly grateful to them for their well-timed liberality.
I regret, however, gentlemen, to have to add that with
our extended sphere of usefulness, so also have increased
the demands upon our resources; and at the present
moment the Standing Committee are sadly hampered from
want of funds to meet their engagements. It therefore
behoves all sincere well-wishers of this truly valuable in¬
stitution to redouble their efforts on its behalf, and to co¬
operate heart and hand with its governors in their efforts
to extricate it from its present difficulties. Whilst upon
this theme, I may be permitted to throw in a word in
season, specially addressed to the students of the hospital,
and it is this—that, individually, they should exert them¬
selves amongst their friends and relations to increase its
funds, and thereby extend its usefulness. It cannot be ex¬
pected that all should follow the bright example set them
by that fellow-student whose name, I remark, has recently
been inscribed upon the tablets which set forth the list of
our governors, “Edward Percival, a pupil of the hospital,
But each of you can do something in your immediate
circle, and the old Scotch maxim Bhould not be lost sight
of that “ Every little makes a muckle,” and you may depend
upon it, gentlemen, that to a true-hearted physician or
surgeon no pleasanter feeling can exist than that his
Alma Mater , the institution in which first his eyes
were taught to distinguish between darkness and light,
should prosper and flourish.
Passing from these material changes in our hospital I
have next to draw your attention to the introduction
of a new name amongst our surgical staff, in the room
of our former colleague, Dr. William Stokes, junior,
and here at once I may be permitted to congratulate
all true workers in our vocation that this change has
not been necessitated by any more untoward occurrence
than a natural desire on his part to shift the scene of
his labours to an institution which early associations
had rendered more congenial to his tastes. He still
lives and labours in our midst, and I trust will long be
spared to enhance the reputation of a name distinguished
in our medical annals now to the third generation. In
his place we have secured for you the services of Mr.
Stronge. Had this gentleman’s appointment been but
of a few days’ duration, I should have felt it my duty,
as my privilege, to enlarge upon his qualifications for
the post—qualifications vouched to us by a most successful
professional career, by a most distinguished provincial
reputation, by a life professionally and otherwise irre¬
proachable as to honour, integrity and the nicest sense
of what becomes the Christian and the gentleman. But
as circumstances have so eventuated, it is quite unne¬
cessary for me here to enlarge upon his merits. His
appointment now dates back so far, that you yourselves
are competent to decide upon the point/ He has been
working now amongst you for some months. You are
witnesses to his zeal, skill, urbanity, and courteous
demeanour. To you, gentlemen, with confidence, I leave
the decision, and I am sure that your sense of justice
and keen appreciation of all that should characterize
a conscientious, hard-working, and able clinical instructor,
will ratify the decision of the Medical Board. (Great
applause.^ Gentlemen, I accept your verdict, and shall
see that it be recorded in Mr. Stronge’s favour. I regret
that, owing to severe indisposition, he is not here per¬
sonally to receive it at your nands.
Of late years the question has been rather keenly debated,
whether medicine has or has not any right to claim for
itself a position amongst the exact sciences. I here employ
the term medicine in the most comprehensive sense of the
word, and wish to be understood as including in it all the
many collateral branches into which the healing art has,
in modern times, been subdivided. Those who claim for
it such a position do so, doubtless, with the best inten¬
tions, and with a laudable anxiety to elevate its status.
But, in my opinion, they who claim for it such a posi¬
tion, ignore the essential principles upon which medi¬
cine must unalterably be founded, and do injustice to
the vast difficulties which attend upon the successful pur¬
suit of the healing art; difficulties far greater than attend
upon the study of any of those sciences which have their
claims freely admitted to the term exact. To illustrate
my meaning, let us for one moment reflect upon what
would be the position of the mathematician who
attempted to solve any problem, taking for the basis of
his calculations the labour of some preceding mathemati¬
cian into whose calculations some fundamental error had
inadvertently crept—no matter how accurately his por¬
tion of the problem may have been worked out, a radical
error such as this must vitiate his conclusions, and leave
him no other resource than to commence his calculations
de novo , to establish the principles upon a sounder basis,
when he may expect more accurate results. Medicine,
;entlemen, is precisely in this position. So far as she
lerself is concerned, she may be tne most exact of all the
sciences, but thanks to the follies, the sins, and the here¬
ditary curse of man, in her case the preliminary calcula¬
tions are of the most uncertain, of tne falsest character,
and consequently the results are but too frequently of the
most disappointing nature. And yet withal, how noble,
how imposing is the superstructure which its votaries
have erected upon these shifting quicksands ! How
arduous, how meritorious must have been the labours of
those who in spite of all such almost insuperable difficul¬
ties have advanced medicine to its present proud position.
Gentlemen, it will be yours still further to advance the
reputation and utility of your art, you must see to it that
you fittingly qualify yourselves for the task even now, at
the very threshold of your studies. Medicine may well
be described as a tripod, the legs upon which it
rests being anatomy, pathology, and chemistry. No
doubt, in the course of the next few days, you will
have sufficiently impressed upon your minds the all¬
importance of the study of anatomy, and of its eldest
born, physiology, in the opening addresses which
will be delivered to you at your respective schools of medi¬
cine. I shall content myself with observing, that the
importance of these portions of your medical education
cannot be too strongly enforced upon your attention, in¬
asmuch as that whilst now every facility will be afforded
you for the pursuit of your anatomical studies, hereafter
such facilities will not be forthcoming, and ahonld you
neglect your present opportunities, in time to come, believe
me, gentlemen, that you will bitterly regret such neglect.
Shortcomings in almost every other branch of your studies
may be supplemented by diligent application during your
future professional career; not so with anatomy. In the
words of Professor Hargrave, so lately enunciated to you
in the able address delivered by him at the opening of our
session, at the College of Surgeons, this study on your part
must be “ Nunc aut nunquam.” Were further argument
required, to carry conviction to your minds, it would be
found in the devotion shown by the great master minds of
surgery to anatomical pursuits. In the very zenith of their
professional successes, it is well known to us all how John
Hunter and Sir Astley Cooper found their greatest plea¬
sure and relaxation in renewing and perfecting their anato¬
mical knowledge. Admittedly all important then as is to
you the study of anatomy, perhaps not much less so to the
science of our profession is an intimate acquaintance with
the facts and laws of chemistry. Each day does its
wondrous bearing upon vital problems become more ap¬
parent, and more ana more is it pressed into the service of
physiology. Were our present knowledge of chemistry no
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INTRODUCTORY ADDRESS.
December 0,1868. 463
more accurate than it was in the days of Paracelsus, then
indeed the claims of medicine to rank amongst the sciences
would be poor indeed, but to discuss this subject further
would be foreign to the scope’ of an address suited for an
occasion such as this. I must rather hurry on to the con¬
sideration of the third leg of ray tripod, pathology, which
intimately concerns us here, inasmuch as its study must be
most beneficially carried on within the walls of the institu¬
tion where during life the symptoms of the disease which,
in spite of our best directed efforts, at last has proved
fatal had been observed. In pathological investigations
we will frequently find the solution of the enigma which
during life had perplexed and baffled us; and it is as much
your duty, gentlemen, to attend in our mortuaries the in¬
vestigation into the nature of the disease, and the cause of
the failure in our efforts to cure it, as it was your business
to watch in our wards the symptoms presented during life
by the patient. Every such investigation is attended with
special instruction, and no one can predict how soon the
information so acquired may prove of incalculable service
in the treatment of a suffering fellow-being. Day by day
is the value of pathological study becoming more fully
recognised, and it is a proud boast for the Dublin School
of Medicine to be enabled with truth to assert that years
before a similar society existed either in the London or
Edinburgh schools, the Dublin Pathological Society had
attained a high rank amongst scientific associations. And
here permit me to impress upon such of you as shall be
allowed the high privilege of attending its meetings, to be
punctual in your visits and earnest in your study of the
various diseased structures which will be brought under
your observation. To the industrious and intelligent
student this society holds out many attractions, prominent
amongst which may be enumerated the gold and silver
medals annually awarded at the termination of each
session to the authors of the best theses on some patho¬
logical subject, the nature of which is specified at their first
meeting. An inspection of the shields which hang above
our heads in this theatre, gentlemen, will show that a
goodly number of these most honourable distinctions has
fallen to the lot of former students in this hospital.
Not many more than twenty years have elapsed, gentle¬
men, since the majority of your present staff occupied, as
pupils, seats upon the benches which you now fill. It is not
much more than that number of years since your present
senior surgeon, the President of our College of Surgeons,
my distinguished colleague, Mr. Porter, was, as you now are,
a student within the walls of this hospital. Twenty years,
gentlemen, may be a long time for you to look forward to,
believe me it is but a short time for us to look back to.
Yet, what changes in the history of surgery have come to
pass within these twenty years. Science within this period
may boast of telegraphy and photography, yet, a strict
sense of honesty would entitle us to claim these modem
marvels of science to be placed to the account of medicine,
inasmuch as they are the offspring of one of its branches—
chemistry. We shall let that pass, however, and confine
ourselves now to matters purely surgical. Twenty years
ago, doubtless, all of us thought then, as probably you think
now, that there was room but for little improvement in
our art, and little indeed could even the most sanguine
amongst us have dreamt of the vast strides surgery was
destined to take within the next twenty years. At the
period to which I allude the severest operations in surgery
had to be performed upon the conscious patient writhing
and screaming with agony. I well remember the strong
man grinding his teeth to keep down the groan that he
fancied would disgrace his manhood. The terrified and
agonizing cry of the child vainly calling upon its M mother,
mother,” to save it, still rings upon my ear, and dwells
upon my memory. Even ctill, I can see the poof, wretched,
all but heart-broken mother sitting in our waiting-room,
sobbing convulsively, with head wrapped up to exclude the
sounds of her darling's agony—impotent to give it relief,
and knowing well how essential to that darling's life was
all this seeming cruelty. These, gentlemen, were harrowing
scenes, now, blessed be the great and good God, for ever
banished from our operating theatres by the wondrous,
priceless gift of chloroform. The inestimable boon that
chloroform has unquestionably proved to suffering humanity
cannot be overstated ; and, like all other immortal dis¬
coveries, its illustrious prophet must look for the due
appreciation of the value of his labours to generations yet
to come. It is an ungrateful fact to have to state, and,
perhaps, to the ardent mind of youth, a discouraging one
to boot, that all experience justifies me in thinking that to
the words “ a prophet has no honour in his own country,"
may well be added, “ nor in the century within which he
lives.” This, however, is a theme upon which I shall no
longer dwell. I shall leave it, at all events, for the pre¬
sent, and resume the thread of my discourse. That oc¬
casionally, though rarely, we meet with cases in which the
exhibition of chloroform, from some mysterious and
hitherto undisclosed cause, is attended with fatal results,
is now-a-days a fact so admitted that the well-informed
surgeon naturally hesitates to recommend its use unless in
cases the gravity and severity of which imperatively
demand its administration. I say advisedly “ the well-
informed surgeon hesitates," for in this, as in many other
instances, “ fools rush in where angels fear to tread.” Hence
it was that until the past year or so we frequently con¬
sidered it more prudent to permit patients to suffer tran¬
sitory pain, intense though for the moment it might be,
than to subject them to the extra chance of death, infini¬
tesimal though that chance admittedly is which the
exhibition of chloroform, even in the most skilful hands,
involves. Now, however, it is no longer necessary that
even in these trivial cases patients should suffer pain,
thanks to the laborious and scientific labour of Dr. Richard¬
son of London. In local anaesthesia we find an admirable
substitute for chloroform in cases of the character to which
I allude. Tumours can be excised, whitlows incised (per¬
haps for the time it occupies by far the most painful
procedure in surgery), abscesses opened, and many other
similar operations carried out by the surgeon, whilst all
the time the patient calmly looks on, perfectly unconscious
of the agony which otherwise he unquestionably should
have suffered. At the time to which I allude, gentlemen,
limbs were ruthlessly sacrificed which now-a-days are
saved. Resection of joints has in many instances taken
the place of amputation of limbs, and at the present
moment people are walking about on legs which twenty
years ago would have been removed, ana are feeding ana
supporting themselves with arms which then would have
been consigned to the tender mercies of the amputating
knife. To this important development of conservative
surgery Irish surgeons have contributed their full quota.
. . . . At the period to which I allude, the patient
suffering under popliteal aneurism had no other alternative
affordea him than to submit to a difficult and dangerous
operation, deligation of the femoral artery—an operation
which frequently, from causes independent of the operator,
terminated fatally. Now, thanks to the labours of our
Dublin sturgeon*—foremost amongst whom must be named
the late lamented Doctor Bellingham—ligature of the
femoral artery, with all its concomitant dangers, is an
operation rarely in this city called for ; the treatment by
external compression proving eminently successful. A
strange feature in connection with this mode of treatment
is that, even to the present moment, our Irish surgeons
seem to enjoy a speciality in it—it not having even as yet
taken its legitimate position amongst surgeons on the
other side of the Channel. What I should say is the
characteristic feature in Irish surgery is, that it is pre¬
eminently eclectic. No sooner do we hear of a novelty in
practice than it becomes to us the subject of thoughtful
consideration. Not rashly taking it up because of its
novelty, we view it with all the lights which modem science
can throw upon it, and, if weighed in this manner, the
procedure seems to have merit, we practically test it, and
the result of our experience we honestly communicate to
our fellow-labourer*. By such means only we conceive
Digitized by
484 The Medical Press and Circular.
INTRODUCTORY ADDRESS.
December 9,1868.
can our profession be advanced ; to act otherwise would
be but to apply drags to the chariot wheels of surgical
science, to deprive those who consult us of the advantages
of modern improvements in our art, and in the end sen¬
sibly to affect the proud position now enjoyed by our Irish
School of Surgery. Intimately connected with the treat¬
ment of aneurism by compression, must always be ligature
of the femoral artery, inasmuch as in cases of failure by
the former plan of treatment, the latter must be the sur¬
geon’s last appeal. In studying the history of deligation
of the femoral artery, it is interesting to remark how the
progressive tendency of the surgical mind is to apply the
ligature at increasing distances from the site of the disease.
Tims Hunter applied it in the centre of its course, in that
space which still bears his name. Antonio Scarpa, selecting
a site higher up, gave his name to the space in which now
it is most frequently deligated. But within the period to
which I am confining these remarks, that surgeon of whom
we in this hospital are so iustly proud, the late Professor
Porter, selected a site still higher up, in which, as he
proved, the artery could be reached with greater facility,
and secured with greater safety to the patient’s life. Had
he been bom an Englishman, or even an Italian, this
space would long ere now have been described in the
annals of English surgery as Porter’s space. But, gentle¬
men, unfortunately in this particular for himself, though
fortunately for the reputation of our Irish school of sur¬
gery, he was Dublin bora and bred ; and inasmuch as it
takes a long time for facts in surgery of Irish origin to
travel eastward, we must only console ourselves with the
truth of the maxim, “ Magna est veritas, et prevalebit.”
In a communication which I had the honour of making to
the British Medical Association at their meeting here last
year, which communication will be found in the pages of
the Journal of the Association for the year 1867,1 entered
somewhat fully into this subject in connection with a case
in which I successfully delegated the femoral artery in
Porter’s space; and, as I flatter myself, proved to the satis¬
faction of all present that so far as our present statistics
go, this operation most justly claims a foremost rank
amongst the great advances made within the past twenty
years in the science and art of Burgery. Were a surgeon
some twenty years ago consulted by a patient labouring
under ovanan disease, what line of treatment could he
adopt ? what amount of hope as to ultimate recovery could
he honestly hold forth ? At that period, gentlemen, his
treatment could only be palliative, and as to hope of
ultimate recovery, little, indeed, could he afford the
wretched sufferer. It is true that some temporary relief
might have been afforded by the trocar ; but only that in
the vast majority of cases her sufferings should speedily
return, and her doom was but too surely, at no far distant
period, a grave. How now are matters with us ? I sup¬
pose, gentlemen, that I am by no means overstating the
results of the modern operations for ovariotomy, when I
assert that the number of patients thus rescued from all
but certain death can now be counted by hundreds, whilst
in former times the most skilful treatment could only
boast of its units.
Let us consider, gentlemen, how within the past few
ears that most formidable disease, stone in the bladder,
as been to a great extent deprived of its dangers and
robbed of its horrors by the substitution in suitable cases
of the operation of lithotrity for lithotomy, a substitution
which has been brought about within the period to which
I allude. Again, gentlemen, when I was a student, cases
of urethral stricture required a period of from six to eight
weeks for their successful treatment. How often have
you not now-a-days, within the walls of this very hos¬
pital, seen such cases effectually cured in a fewer number
of minutes ? From the earliest records of operative sur¬
gery down to the days of Ambrose Pare, and even later,
the descriptions we have of surgical operations were but
one page of sickening horrors. To the student looking
over tne historical records of our profession no subject
can present greeter or yet more painful interest than the
methods adopted in the older times for the arrest of
hcemorrhage after surgical operations. To a person pos¬
sessed of a vivid imagination and of a humane disposi¬
tion, nothing can be more harrowing than the calm way
in which is described the employment of a knife, heated
to redness, with which to make the incisions, and, at the
same time, staunch the bleeding. In spite of ourselves
we cannot avoid reproducing iu our imagination the
heart-rending screams of the patient, struggling fiercely,
but ineffectually—for he is firmly bound, and anaesthetic
agents are unknown ; the hissing of the poor creature’s
flesh as the glowing knife traverses it, the sickening
odour that arises from the cauterised tissues, the screams,
at last, become hoarser, as they issue from a throat
parched with agony, and weaker, as they are emitted
from a frame exhausted by physical suffering and the un¬
avoidable loss of blood ; tne subsequent application of
red-hot cauteries, more screaming, more hissing, more
odours ; and, as if all this were not sufficient, agony is
piled upon agony by the occasional additional application
of boiling oils, boiling pitch, boiling turpentine, melted
lard, melted sulphur, &c., according as the individual pre¬
dilections of the operator prompted him. Whilst the
subsequent dressings of the stump of such of those as sur¬
vived the operation bring up equally painful associations;
the grim list of digestives employed not being one whit
more merciful, u Oyle of Elders boiling hot/* being that
most in vogue during Ambrose Pare’s earlier experiences.
All honour, then, to that Ambrose Pare who delivered us
from all such cruel necessities by the heaven-sent inspi¬
ration—I can scarcely content myself with calling it in¬
vention—of the ligature ; an invention which apparently
gave such relief to the minds of surgeons, as a calm suc¬
ceeding a storm, that until within the past few years they
have rested satisfied with it, notwithstanding its nume¬
rous and frequently acknowledged drawbacks and incon¬
veniences. Believe me, gentlemen, that no conscientious
surgeon sleeps upon a bed of roses, so long a9 the ligature
which he has tied upon one of the principal arteries has
not come way. No ; the sword of Damocles is suspended
over his head until that event happily arrives, and then
how deep is the sigh of relief which at last he draws!
Thanks to the energy of that great man, Sir James
Simpson, surgeons at last are being aroused from their
state of lethargic contentment, and acupressure is upon
its trial. Whether it will fulfil or not all our require¬
ments, I am not as yet in a position positively to state.
As you are aware, gentlemen, I am subjecting it to the
crucial test of experience in every suitable case, but im¬
portant problems such as this require extended clinical
investigation; anything short of that would be but to
betray the trust confided to our charge. That acupres¬
sure has proved emiuently successful in many of the cases,
and those of great gravity, in which I have employed it,
is true—that in the hands of other surgeons, especially
those of Aberdeen, in severe surgical cases, its reputation
has even been more signally upheld, is also true; and
that it may yet eventually to a great extent, if not alto¬
gether, dethrone its long-established rival, the ligature,
iu the hands of all unprejudiced surgeons, may be pro¬
bable ; but even should all these anticipations be diWp-
pointed, should it utterly fail in realizing the hopes of
even the least sanguine amongst us, it will have done one
good service to the progress of scientific surgery—it ha?
roused us from apathy, it has opened our eyes to the im¬
perfections of the ligature, it has set our nunds to work;
in one expressive word, it has put us upon our mettle;
and as tne result, gentlemen, I feel convinced that the
days of the ligature, if not actually numbered, are de¬
cidedly shortened. In my early days patients suffer¬
ing under fractured legs were confined for weeks upon
weeks to their beds. Now, within a few days of the
accident, we meet them walking about our wards. For¬
merly silk, hemp, or some other organic substance, was
our only form of suture; now iron and silver wire occupy
their place with resulting advantages too numerous here
Digitized by
Google
The Medical Press and Circular.
ORIGINAL COMMUNICATIONS.
December 9,1868. 485
to enumerate, but which a few months spent in our wards
will enable you to appreciate. Even at the moment at
which I speak operative surgery is threatened with being
completely revolutionised as to its results by the carbolic
acid treatment of Professor Lister. Vesico-vaginal fistula)
no longer consign their wretched victims to a miserable
life, to which in many instances death itself is preferable.
Fissured palates no longer are dependent upon mechauical
means for their relief. Deformities now more rarely
offend our eyes, and surgery, as Alexander of old, bids
fair soon to have to sigh for new worlds to conquer. I
have considered, gentlemen, that a retrospect such as this
of the events that have occurred in surgery within my
own recollection, cursory and incomplete though of ne¬
cessity it should be, cannot be unattended with some ad¬
vantage to you. It must tend to prove that if such strides
have been taken in the comparatively few years that have
elapsed since I, like yourselves, was a student, what may
not be looked for before the next period of twenty years
has expired? You have physical aids to investigation
absolutely unknown to the studeut twenty years ago, or
inaccessible from their price. Then a savant would feel
proud of the possession of the instrument which at the
present day, in consequence of its moderate price, is
termed the Students’ Microscope. Our only means of
examining the throat and windpipe was the spoon, with
which we depressed the tongue ; you have the laryngo¬
scope. Visual examination was the only means we had
of ascertaining the nature of diseases of the nostrils—
a method by which we were utterly at fault when the
posterior aures were the seat of the disease; you have
the rhinoscope. For diseases of the rectum and vagina
it is true we had specula of various forms ; but, in
addition to those, you have now the endoscope, whilst
the osteoscope and the ophthalmoscope give you great ad¬
vantages in the study of diseases respectively of the ear
and of the eyes. Of a verity, gentlemen, much is now
intrusted to your charge; see to it, that hereafter you
will be able to give a good account of your stewardship.
My time here, gentlemen, is rapidly drawing to a close,
and yet would I fain say a word more to you, not so
much about your professional as your extra-professional
studies. As yet, none of our licensing bodies demand of
you proofs of having studied hygiene, and yet, perhaps,
it is the one subject of all others most important to the
public weal, that to the value of which the public gene¬
rally are becoming more alive. Upon a thorough ac¬
quaintance with its principles the health not only of
individuals, but of communities, depends. And here
again, at the risk of being considered vainglorious, I will
venture to assert that Irish surgery has taken the lead.
Years since, in 1844, our College of Surgeons established
a professorship of hygiene ; the lectures are delivered
during a comparatively unoccupied period of your year,
in the summer session ; no fee is exacted for attendance
upon them; they are open to all comers, lay or medical,
male or female ; the reputation of the professor, Dr.
Cameron, is sufficient guarantee for the manner in which
the duties of the chair are discharged. Let me, then,
most earnestly impress upon you the importance of
taking advantage of this opportunity afforded you of be¬
coming versed in a subject which hereafter will prove of
such importance to you in your professional relations.
“ All work and no play makes Jack a dull boy,” is an old,
and, I believe, a true adage; and what is true of the boy
doubtless is true of the student. You cannot—nay, more,
you ought not —employ all your hours in the study of
medicine ; you must have some relaxation. In spite of
what has been frequently urged elsewhere. I believe that
the preliminary education of medical students has been
muen improved of late years. I believe, also, that much
of this improvement is due to the steady enforcement by
our College of Surgeons of an amount of information on
the part of those who pass our preliminary examination,
equivalent—to state it in the mildest manner—to what
would enable the student to pass the entrance examina¬
tion in Trinity College. Whilst, therefore, I cheerfully
acknowledge this improvement in vour preliminary
studies, still I fear that, as a rule, there is a sad defi¬
ciency upon your parts, so far as an acquaintance with
modern languages is concerned. Now, gentlemen, if you
but knew the amount of absolute pleasure of which you
thus deprive yourselves, I think you would make some
exertion to remedy this state of things. When tired of
professional work, if, instead of seeking questionable
hauuts of so-called pleasure, you would only attend some
of the numerous evening classes carried on in our city
for the study of modern languages, you would unbend
the bow, and at the same time discover that for which the
profligate and effeminate monarch of old sought in vain
—a new pleasure. At the present period of your life it
would be impossible for you to estimate at its just value
the future importance to you of a moderate knowledge of
even one of the continental languages. In conclusion,
gentlemen, permit me to remind you that it is in the
wards of your hospital that you are to study disease, that
there it is you will see carried into practice all the theo¬
retic precepts inculcated upon you elsewhere, that disease
is Protean in its character, daily, nay, hourly, changing
its features, and that hence will it demand of you the
closer study ; that to miss one day’s observation of the
case in which you take an interest is, as it were, to lose
the thread of a discourse, and may render all your pre¬
vious attention of but little avail. Let me advise you to
be puuctual in your attendance here each morning. In
your intercourse with the sick entrusted to your charge,
be kind, be forbearing, be gentle, be humane, remember¬
ing that they are your fellow’-men, God’s creatures, in but
too many instances, sadly and sorely afflicted. Upon
your return to your homes each evening, reflect over the
observations you have heard made upon their cases by
the suigeons in attendance, contrast these observations
with the phenomena of the disease which your owm
powers of observation have enabled you to collect, read
concurrently the w orks of authors of standard reputation
upon the subjects of your morning’s study, preferring as
much as may be monographs to manuals, and in your
reading let the words of Bacon ever influence you—
(< Read not to contradict and confute, nor to believe and
take for granted, nor to find talk and discourse, but to
weigh and consider.” If with all this you cultivate the
habit of accurately recording the cases entrusted to your
charge ; if you seize every opportunity of practically fa¬
miliarising yourself with such details of minor surgery
as usually falls to the lot of students in an hospital, you
will have done much to qualify yourselves hereafter to
discharge with credit the duties which may devolve upon
you. Gentlemen, 1 have dene ; but before we part I
have a solemn message to give you—a message the more
worthy of your attention, inasmuch as ages ago it ema¬
nated "from the lips of the wisest human Deing who ever
lived—it is contained in a few words, and is simply this
—The fear of the Lord is the beginning of wisdom.”
-«-
#ri0iaRl Camittttititatiaws.
ON A NEW SPHYGMOGRAPH.
Invented by M. Longuet.
Translated by Thomas W. Orimshaw, M.D.,
One of the Physicians to Cork Street Fever Hoapital; Lecturer on
Materia Medica in Steevens’ Hospital.
M. Behif.r exhibited at the Academic de M4d4cine, on
the 10th of November, a new Sphygmograph, the inven¬
tion of M. Longuet, of which he gave the following
description:—
The essential part of 'the instrument consists of a verti-*
cal stem A, (see fig.) terminating above in a crutch-shaped
Digitized by 1^,000 Le
486 The Medical Press and Circular.
r HOSPITAL REPORTS.
December 9,1848.
The instrument has the following advantages over that
M. Marey. 1st. The arm does not experience any
•essure except at three points of little extent, namely,
v~e two supports and the terminal plate. This pressure
is ----
2nd. The mode of support of the
plication c. _— 1—--
L • . i .a -i.__ nr c«:_l^„
extremity B, to which is attached a thread, which is
wound round a moveable axle, and its lower end terminates
in a plate and button, which presses upon the skin cover¬
ing the artery to be examined.
A spring C presses against this stem which it depresses,
after tlie stem has been raised from below by the shock of
the artery. Upon the moveable axle is fixed a wheel H,
which by each movement of the artery is made to describe
an arc of a circle proportional to the force communicated to
the vertical stem by the shock of the arterial pulsation.
e two supports and the terminal plate.
not sufficient to obstruct the venous circulation.
____ “ » arm permits the ap-
of the instrument to children, thus supplying
pointed out by M. Siredey in the examination of
young subjects.
3rd. The pressure upon the artery is made perpen¬
dicularly and is much more limited, the tracing is conse¬
quently more precise.
4th/ The pen is much more manageable than that of
M. Marey ; it is not only capable of being removed with¬
out changing the position of the instrument, but also its
holder can be lengthened or shortened, by which the
described arc can he increased or diminished, the result
being that the tracing from the same pulse can be rendered
more or less ample according to the object of the experi¬
ment. The indications given by the instrument remain,
however, comparable with one another.
5th. The dynamometer not only indicates the general
presence (as the dynamometer adapted to Marey^s sphyg-
mograph by M. Bchier), but also the force exercised by
the pulsation.
6th. The movement of the clockwork lasts longer than
in Mary’s sphvgmograph, allowing the employment of
a longer band‘of paper, and permits the registration
the endless
be used.
arranged and applied without
7th. Enamelled paper is not required
hands used for telegraph purposes may '
8th. The apparatus can oe i v
any pressure upon the artery, (an ini-
the stem mal. — v ^ A ,. .
provement already introduced into Marey’s instrument ly
Si. Befiier).
9th. The sliding rest, upon which the w hole apparatus
supported, is moveable in such a way that the terminal
ate and button can be moved outside the stand by giving
e apparatus a turn, thus making the instrument avail-
>le for examining the pulsation of the heart, the
moral, &c., by applying the stand upon the chest,
MERCERS' HOSPITAL.
CALCULUS IN THE BLADDER WITH REFLEX rAJtALYSIS—
LITHOTRITV.
Successful issue.
By Mr. Morgan, F.R.C.S.I., Surgeon to the Hospital.
M.B., jet. thirty-eight, a musician and ex-pensioner in
the army, and father of four children, was admitted July
10, 1868, being sent from the country as an aggravated
case of paraplegia. He gave the following history
About eight months previously he suffered from pains in
the lower limbs, the legs were cedematous, and he was
troubled by incontinence of urine. The lower extremi¬
ties became completely paralysed, alternating with spas¬
modic contractions at intervals. An extensive slough
formed over the sacrum, and he suffered much from pain
and great prostration. The urine was constantly flowing
away, and there was excessive irritation about the bladder.
This condition had existed for six or seven months with¬
out mitigation.
On admission he was in a most pitiable condition,
suffering greatly from spasms and pains in the lower limbs.
The urine constantly dribbling away, the penisbeing nearly
always retained in the urinal. The prepuce is partially
sloughed away, and the faeces are passed involuntarily.
The lower extremities are wasted anu the legs cedematous.
Sensibility is perfect There is constant irritability of
the glans penis, and pressure over the pubis causes con-
way that the artery shall be placed under the plate and
button. The whole instrument is now brought down by
means of the sliding arrangement until the terminal
button presses upon the skin covering the artery ; imme¬
diately the needle describes an arc of a circle indicating
the pressure, and at the same time the wheel also makes
a partial revolution.
By a few repeated trials we arrive at the maximum of
oscillation, "when the instrument is in proper position.
The pen is now placed upon the wheel and maintained in
position by the clamp; the point then marks the paper
Dy a to-and-fro movement, which by the motion of the
paper isLCOnverted into an undulating line.
The Medical Prea m d Circular.
HOSPITAL REPORTS.
December 9,1868. 487
siderable pain. The urine is alkaline, with a large quan¬
tity of pus and phosphates. A catheter was introduced,
aud on its passing into, the bladder violent contractions of
the limbs took place, and the rectum emptied itself at
once. Very little urine was drawn off, and a calculus
could be detected close to the vesical orifice.
The bladder was washed out with warm water and
emptied by Clover’s apparatus, which was extremely
serviceable and convenient. The prepuce being in a
semi-sloughed condition it was divided freely, and the
glans exposed. Nitro-muriatic acid and Pereira brava
were administered, and the parts carefully dressed with
chloride solution.
Looking on the paralysis as reflex, and depending on
the irritation caused by the calculus, I determined on
breaking down the stone by lithotritv, as the case was
otherwise favourable, when the general health and the con¬
dition of the urine was improved. On the 23rd July I
passed in a Charriere’s lithotrite, and after some manipu¬
lation I succeeded in seizing the stone, which I crushed
successfully and without causing any pain to the patient.
A warm poultice was put over the lower part of the belly,
and a free anodyne administered. Thera was no irrita¬
tion or pain caused by the operation, which occupied four
minutes.
The bladder was not washed out, but left quiescent, and
shortly small portions of detritus were passed.
3rd August. Since last report several portions of calcu¬
lus have been passed, including one large fragment which
had been partially impacted in the urethral orifice for a
few hours.
The paralytic symptoms had visibly improved, the pain
in micturition abated, and considerably more power of
retaining urine had been gained. On careful examina¬
tion with the lithotrite, at a sitting this day, a rather
large fragment of stone was found and crushed. The treat¬
ment was continued.
August 11th. Another sitting was held to-day, and
the remaining fragment of stone seized and crushed. As
these portions were small I washed out the bladder with
warm water.
From this date the symptoms steadily improved,
the detritus gradually disappeared, till on the 20th
August the patient suddenly found great difficulty in
passing water. On introducing a small catheter a frag¬
ment could be felt at the orifice of the bladder. I then
passed the Clovers catheter, and withdrawing the stylet
the fragment fell into the large eye of the instrument,
and so I removed it—measuring about the size of a large
pea and irregular in outline. No further fragments were
passed or could be detected after this date.
The patient gradually improved now from day to day,
the power of retaining urine increased, and the pain in
micturition almost disappeared by the first week in
September, when he was able to sit up, but with diffi¬
culty, as unfortunately an extensive slough had formed
over the sacrum, corresponding to the cicatrix of the
original one. This retarded his recovery very materi¬
ally. On the third week of September the patient was
able to stand a little, and gradually improved in walking
and power over the limbs, when he was discharged
cured, being able to go home to Athlone by himself, and
to walk steadily with the help only of a stick.
He passes urine but once or twice a night, there is no
calculus of any kind to be felt on moat careful examina¬
tion. and the limbs are increased fully one-fifth in size.
The instrument of Charriere’s I first used was a combi¬
nation of catheter and lithotrite. At the second sitting
there was some difficulty in withdrawing, and on exami¬
nation I found that the hollow rod had partially given
way, and that this was at a welding point. I subse¬
quently used the instrument with the sobd rod, which I
found serviceable and I am sure more reliable, unless for
a very soft stone. This stone was soft, phosnhatic, and
nearly measured lj by 14 inch, and was so Droken up
that I could obtain- but three fragments of any size ; the
rest passed as copious detritus.
In this case the condition of the lower limbs was very
marked, and the spasms on passing an instrument or
moving it in the bladder were so severe that the students
present had to steady the limbs by pressure; and it was
very interesting as proving the high degree of reflex irri¬
tation, that on passing along the urethra there were no
spasms till entering the bladder, and when entered they
were excited by the slightest touch to the interior, and
this to a very violent degree. The progress of the case
towards cure, once the stone was well crushed, was most
steady and satisfactory, the patient walking home an
apparently sound man, who nad some time before been
carried into hospital in extreme misery and prostration.
OASES FROM MELBOURNE.
By Mb. Henry Lee, of St George’s Hospital.
We are indebted to Dr. Bird, of Melbourne, for the
following cases. The first is interesting from the obstinate
resistance which it offered to all remedies ; and the second
from the perfect manner in which the cure was effected by
means of the colonial vapour baths.
Case I. —Intractable case of Communicated Constitutional
Syphilis,
Mrs.-, 80 1. thirty-seven, atro-bilious temperament,
came under my care in 1862, suffering from neuralgia of
the face and head, not decidedly intermittent, nor appa¬
rently dependent on any of the usual local or constitutional
causes. She was treated with various remedies, both
external and internal, for about four months, without any
marked benefit, when the pains changed their character,
and became decidedly periosteal with tenderness of the
scalp, the clavicles, ana sternum, and sometimes of the
ulna. I at once gave her iodide of potassium, which
rapidly produced its usual good effect. She continued it
for four months, got fat ana well, and lost all her pains.
Some two months afterwards, she began to get thin,
r t a little blood, and had decided tubercular dick in
left supra-spinous fossa. I put in a little seton in
that locality, and gave her cod oil and iodide of iron.
The symptoms gradually subsided, and have never re¬
curred ; but with the subsidence of the chest symptoms
the old periosteal pains began to return with greater
violence than ever, and now the system was absolutely
unable to bear iodine in any form; even the one-tenth
of a grain of iodide of potassium caused violent vomiting,
and a herpetic eruption on the skin. She began to have
remarkable fugitive nodes on the head, which would appear
at night as large as half a pigeon’s egg, and apparently
filled with fluid, and intensely tender; these would dis¬
appear in 24 hours, to reappear on the other side of the
head ; similar swellings occurred on the sternum. The
iodide and biniodide, or bichloride of mercury, or even
grey powder in the minutest doses, caused violent mucous
irritation and vomiting. I used Lee’s vapour bath, both
with calomel and cinnabar; this was borne well, but
did no good after a lengthened trial. After a year of
intense suffering she got into the habit of taking opium
regularly, about 3ij of Battley in the day. Despairing of
the anti-specific treatment, I gave her tonics of all kinds,
which were borne well enough, but did not affect the pains
in the least. Full diet and low diet were equally in¬
efficacious. She tried hydropathy and homoeopathy ; the
first did rather harm, the latter no good, as it is hardly
necessary to state. Her history is this; she has been
married fifteen years to a gentleman, who allows that he
had suffered very severely from constitutional syphilis, from
which he was, however, decidedly cured before his mar¬
riage. He bears, however, several decided scars of rupia*
ana had undergone very severe treatment at the hands of
many physicians and surgeons on the continent. She had
one miscarriage a few months after marriage, and has
never been pregnant since. The womb is perfectly healthy.
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HOSPITAL REPORTS.
December 9,1808.
Neither he nor she have had any primary symptoms since
marriage, nor has he had any return of the tertiary
symptoms from which he had formerly suffered so long.
About a year ago she was persuaded to consult a quack,
who has a really valuable cholagogue nostrum with which
he treats rheumatism and liver disorders. This did her
more good than anything since the first use of the iodide of
potassium, but has now entirely lost its effect; the pains are
as bad as ever, not limited to any time of day, not affected
by weather or any external causes. She seldom has the
nodes on the head now, and never on the clavicles or
sternum. Four months ago the left eye began to bulge,
and she began to lose the use of the left cheek. She is
now (June, 1868) unable to close the left eyelid, and
the mouth is drawn to the right side. There is a large
periosteal tumour on the right brow and side of the head,
but no other swelling of any kind perceptible about the
head or face, nor any further symptoms of paralysis than
the above. The sight is not affected. I have used at one
time or the'other every sedative I could think of, either
in or out of the pharmacopoeia, both by the stomach and
subcutaneously, without more than a very slight benefit.
Sal ammoniac both in large and small doses, quinine, iron,
zinc, aconite, arsenic, galvanism, acupuncture, sarsaparilla
by % the gallon ; numerous medical men have met her latterly
in consultation, but (with the exception of an eccentric
Frenchman, who proposed to cover her with dry cup from
head to foot), no treatment has ever been proposed which
I had not tried previously without effect. I have no
doubt of the case being one of communicated constitutional
syphilis, which I believe is now attacking the brain. I
may mention that the liver is rather contracted than other¬
wise, and that at the times when the pains are most severe,
she is liable to have bile in the urine, but never jaundice.
I have endeavoured to introduce iodine endermically by
means of iodized soap made of iodide of potassium and
white curd soap; this when rubbed into the skin is absorbed
very readily, but causes the same bad symptoms as when
the drug is given internally ; of course, I have tried the
rubbing in of mercurial ointment till the gums were gently
affected, but with equal nullity of good result. She now
takes no medicine beyond her daily allowance of opium.
Cask II .—Syphilitic Strict tire of Lower Bowel treated by
Mercurial Vapour Bath.
A gentleman consulted me some months ago with the
following symptoms. A hard base of an old chancre on
the prepuce, and scattered coppery scaly eruption about
the trunk. These symptoms dated for some months, and
were avowedly syphilitic. Latterly he had found increas¬
ing difficulty in passing his faeces, which came away in
thin pieces about the diameter of the little finger. When
he had neglected the bowels for some days he was liable
to a hard collection in the caecum, which required repeated
enemas and doses of oil to dislodge. The gut could be
felt as a hard round cord externally, as the sigmoid flexure
dipped into the rectum. The finger fitiled to reach the
constriction, but with a little care a Rectum bougie was
introduced into it, and so tightly gripped that considera¬
ble force was required for its extraction- He had suffered
a good deal from dyspepsia, was very low-spirited, and
had the faded look common to these eases. He had a
horror of taking mercury, because another medical man
had given him £gr. doses of the bichloride, which had
produced violent mucous irritation and had aggravated
the symptoms. I mode him use a Lee’s lamp with Gj of
calomel every other night, and take 10 grs. of ox gall
with gr. j of extract of aloes every night. This made the
faeces so soft and homogeneous that they passed readily
without the necessity for enemas. The treatment was
aersevered in for four months, at the end of which time
ie had no trace of syphilis visible, and passed large
] tealthy stools without any trouble. He is now in better
iieslth than he has been for many years.
CORK STREET FEVER HOSPITAL.
Under the Care of Dr. Grimshaw.
The two following cases are of interest on account of
the peculiar nervous lesions accompanying them. Un¬
fortunately no post-mortem examination was obtainable in
either case.
Case I.—Kate K—., aged thirty years ; eight days ill
before her admission into Cork-street Hospital on August
2nd, 1868, when she presented all the symptoms of typhus
except maculse, which appeared on the following morning.
Ordered nitro-hydrochloric acid, and four ounces of wine.
August 3rd.—Maculated; doubtful ptosis of left eyelid;
running all right; continue treatment.
4th.—Worse in every way; did not pass water from
visit time yesterday until catheter was used in the evening.
Ordered eight ounces ot wine.
5th.—Worse ; pulse very weak, little chance of re¬
covery ; ordered wine twelve ounces, and blister to back
of neck.
6th.—Paralysis of left side of face ; no paralysis else¬
where ; continue treatment.
7th.—Got a little better yesterday, but is now worse,
quite insensible ; paralysis of face continues ; doubtful
paralysis of right leg; bowels coufined; ordered turpentine
enema. Got somewhat better after the enema, but died
in the afternoon.
Paralysis in connection with typhus fever is rare, bat
less so as a sequela than as a complication, as occurred
in this case.
Case II.—Thomas C—., aged twenty (?) years ; married;
a shoemaker; eightdaysill before his admissioninto hospital
on July 28th, 1868. Has Pot’s curvature of the spine, for
which he has been treated in Mercer’s Hospital Has
paralysis of the lower limbs ; cannot or will not speak
except in occasional monosyllables ; great hypenesthesia
of legs ; cuspes on the right side of the penis and scrotum;
tongue dry, and lower extremities cold; pulse pretty good.
Ordered heat to extremities ; chloric ether ; and two
ounces of whiskey made into punch.
July 29 th.—Maculated ; passed urine and fceces in¬
voluntarily ; pain and stiffness of arms ; cut part of his
shirt. Ordered blister to nape of neck ; calomel three
grains, wine six ounces.
30th.—Maculae numerous and distinct; delirious and
dangerous during night; pulse 102, very weak ; arms very
stiff and painful; respiration, 32 ; temperature, 102*8;
some bronchitis. Ordered blister to chest, leeches to
temples ; repeat calomel.
31st.—Decidedly worse; pulse 108, very weak ; respi¬
ration, 36 ; temperature, 132°; retention of urine, a small
quantity of urine was removed by the catheter; blister
did not rise on chest. Ordered wine sixteen ounces,
whiskey two ounces ; continue cantharides to head and
chest; continue calomel.
August 1st.—Worse ; pulse, 120 ; very weak; tongue
black ; respiration, 42 ; temperature, 102*4 ; continue
treatment.
2nd.—Died at 4 a.m.
The above case is of interest on account of the previous
diseased state of the spinal cord, the membranes of which
were evidently attacked by fresh inflammation during the
attack of typhus fever.
KING’S COLLEGE HOSPITAL.
Cases under the care of Dr. Beale, F.R.S.
(From notes by Dr. Tongk.)
ERYTHEMA NODOSUM.
Kate B., ait. twelve, admitted February 23, discharged
March 23 ; in hospital thirty days ; recovery. Never
strong; fourteen days ago had rigors, loss of appetite,
vomiting, and headache ; three days ago circumscribed red
painful swellings appeared on legs. On admission and
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SCOTLAND.
December 9,1668. 489
scrofulous patches of erythema nodosum above condyles of
hameria, and over front of legs ; frontal headache, tongue
furred, pulse 120, respiration 50 ; no fresh patches after
three days later.
Grey powder, rhubarb, and magnesia; dilute muriatic
acid ana chloric ether; cod liver oil ; fomentations to
legs.
Ellen L., set. three, admitted June 26, removed by father
June 27 ; in hospital one day.
Quinine, iron, dilute sulphuric acid, and chloric ether.
CHRONIC ECZEMA.
Georgina P., set twenty-two, servant; admitted July 6 ;
discharged November 4 ; in hospital 121 days ; recovery.
(Dr. Beale, voL 7, p. 209.) Eczema three or four times
yearly for last six years. Never quite free from it during
that time. Previous illness seven weeks, Commenced on
face, then on neck, front of chest, axillte, abdomen, but¬
tocks, lower part of back, and inside of thighs. Skin of
these parts red, moist, and covered in places by incrusta¬
tions. Much smarting and itching.
Bicarbonate of potass and sulphate and carbonate of
magnesia; afterwards bicarbonate of potass, aromatic
spirits of ammonia, and liquor cinchonse, cod-liver oil.
Locally, glycerine lotion, benzoate of zinc ointment, tar
ointment, alkaline lotion, ointments of oxide of zinc, and
of nitric oxide of mercury. Wet packing.
T. B., net. fifty-two, dockyard labourer; admitted
June 24 ; discharged August 20 ; in hospital 57 days ;
very much relieved. During last four months has
had oedema of both legs, and an eczematous eruption
on left leg. On admission lower half of left leg and upper
part of right calf red and shining, and partly covered with
crusts. Has had gout
White mixture o.m.; spirit lotion ; lead lotion.
--
SCOTLAND.
SCOTTISH HOSPITAL IN LONDON.
On the evening of St. Andrew's day the 204th Anniver¬
sary Dinner of this Hospital was held at the Freemasons'
Tavern. The Marquis of Bute was in the chair. There
were several ladies in the gallery, and in the body of the
hall about 350 gentlemen. “ The Queen and the Royal
Family ” was the first toast that was drank ; next, the
Army, Navy, Militia, and Volunteers, which was responded
to by Sir J. Hay, M.P., Captain W. M‘Gregor, and Cap¬
tain Lumsden ; after which came the toast of the evening,
“ TheBcottish Hospital'' The Chairman, in proposing it,
said that in England it was not unusual to attribute to
the Scotchman a certain degree of coldness, calculation,
and hard-headedness ; but the history of the Charity
whose cause he had the honour to advocate, would, he felt
satisfied, clearly prove that Scotchmen were no less alive
than others to every kindly feeling. The toast was re¬
ceived with loud cheers, and the Duke of Roxburgh, the
President of the Hospital, returned thanks. During the
dinner the band of the Scotch Volunteers played, and the
strains of the bagpipes were heard at intervals. The
health of the Chairman was drank with all the honours,
followed by the custom of placing one leg on the tabic
and breaking several glasses. The health to the ladies was
rapturously acknowledged.
This is an institution of which we cannot speak too
highly. It was founded in the reign of Charles II., and
ever since that period has been the means of relieving
suffering and restoring health in no ordinary degree. It
was founded to assist the infirm, the aged, and the indi¬
gent natives of Scotland resident in London who were
not receiving parochial relief. It has worked efficiently in
carrying out these objects for years ; and the last year has
been as productive of good as its predecessors. Pensions
have been granted to 200 persons varying from 6/. to 25 1.
per annum ; more than 210 per month have received gifts
in money, sometimes as much as 5/. at a time. Casual
relief has been given to more than 12,000 poor people.
Free passages back to Scotland have been provided for
upwards of 200, chiefly mechanics, and 140 Scottish chil¬
dren have been educated at its expense.
SCOTTISH REGISTRARS.
In the returns for the last quarter we find the following
notes which have been collected, and which may perhaps
interest some of our Scottish readers :—
Huntley, Aberdeen.—“ The deaths here have been regularly
di minishing for two years; can the introduction of a copious
supply of excellent water have anything to do with this?”
Eyemouth, Berwick.—“ This parish has enjoyed a longer im¬
munity from epidemics than usual, which is attributed to the
extra supply of water lately obtained and to other sanitary
arrangements.” Jedburgh, Roxburgh.—“ Of the 52 deaths
84 resulted from Scarlatina, which, for two months, has been
epidemic. Whole families of children have been prostrated at
once. Had it not been for the excellent sanitary state of the
town and the abundant supply of good water, the registrar
has no hesitation in Btating that the disease would have be¬
come a pestilence. About 1842 or 1843, when the town was
not so well supplied with water, scarlatina broke out, and in
the course of six weeks 60 young children died from it.” St.
Andrew’s, Dundee.—‘‘After a good deal of inquiry the re¬
gistrar is quite convinced that the greater proportion of cases
of diarrhoea and British cholera recorded in August were of a
preventible type, and were caused by carelessly kept dung-
stances in rather close proximity to houses in ill*aired courts
and closes, and bad drainage in connection with the oppressive
sultriness that prevailed.” Auchtergaven, Perth.—“ The ages
of the 12 persons whose deaths were recorded this quarter,
ranged from 54 to 89 years; the extreme heat of July appears
to have been fatal to the old.” Lochlee, Forfar.—“ Of the 4
deaths in the return three were of people whose united ages
amounted to 236 years.” Insch, Aberdeen.—“ The deaths in
most cases were of persons considerably advanced in years.”
Kintore, Aberdeen.—“ Half the deaths were those of aged
persons.” Kirknewton, Edinburgh.—“ Of the 7 deaths re¬
gistered 5 were of persons above 60.” Milton, Glasgow.—
“ 266 deaths ; 25 were of persons above 60, one being 97.”
Gairloch (North), Roes.—‘‘Three deaths registered ; 2 were of
persons aged 86 and 105.” Barras (insular).—“Of the 17
deaths recorded six were of persons whose ages averaged 91 ;
one was 78, one 88, two 94, one 95, one 98.”
Dr. Richard, of Dumbarton, presided at a dinner given
in honour of Dr. R. Buchanan, of Knoxland, who for fifty
years had been a practitioner in the county. A large
company of medical men were assembled, and after dinner
an address, enclosed in a handsome silver casket, was pre¬
sented to him by the chairman, commemorative of his high
E rofessional merits, and the esteem in which he was held
y all who knew him.
THE UNIVERSITIES OF EDINBURGH AND
ST. ANDREW’S.
The election of Member of Parliament for these Uni¬
versities closed on Friday, and on Saturday, at the de¬
claration of the poll, which was held in the Library Hall,
Edinburgh, the Vice-Chancellor announced that Professor
Playfair was duly elected. He said, that in his opinion,
both candidates were equally qualified to represent the
Universities, and it would have given him great satisfac¬
tion to have seen them both elected. He shook hands
with Professor Playfair, and congratulated him on liis
election. Professor Playfair said he should bear in mind
that lie was the representative, not only of the majority
which supported him, but of the whole constituency, and
should pay unvarying attention to the interests of the
Universities. He closed by expressing his gratitude to
the Vice-Chancellor for the impartial and able manner in
which he had superintended the election.
GLASGOW AND ABERDEEN UNIVERSITIES.
At the close of the fourth day's poll the numbers were
a majority of thirty-six for Mr. Moncrieff. "We shall not
get tne result before going to press.
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EDUCATIONAL REFORM.—No. II.
The Report of the Council of the Medical Teachers*
Association hits the main blot in our educational system
when it draws attention to the fact 4C that there does not
yet exist, either by authority or common consent, any one
set of regulations which may be cited as representing the
national minimum of requirement.” There are no less
than nineteen different corporations selling diplomas, de¬
grees, or licences to practise, acting almost uniformly in
independence of each other, and issuing separate conditions
and separate schedules. The consequence is, that the
student who wishes to present himself at more than one
examining board has to serve two or more masters, whose
conflicting rules impede the progress which they were
fashioned to promote, and bewilder him into a contempt
for every kind of authoritative regulation for study.
Lecture after lecture is piled upon him, until he nauseates
the theatre and illustrates a well-known proverb by de¬
clining to drink at the stream to which compulsion has
driven him. He is compelled to attend, without any re¬
gard to common sense or common convenience, a number
of different courses of instruction. Natural Science, Prac¬
tical Anatomy, Lectures on Anatomy, Physiology, Sur¬
gery, Midwifery, attendance in the wards, and Clinical
Lectures, are all jumbled up together in one educational
period. The “ pious and fostering cate of the licensing
bodies” has made collective provision for more days than
actually exist in the given period. If the student were
to attempt the impossible task of universal conformity,
he would find at the end of it that passive obedience had
entailed a serious risk of w reference to his studies,” to
use the polite phraseology which soothes the wounded
spirit of rejected candidates. He is therefore driven to
neglect altogether the subjects which do not bear upon
his examinations, or to attend them in so slovenly and
superficial a manner that attendance on them at all be¬
comes absolute waste of time. Now, every independent
thinker on these matters deeply deplores the chaotic state
which is the result of allowing the student to be ruled by
many masters, to none of whom can he hold and all of. 1
whom he must, more or less, despise or disregard. Every
eminent medical reformer—except, perhaps, a writer in
the Westminster Review some years ago—has urged the
establishment of a single and uniform examination, or
course of examinations, for the bestowal of a minimum
qualification to practise. This licence to practise it would
only be reasonable to require every medical student iu
Great Britain to obtain. There would be one set of regu¬
lations, one set of examinations, and one diploma em¬
bracing guarantees of fitness in all the branches of pro¬
fessional knowledge. Those who desired to give proof
of superior acquirements in one or more of the branches
of study, could still do so by taking University Degrees,
or becoming by examination Fellows of the Colleges of
Physicians and Colleges of Surgeons. But all the differ¬
ent fragmentary titles which represent the lowest present
attainable qualifications would be swept away. The
M.R.C.S.I. would no longer exist as a title conferred
without Examination in Botany, Chemistry, Materia
Medica, Midwifery, Forensic Medicine, and Hygiene.
The L.S.A. would disappear altogether, to the great relief
of all who advocate the dissociation, in fact and idea, of
the profession of medicine from a trade in drugs. The
L.R.C.P., respectable qualification though it be, would
have to be* sacrificed to the establishment of a general
licence.
And yet, absolutely necessary as this simple measure
has become for the real welfare and elevation of the pro¬
fession, the obstacles in the way of its accomplishment
are of a very formidable description. The interests of
all the nineteen licensing corporations would, more or
less, be affected, and some of them so seriously that the
stoutest and most obstinate opposition would be main¬
tained. All the vested interests likely to be injuriously
affected by the change would unite and present a front
of obstruction which even the English College of Sur¬
geons, with all its efforts, has not yet been able to show.
Under the existing constitution of the Medical Council it
would be almost, if not quite, impossible to get a measure
passed for conferring a single minimum state licence for
the three kingdoms; and, even if the Medical Council
should be reformed in accordance with the wishes of the
profession, it is exceedingly doubtful whether the desired
end could be attained in this manner. Representatives
of the registered practitioner might be added to the
Council, and that absolute control which it ought to
possess in educational matters over the corporations
might be conferred on it; but still it might be undesir¬
able to endeavour to carry by force that which could be
obtained, to all intents and purposes, by management
and persuasion. We do not despair of ultimate success,
but we look for its complete accomplishment through a
combination of influences, concurrent or eerial, originat¬
ing in various quarters; not by attempting to storm the
citadel, but by obtaining its surrender by negotiation and
on terms advantageous to its present possessors ; not by
aiming all at once at theoretic perfection, but by securing
the immediate redress of all practical grievances, and
leaving those points which cannot be gained by a comp
4e main to the operation of those liberalising movements
in the profession which are now slowly, yet surely, con¬
verging to the same central point. Into this subject we
•shall enter more at length in another article.
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LEADING ARTICLES.
December 9, 1808. 491
HOMOEOPATHY IN THE ABERDEEN ROYAL
INFIRMARY.
By the end of this month the managers of the Aberdeen
Infirmary, at their annual meeting, will be called upon to
decide whether they ought to re-elect Dr. Arch. Reith as
one of the Physicians of their Institution. That gentle¬
man has, for some years past, been teaching and practising
a system of therapeutics, which some consider as bordering
on homoeopathy, and published some papers advocating
doctrines which greatly scandalised his colleagues. The
case having been submitted to the managers of the Infir-
mary, they applied for counsel to Drs. Dyce and Kilgour,
the consulting physicians, who gave their deliverance in
the following terms :—“ Whilst there can be no objections
to any medical man following any mode of treatment he
may choose to adopt with his private patients, or such as
may come voluntarily under his charge, yet as homoeopathy
is not accepted as sound and rational treatment by the
medical profession nor by the public, it is certain that a
hospital in which such is practised would not possess the
confidence of the one party or the other. Those for whom
its benefits are intended would not likely be recommended
to it by medical men or others ; and within its walls there
could be no harmonious cooperation, or such a thing as a
joint consultation on cases however obscure or dangerous.”
In consequence of this judicious finding, the above ques¬
tion will be brought before the Court of Managers. Wo
sincerely regret that such a misunderstanding should have
arisen to mar the harmonious working of that valuable in¬
stitution, and especially that Dr. Reith, a gentleman of such
talent and promise, should be the cause of this disturb¬
ance.
It is the opinion of others equally able to form a true
judgment upon the question, as well as our own, that if he
is to retain his connection with the Infirmary a concession
on his part should be made on a subject which, at the
present phase 'of its discussion, is well calculated to try
the temper of those who are engaged in the dispute, and
who are immediately concerned in its settlement. We
shall, at an early opportunity, bring before our readers the
merits of the question in a scientific point of view. Our
object at present is to try, if possible, at this the eleventh
hour, to bring about an understanding between the con¬
tending parties. We have watched the case with deep
interest from its very commencement, and it appears to us
that Dr. Reith decidedly prejudiced his own case by bad
pleading. Nothing was further from his intention than
to range himself amongst the homceopatliic fraternity. To
the writers of the Homavpat/iic lie view , who, on the pub¬
lication of his papers, rallied round him with emprmement ,
hailing him as a friend and a brother, his reply was stem
and decisive enough. But it is to be proved that the
blandishments of that party, on the one hand, and the
severity of his colleagues, on the other, threw him off his
balance, and, like Dr. Faust, in an evil hour he was be¬
trayed by the black dog—he gave himself a bad name,
and thus he is a homoeopath rmlgrk lain.
We are glad to see that Dr. Reith already begins to
look upon this question on its own merits, apart from the
heat and dust raised through temporary excitement and
local jealousies ; and from what we know of the kindly
spirit and temper of his excellent colleagues, we can see
no reason why it should not be arranged amicably.
Whilst we thus speak of Dr. Reith we must not forget
Dr. D. Dyce Browne, lately Assistant Professor of Materia
Medica ! He is decidedly too young to be a homoeopathic
martyr.
ARMY MEDICAL DEPARTMENT REPORT FOR
THE YEAR 1866.
In last week’s number we gave a few quotations from
this admirable work respecting the health of our home
troops ; we now desire to speak about the health of those
on foreign service.
And first, of the far-famed Rock of Gibraltar. It ap¬
pears that the average strength of non-commissioned offi¬
cers and men during 1866 was 4,585 at Gibraltar. There
were only twenty deaths out of this number, or only 4*36
per 1,000 men. This great healthiness seems to be attri¬
buted to the absence from spasmodic cholera, which disease
had in 1865 trebled the mortality. The ventilation of the
soldiers’ apartments seems to have been much improved.
With regard to Malta, we find that the average number of
troops stationed in that island in 1866 was 5,202. The
death-rate appears to have been 12*88 per 1,000 men.
Although the admissions for venereal diseases were con¬
siderably below the average of seven preceding years, and
below the average of the other foreign stations, on account
of police examination of prostitutes, they showed in 1866
an increase of 15 in 1,000 over 1865, entered as syphilis.
As to the health of troops in Canada, the average
strength of men in Canada in 1866 appears to have been
9,519, and the deaths amounted to 96, or 10*10 deaths per
1,000. Dr. Muir states that every soldier in the command
had his 600 regulated allowance of cubic feet, notwith¬
standing that the garrison accommodation is very limited
in Canada. An excellent general hospital has been con¬
structed in Montreal. The ill effects of impure air are
alluded to by Dr. Muir as follows :—“ When thirty or
forty men are put into a single room, where they take
their meals as well as sleep, for six or seven months con¬
secutively, there can scarcely be a question that the seeds
of grave disease, especially consumption, are laid. I can¬
not help thinking that the large number of men treated
and invalided for chest diseases during the five years I
have been in this command bear a close relationship to
this impure state of barrack air.” In Nova Scotia and
New Brunswick the average strength of troops in 1866
was 3,247, and there were 25 deatns, i. e., only 7*70 in
1,000 men. In Newfoundland, out of 287 men, there was
four deaths—13*92 deaths per 1,000 men. In Bermuda,
out of 1,249 men, there were 30 deaths, or 24*01 per 1,000
—a very high death-rate in 1868.
We now come to the celebrated West India Islands, a
residence in which used to be considered as almost certain
death to our poor troops, who were in the good old davs
abominably housed and treated. In the command of tne
West India Islands there were, in 1866, 888 men on an
average, and a very high death-rate, namely, 29*29 in 1,000.
This death-rate is very greatly in excess of the average of
usual years of Lite in the West India Islands. Paroxysmal
continued and yellow fever seems to have been unusally
prevalent in 1866, and dysentery and diarrhoea were epi¬
demic. In Jamaica, there were 24*71 deaths in 1,000
during the year. The prevalence of fevers during the
years 1865 and 1866 is ascribed to the necessity of em¬
ploying white troop at some of the stations on the plains,
instead of their being chiefly quartered at Newcastle. The
admissions at Up Park Camp and Port Antonio for fever
were very numerous. There were 954 black troops, and
their mortality was no less than 23*06 in 1,000. Tuber¬
cular diseases are important causes of death among the
black troops. There is a swamp in the neighbourhood of
Port Antonio.
As to the health of the troops serving in Western
Africa, we find that there were only about fifteen white
troops, of whom only one died of dysentery. Of 498 black
troops stationed at Sierra Leone, that grave of the Euro¬
pean, 2812 per 1,000 died—a high mortality, and showing
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December 9, IMS.
492 The Medical Prew and Circular.
that the locaHf^very fatal to our black brethren as well
as to ourselves.
The mortality per 1,000 of the black troops stationed at
the Gambia Lagos and the Gold Coast varied from 52‘38
to 42*78. Surely the barracks must be very faulty.
Miasmatic diseases have been greatly above their average
at Lagos, but under it at Sierra Leone. Yellow fever was.
it seems, very fatal among the whites at Sierra Leone.
Syphilis was very prevalent also. Itch and Guinea worm
were common at Gambia. In the island of St. Helena
there were about 360 men in 1866, and the death-rate was
only 8*34 in 1,000. In the Cape of Good Hope the
average amount of troops was 4,135, of whom 44 died,
i. e., the death-rate was only 10*62 in 1,000 men. Rheu¬
matism, as usual, appears to have prevailed greatly among
the troops. There was much enthetic disease, the admis¬
sions being in the ratio of 846 in 1,000 of strength ; of
these 385 were classed as syphilis, and 187 as gonorrheal.
In the Mauritius the average strength of the troops in
1866 was 1,781, and 25 died, being at the rate of 14*01
deaths per 1,000. Paroxysmal and continued fevers were
above tne average of ordinary years. All the deaths from
fever occurred in Port Louis, the classic city of Paul and
Virginia.
Dr. Reid, the Principal Medical Officer, directs atten¬
tion to the amount of intemperance as a source of disease
among the troops. As to the Island of Ceylon, the
average strength there, in 1866, was 1,177, and 19 deaths,
or 21*44 in 1,000 men, took place. Paroxysmal and con¬
tinued fevers were more prevalent than usual. The mor¬
tality of the black troops was not so high, being only 14
in 1,000.
Australia and Tasmania are not, like Sierra Leone and
Western Africa, inimical to the life of one portion of the
race; but there were only 547 troops in 1866, of whom
five died, being in the proportion of one death to 1,000
men. The dry-earth latrines seem to be in fashion for
the barracks near Melbourne, and the soiled earth is con¬
veyed away every night in carts.
In New Zealand there were, it seems, in 1866, no less
than 5,598 troops ; but the death-rate was low, being only
12*86 in 1,000 men. Disease of the heart and aneurism
are mentioned as among the chief causes of death, 26*5 per
cent This, it is said, often occurs after a harassing war
of some duration, from severe exertions made during the
hot weather and marches.
—-♦-
ffutrs 0ii fcmrt $0$irs.
New Examination in Operative Surgery in
the Royal College of Surgeons in Ireland.
The Council of the Royal College of Suigeons have, at
tlieir last meeting, approved of the practical details of the
arrangement for the introduction of Operative Surgery
into the examination for their licence, which they recently
sanctioned in principle. The matter has been, since its
first consideration by the Council, under the attention of a
Committee, and their Report was laid before the Council
last Thursday and, after some discussion adopted. It is,
as amended, as follows :—
“ 1st. That for the future the. Quarterly Examinations
for the Letters Testimonial of this College shall be held
in the months of January, April, July, and October; and
that the Examinations lot the Junior Class shall com¬
mence on the second Tuesday, and those for the Senior
Class on the fourth Tuesday in these respective months.
“ 2nd. That the Examinations in Operative Surgery
shall precede the vivd voce Examination for the Senior
Class, commencing on the fourth Monday in the months
in which the Quarterly Examinations are to 1>e held;
that they shall be conducted in the large Lecture Theatre
of the College, and that each Candidate shall be called
up in alphabetical order to perform the operation required
of him.
“3rd. That the Examinations in Operative Surgery
shall be conducted by the four Surgical examiners, who
shall meet previously for the purpose of comparing their
questions; which shall then be written upon cards, to be
deposited in a balloting-box, from which each Candidate,
as called up, shall be required to draw his question, and
to perform the operation therein indicated.
“ 4th. That the respective merits of the several Can¬
didates, so far as this portion of their Examination is con¬
cerned, shall be determined by numbers, as in the vied tact
Examinations: these numbers to be given to the Coun¬
cillor in charge of the Candidate.
“ 5th. That any Candidate v/ho fails to acquit himself in
Operative Surgery to the satisfaction of the Examiners
shall not be permitted to present himself for the subse¬
quent Senior Class vivd voce Examination.
“ 6th. That the Preliminary Examination shall beheld
for the future on the third Wednesday in the months of
January, April, July, and October.”
Superannuation of Irish Poor-law Medical
Officers.
The Council of the Royal College of Suigeons of Ire¬
land have lost no time iu acting on the hint of Colonel
Wilson Patten, the Chief Secretary, in favour of the im¬
mediate introduction of a superannuation bill. Colonel
Wilson Patten’s reply to the deputation, as recorded in
the Journal of the Irish Medical Association last
week, was to the effect that t( he would take care to have
the statements made by the members of the deputation
brought before the Government, and that they should
receive his warm support; he inquired if there was auy
Bill in preparation by any member of the House, for the
purpose of providing remedies for these evils, and being
iuformed that such a measure was in preparation, he
suggested that it should be proceeded with at once, and
promised to give it his best and most fav ourable conside¬
ration.”
The Solicitor to the College attended the meeting of the
Council last week and received instructions to prepare a
Bill and submit it to legal counsel for approval.
The general instruction conveyed to the solicitor was
that the Bill should be permissive; that no period of
service should be fixed in it for superannuation, so that a
Poor-law Medical Officer might receive a retiring pension
at any time he might be disabled from discharging his
duties. It was not decided who should be requested to
take charge of the measure iu the House of Commons,
but it was suggested that Mr. Pirn, whose name was on
Sir Colman 0‘Loghlen’s late measure, and Sir Arthur
Guinness os representing all shades of political opinion,
and Dr. Brady, M.P. for Leitrim, as the representative of
the profession, would be likely to ensure prestige for the
measure on its introduction to the Legislature.
Sir Dominic Corrigan.
A contemporary is misinformed when it states that
one of the members for Meath is about to resign his seat
in favour of Sir Dominic, who has rendered himself so
popular with the political party to which he belongs,
that he will fiud little difficulty in obtaining a seat when
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NOTES ON CURRENT TOPICS.
December», 1668. 493
opportunity offers. We take it for granted that on
matters of which he has such intimate and special know¬
ledge he will be freely consulted by the Government
which bas now come into power.
Junior Surgical Society.
The opening meeting for the seventh session of this
Society will be held in the Albert Hall Royal College of
Surgeons on Wednesday evening at 8 o’clock. The
President of the College will take the chair, and some of
the Professors will address the members; blit the most
interesting feature of the meeting will be the reading of
an essay and of cases by the students themselves. Such
efforts will he far more agreeable to their teachers and
other members of the profession who may be present
than the oratorical displays and laudatory speeches so
often made on similar occasions.
The Last Appointment of the Late Govern¬
ment.
Very shortly before the resignation of the Ministry,
the Resident Superintendentship of the Downpatrick
Lunatic Asylum was conferred on Dr. Tyner, who a few
months since was .appointed to the Clonmel Asylum. Dr.
Garner, F.R.C.S.I., of Downpatrick, has been offered the
last-named office.
Medical Evidence.
In the Court of Queen’s Bench an action was brought
to recover damages for personal injuries occasioned by
negligence on the Loudon and North-Western Railway.
We mention it in consequence of the conflicting evidence
of the medical witnesses, who, it seems, were eminent
medical men. The plaintiff's witnesses, including Sir W.
Fergusson, were decidedly of opinion that his brain and
spine were affected, while the witnesses for the defence
declared as decidedly that they thought not. How are
we to account for this ? Are symptoms so equivocal as
to justify such adverse opinion l or has the side on which
a witness is c*illed to speak any power to warp his judg¬
ment ? That is, does he make his observations under
the influence of a preconceived idea, ready to mark only
those signs which will establish his evidence, and to dis¬
regard all the rest l
French Medical Bibliography.
The following new additions to the literature of our
Profession are announced from Paris, “ Aphorisms on
Venereal Diseases,” with a special formulary, by Edward
Langlebert, 2 francs. Syphilis—Jerome Fracastors’
Latin poem, translated by the same author.
“ Mexico, from a Medico-Chirurgical Point of View,” by
Leon Coindet, chief surgeon of the 1st and 2nd division
of the Mexican Army.
14 Photographic Studies of the Nervous System of Man
and some of the higher Animals from Dissections of con-
gelated Nerve Tissues,” by Dr. Pierre Rondanovsky,
203 Photographs in 20 Plates, francs each.
“A Memoir on Surgical Intoxication,” by M. Mais-
8oneuve, price H-francs.
“ The Method of Continuous Aspiration as a means of
Core after Capital Amputations,” by M. Maissoneuve,
price l£ francs.
The Manslaughter of a Medical Student in
Dublin.
A very unusual degree of excitement has arisen in
Dublin from the circumstances under which Mr. Miles
has come to a violent and instantaneous death. Such a
catastrophe would have created strong feeling, from what¬
ever rank the victim might have come, hut Mi*. Miles’s
position, his many personal merits, and his connexion
with the medical profession, have doubly excited the
public mind. The circumstances were simple and brief
enough. Mr. Miles had been supping with a friend in a
well-kuown oyster-house, and proceeded homeward. As
the car was passing a group on the pavement something
was said by one of the cluster which appeared to irritate
Mr. Miles. He jumped off the car, and a scuffle ensued,
in which he fell heavily, and when lifted up was found to
be insensible, and all but dead. The only external
wouuds in this case were one on the hack of the head, a
simple scalp wound, manifestly the result of the fall, and
another, about three-quarters of an inch long, at the under
and inner part of the left eyelid. This had more the
appearance of a lacerated thau an incised wound ; there
was slight extravasation of blood under the conjunctiva,
and a good deal of contusion about the eye itself; the
patient never recovered consciousness, and died shortly
after admission.
On 2 >o 8 t-mortem examination, the wound on the head
was found simply to be one of the scalp, hut that in front
under the eye showed the severe nature of the injury
which caused death. The instrument, which must have
been almost a blunt one (and which afterwards was
shewn to have been an umbrella) penetrated nnder the
eyeball, entered the inner side of the orbit, broke
through the ethmoid and sphenoid portions of the
cavity, and entered the floor of the skull. Opening the
side of the cavernous sinus, and penetrating iuto the brain
fully one inch or more deep, the upper and inner part
of the orbit were completely broken up, and the under
part of the left anterior lobe of the brain was ploughed
up by the instrument in its course; there was a good
deal, but not a very excesiive amount of clot about the
wound internally. The coarse and direction of the
wound indicated what is hoped and supposed to be its
fortuitous infliction, by the point of an umbrella used in
the excitement of the moment; the anatomical formation
of the parts, and the comparatively delicate structure of
the bony walls, will easily explain how a very moderate
amount of force would penetrate and cause the extensive
and hopeless injuries inflicted in this instance, cutting
off in the full promise of manhood and vigour one of the
finest young men we have seen, whose amiable character
had attached to him so many friends and fellow students.
The coroner’s jury, after two days’ sitting, gave in an
open verdict, but we believe that no doubt exists that the
person by whom the injury was inflicted is known. Such
a lamentable result of a common street fracas can hardly
be laid at the door of any person, and as far as the cir¬
cumstances have yet been made public there is no cause
for other feelings than those of regret.
Mr. Miles was a young gentleman of the highest pro¬
mise, a universal favourite amongst his fellows, a student
of talent and industry in his profession, and the winner
of the Carmichael prize in the Richmond hospital. He
had travelled far and wide, and was almost a model of
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494 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
December 9, 1808
manly strength and athletic development. His death
sheds a deeper tdiade of melancholy over his bereaved
family, for he was the third son who had met with violent
death in the prime of manhood. One had met his end
by drowning at sea, a second had died from the effects of
a fall from a tree, and now the third has fallen victim to
a petty street squabble, for which, as usual, no one
appears to have been to blame.
Goodsir’s Anatomical Works.
Tuere is always some danger lest the works of our
great anatomists should be lost sight of. In our busy age
men engaged in the cares of practice have not much time
to bestow on Anatomy, and not a few of the busiest are
scarcely aware of the progress that is being made. The
Journal of Anatomy and Physiology will, we doubt not,
do much to encourage anatomical reading, and this pub¬
lishing season has been signalized by Messrs. A. and C.
Black in a manner that deserves the thanks of all. They
have published in two magnificent volumes the “ Anato¬
mical Memoirs of John Goodsir,” edited by Professor
Turner, and illustrated with well-executed plates. It
would be superfluous for us to enlarge upon the value of
such a work to the many men who are pursuing the branch
in which Goodsir laboured so long and so well ; while to
analyze his contributions would take much space—more
than we can at present devote to it. On a future occasion
we may be able to go at length into the subject. To-day
we do not pretend to criticise or review the works of our
revered master. We only register the fact that his
scattered papers have been collected, and are now easily
accessible to all. We should be glad to think that Messrs.
Black had a prospect of a return for the outlay they have
made. It is certainly an encouraging thing that pub¬
lishers should be willing to undertake such works as these,
and we most sincerely hope the result may lead to other
equally valuable works of science being produced.
Public Health.
We give our usual quotations from the weekly returns
of the Registrar-General. In the week that ended on
Saturday, 28th November, 3,488 deaths were registered
in London and in thirteen other large towns of the United
Kingdom. The annual rate of mortality was 28 per 1,000
persons living. Small-pox continues fatally prevalent in
Sheffield, and 12 deaths were referred to this disease
during last week within that borough, making a total of
102 deaths from this cause iu the nine weeks of the
current quarter ending last Saturday. The deaths from
small-pox in London during the past nine weeks have not
exceeded 43 in a population more than thirteen times as
large as that of Sheffield. The deaths registered in
London during the week were 1,561. It was the forty-
eighth week of the year ; and the average number of
deaths for that week is, with a correction for increase of
population, 1,646. The deaths in the present return are
less by 85 than the estimated amount, but exceed by 54
the number recorded in the preceding week. The deaths
from zymotic diseases were 341, the corrected average
number being 375. Three deaths from small-pox, 39
from measles, 99 from scarlatina, 13 from diphtheria, 30
from whooping-cough, 59 from fever, and 12 from
diarrhoea were registered. The mortality from scarlatina
exhibits a slight decrease when compared with the num¬
bers recorded in seven preceding weeks. 192 deaths
occurred from phthisis, 217 from bronchitis, and 110 from
pneumonia. In the preceding week the deaths from
phthisis were 166, from bronchitis 223, and from pneu¬
monia 112. Diseases of the brain and nervous system
proved fatal to 160 persons, and 71 persons died from
diseases of the organs of circulation. The deaths of four
persons from alcoholism, of twelve infants and one adult
from syphilis, of seven children and two adults from
burns or scalds, of five persons from drowning, of three
infauts and two adults from suffocation, of five persons
who committed suicide, and of three persons who were
killed by horses or carriages in the streets were registered.
Inquests in St. Pancraa
A committee of the St. Pancras guardians have made
a report to the board in which they say that the in-door
medical officers have caused an unnecessary number of
coroner’s inquests to be held on persons dying in the
workhouse, and the guardians broadly and distinctly
charge them with doing so for the sake of adding to their
income by the fees received for attending such inquests
and making post-mortem, examinations. To prevent this
the board of guardians now require them to report to the
clerk of the board all cases of suspicious death, instead of
communicating direct with the coroner’s officer.
It is thus to be left to the discretion of the clerk, and
not to the coroner, whether an inquest is necessary or
not; or at least whether he will consult the coroner in
any particular case of death reported by the medical
officer.
Testimonial to Dr. Chowne.
A meeting was held in the board-room of the Charing-
cross Hospital on the 3rd instant for the purpose of pre¬
senting a testimonial to Dr. Chowne. After thirty-three
years of unremitting and well-performed services Dr.
Chowne has retired from the post of physician to the
Charing-cross Hospital, and the council, in accepting his
resignation, unanimously passed a resolution expressing
their regret at the cessation of his more active work in
the hospital, and nominating him an honorary life
governor as an acknowledgment of the zeal and ability
with which he has for an unusually long period dis¬
charged his responsible and onerous duties ; of the care
and kindness he has shown to the patients placed under
his charge; and for his assiduity in promoting the general
welfare of the institution.
The testimonial was presented by the chairman, Mr.
R. Few. In returning thanks 'Dr. Chowne addressed the
meeting at some length, relating the history of the hos¬
pital, and congratulating those who would succeed him
on its improved condition. Thanks were voted to the
chairman, when the meeting closed.
Bridewell and Bethlehem Hospitals.
At a special meeting of the governors, held on the 30th
ult., the Lord Mayor (Alderman James Lawrence) was
unanimously elected president, Mr. J. E. Johnson, whose
sudden death occurred lately, was the former president
Fever in London.
Dr. Buchanan, medical officer of health for St. Giles’s
district, in consequence of the great increase of fever in
the metropolis, has urged upon the local board of works
the necessity of establishing a public disinfecting chamber
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NOTES ON CURRENT TOPICS.
December 0,1868. 495
for the purpose of purifying infected clothing, bedding,
pursuant to the Sanitary Act, 1866, sec. 23 ; and as
a preliminary step the board have invited the local boards
of adjoining parishes to join with them in providing such
an establishment. This is a measure which the medical
officers of the metropolis have long UTged upon their
respective boards, but without success in even a single
instance.
Civic Honours to Medical Men.
The Lord Mayoralty of Dublin, which has been held
for the last year by a member of the Profession, will be
this year again occupied by a medical man. The present
Lord Mayor entered on his functions as Dr. Carroll, and
he retires from them as Sir William, having been honoured
with knighthood to celebrate his entertainment of the
Prince of Wales. The corporation have nominated Sir
John Gray, also a member of our Profession, for the
Mayoralty of the ensuing year, but it is believed that he
will decline the honour, and that Sir William Carroll
will continue in office.
Dr. Babington, of Londonderry, has been also placed
by his fellow townsmen in the chief magistracy. With¬
out arrogating to the Profession any peculiar claims to
civic dignities, we are gratified to see that medical men
are at length stepping forward into public positions.
Hitherto it has been the fashion for doctors to adopt a
miserable timid policy of keeping themselves in the back¬
ground. A successful practitioner has been supposed to
have no mind or judgment of his own, and a discreet one
was supposed never to give expression to any idea beyond
his actual business, for fear it might cost him a guinea.
We congratulate ourselves on the end of such a system.
A New Principle of Medical Editorship.
The Gazette Medicate de Lyon and the Journal de
Medicine de Lyon have, it appears, amalgamated, and will
appear aa a single periodical. In announcing this fact, the
Courrier de Lyon took occasion to add that in future there
would be no permanent editor, but that the new journal
would be directed by a committee elected by the sub¬
scribers and re-chosen every four months. The editor of
the Gazette Medicate hastens to deny the latter part of the
information, and declares that such a method of adminis¬
tration would necessarily carry with it too many elements
of instability for any sensible person to think of pro¬
posing it.
The Preservation of Meat.
Another process has been added to the multitudinous
proposals of inventors for the preservation of meat in the
fresh condition, and this time it is one which would at least
appear to effect the desired object, whether it do so or not,
€t to pay.” The process of Dr. Estor, the inventor, which
he last week submitted to the Society of Arts, consisted
simply in using two gases, i.e., sulphurous acid and
chlorine. These gases are not applied simultaneously, but
in succession. For general purposes, and when compara¬
tively small quantities of meat require to be treated, the
most convenient form of applying these gase3 is that of a
pastille, consisting of a clay bowl resembling that of a
tobacco-pipe of large size, coated on the outside with sul¬
phur, the interior of the bowl being filled with a paste
containing chlorine. The action is this—the sulphur of
the pastille, being set fire to, bums, giving off sulphurous
acid gas, and by the time the sulphur is nearly burnt out
sufficient heat has been generated to cause the chlorine gas
to be evolved, thus effecting the object of the inventor—
the subjecting the meat to the influence of the two gases
in succession. The joints or carcasses required to be
treated are hung in a safe or other air-tight receptacle,
lined with tiles or other non-absorbent substances. A
lighted match is applied to the bottom of the pastille ; the
door of the safe is closed immediately the pastille begins
to burn, and the meat left in that condition till required
for use. It is better to keep the meat in the safe till it is
to be used ; but it may be taken out half-an*hour after
burning the pastille, and hung in the open air, without fear
of it suddenly going bad, even in the hottest weather. In
cases where large quantities are required for preservation
for a length of time, he had found from experience that
with the gases he was able to keep meat in a perfectly good
condition for eight weeks in the hot weather, which he said
was the longest period to which his experiments extended.
There was not the slightest taint of decomposition, and the
only difference between that and fresh butcher's meat was
that the former was excessively tender eating. He had no
experience as to the results of this process in the case of
meat sent from a long distance in ships. When it is de¬
sirable to keep meat for a month, or two months, the fumi¬
gation should be repeated. Sulphurous acid alone will
preserve meat for a time, so will also chlorine, but the meat
thus preserved is nauseous ; whereas, when the gases are
used conjointly, in the manner above-described, and in due
proportions, no trace of either remains.
His Royal Highness the Prince of Wales most kindly
forwarded on Saturday week a valuable present of game
for the use of the patients in Westminster Hospital.
At an inquest lately held on the obstetric case of Mrs.
Clifford, of Bethnal Green, the jury brought in a verdict
of manslaughter against Mr. T. W. Popplewell, the surgeon
who attended her.
The Boston Medical Journal says “ In the State of
Ohio, from the 1st of October last, by a new law no one
is allowed to practise medicine who has not graduated in
some legally constituted medical college, and has a
diploma from the same.*’
A banquet in aid of the funds of the French Hospital
in London is announced for Tuesday next, under the pre¬
sidency of Sir B. Phillips. The Princes of the Orleans
family, Mr. Reverdy Johnson, and other persons of dis¬
tinction, have promised by their presence to aid this most
excellent charity.
Dr. Green it is thought, as well os others, will resign
his candidature for the appointment of Medical Officer of
Health for St Pancras, in consequence of the vestry
having passed a resolution that the future medical officer
is to reside i u the parish.
Yesterday a special meeting of the metropolitan
branch of the British Medical Association was to be
holden, to consider the address of the committee relating
to the direct representation of the profession in the
Medical Council
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MEDICO-SOCIAL PENCILLTNGS.
Deeember 9,190.
The Obstetrical Society of Dublin will hold its next
meeting at the King’s and Queen’s College of Physicians,
on Saturday, the 12th, at which a communication will he
read by Dr. Athill on Retroflexion of the Uterus, and Dr.
G. H. Kidd will exhibit some new forms of pessaries.
The board of guardians at Worcester have offered
fifteen shillings per case to their Medical officers for
attendance on parish midwifery. Two gentlemen have
accepted these terms, but one, though he takes them in
all ordinary cases, will expect a larger sum for long and
tedious labours.
The Pathological Society of Ireland held its opening
meeting on Saturday week last, when the following
gentlemen were elected to the various offices in the
Society:—President: Alfred H. M‘Clintock. Vice-Pre¬
sidents : Joseph M. O’Farrall, Robert Adams, James
Duncan, George H. Porter, Maurice Collis, Sir Dominic
J. Corrigan. Council : John T. Banks, Thomas Beatty,
John Denham, Christopher Fleming, Samuel Gordon,
Edward Hamilton, James S. Hughes, Henry Keunedy,
George Kidd, Robert Law, Robert M‘Donnell, Benjamin
G. M‘DoweL Honorary Secretary: William Stokes.
Secretary and Treasurer : Robert W. Smith. Secretary
for Foreign Correspondence: Robert D. Lyons. The
subject of the prize essay for the gold medal of the society
will be M The Diagnosis and Pathology of Diseases of the
Tongue.” _
MEDTCO-SOCIAL PENG1LLINGS OF LONDON
LIFE AND PRACTICE.
No. 2.
TnE position at table that our non-medical friend oc¬
cupied was towards its centre, and between two of
the most loquacious of our set, who undoubtedly taxed
his patience sorely, and tickled his acoustic drums
acutely with the relation of improbable and startling inci¬
dents in which they affirmed themselves to have been the
heroes, and the guiding spirits ; in a word, they painted
with all the flippancy of professed caterers of the impro¬
bable, and the impossible, scenes such only as the most
fertile imaginations could depict. Our non-medical friend
laughed heartily, and pretended to enjoy the “ cataract of
gargle” very much; but at an advanced hour of the
night, when he rose from his seat in order to seek the
hotel whereat lie sojourned—situated a considerable dis¬
tance from my lodgings—the surprise given to his
loquacious friends may be presumed to have been con¬
siderable, from the fact of bending his body and ducking
his head, and saying w ith the studied gravity of an “ old
hand,” adjusting liis neckcloth as he spoke,—“I as¬
sure you, gentlemen, it is now over forty years since myself
was a medical student, and I have a very vivid recollec¬
tion of how I used to stuff with stories such as you to¬
night so kindly favoured me, the ears and the open
mouths of the idiots who unsuspectingly listened to and
likely believed them to be true. Accept my sincere thanks,
gentlemen, and be assured that I shall have much plea¬
sure to hear that you are more successful in the practice of
the profession to which you aspire, than you have been
to-night in convincing me that medical students of your
day are more wise than they were, ere I substituted
the ploughshare for the scalpel, and mangel-worzel foz
calumba root. Good nightand the speaker laughed
heartily, and steadily regarded with keen eyes the crest¬
fallen “ gusliingtons,” until the veins of his forehead stood
boldly and prominently forward like whipcords, and his
full face assumed the ruby glow of semi-suffocation.
They, however, assisted him with his over-coat and
helped to button it too ; and so far became reconciled to
their position, that they even tried to polish his hot
with their sleeve cuffs, and ultimately procured a cab,
into which they handed him iu a most polite and a very
graceful manner.
But having bid him good night, and being satisfied of
his departure, they re-entered the apartment in silence,
and had seated themselves for a considerable space of time,
regarding each other with the undescribable looks of
clever fellows more cleverly “ done,” before one of them
remarked to his comrade in an undertone of voice—
“ What a rum old stick that, eh ? ”
Our supper was supplied by a purveyor of note, and
consisted of several cautiously selected dishes, which of
course included specimens of the feather tribe, that seemed
to carry their “ visceral arrangements ” as parish beadles
carry their cocked hats in warm weather, and whoso lower
extremities had been “ lopped off” according to no recog¬
nised surgical rule or precedent. We had sherries and
champagnes, pastries and pomades, soda and “ Sally
Luuns in fact, a very replete supper table, judged, of
course, according to our crude notions of a gastronomic
success.
Grace was said, operations were commenced,progressed
satisfactorily, and finally concluded brilliantly. Then
the fragments and their ornamental addenda were
removed, to make way for the Fiery Elements, their pro¬
ducts and protegees 9 represented by Cognac, LL., steaming
tankards, latent Vesuvians, loaded pipes, and slim-looking
cigars. These arrivals were evidently regarded by the
company with a large amount of favour, made manifest
by sundry well-marked symptoms of applause.
Preliminary arrangements being completed at length,
so that “business” might proceed, the Toast-master
called for silence, ar.d the Chairman called “To busi¬
ness—fill up, gentlemen.” What a metallic “chink,”
what a busy tingle, what simultaneous giugle followed
this “gentle call of duty;” so short, and sharp,
and decisive, a3 if there was a sudden and a general
“ insurrection ” of plated spoons and of loaf sugar pellets,
and that the instantaneous demolition of all flint ware, re¬
gardless of size, shape, pattern, and condition, had been
resolved upon. And, os “hot water” from time im¬
memorial has been fancifully represented as the element
into which unsuccessful rioters invariably plunge them¬
selves, that gentle liquid entered the combat in the magic
power of high pressure, and made sad havoc amongst the
rioters, absorbing one section of them, and literally com¬
pelling another section to warm and to glow under its in¬
fluence, and to attempt a display of that keen and that
pleasing enjoyment, vanquishers with spirits up to proof,
and if not bounding and elastic, certainly (in this par¬
ticular instance) grateful and palatable, may assume with
impunity, and nevertheless appear to the untrained eyes
of the unmethodical observer magnanimously noble, and
superlatively generous, possessing far, far too much of
“ soul ” to be troubled with a particle of the morbid
growth designated secret satisfaction, at the ignominious
conge of an opponent. Bless me ! will the unmethodical
observer always be a—well—a Tommy Dodd.
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CORBESPONDEIs CE.
December 9, 1869. 497
“ Ready, gentlemen,” reiterated the Chairman, playing
with liia right finger and thumb, and running his eves
along the steaming board as he spoke ; but “ Mr. Chair ”
need not have taken the trouble to repeat his question—
medical students as a rule are not proverbially slow in
taking a hint of the kind, even under far less auspicious
circumstuuces than those in which they were then engaged.
“ Ready, Mister Chair/’ was the response.
Mister Chair stood erect, blushed in his cambric—for
he was a timid gentleman, bowed to the company—for he
was a polite one, and then proceeded with the “ business
of the evening,* his oration being its starting point.
Quid Nunc.
DR. MACCORMAC'S PLAN OF VENTILATION.
TO THE EDITOR OF TUE MEDICAL PAE88 AND CIRCULAR.
Sin,—As a matter of fact, I do not think Dr. MacCormac
has any right to call himself the originator of the mdde of
ventilation described in your journal of the 25th ult., as I
know at least two houses in which for several years past the
rooms have been ventilated by a fire-box at the back of the
grate, one portion of which communicated with the external
air by pipes, the other with the room to he ventilated by
piping inserted in the wall, closed at the orifice by valves, re¬
gulating the quantity of air admitted. A vory common and
simple means of ventilation, many years known, is that of
building either an iron or tile pipe in both sides of the chimney
parallel and close to the flue, and terminating by small holes
in the cornice of the ceiling, ns described by Dr. MacCormac.
This pipe or flue should communicate with the external air by
pipes laid under the floor, and being warmed by the fire, a
circulation of pure warm air is maintained in the room, with¬
out any cold-giving draught, the foul air escaping up the
chimney shaft ny [ erforations made in the ceiling or cornice.
Your obedient servant,
Richard Griffith, Ch. M.
THE FELLOWSHIP OF THE COLLEGES OF
PHYSICIANS.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sib, —At atime when even the credulous Spaniard is question¬
ing the right divine of queens to rale badly, and when our Irish
Establishment is about to fall, may I turn to you for a little in¬
formation with respect to the meaning of the title of F.R.C.P.,
London ? I am glad to be called a Fellow of the Royal College
of Surgeons, becauso I took some pains to qualify myself for
this, by attending six years of hospital practice and passing
an examination in dissections, Ac., for this degree. But it
seems to me, Sir, that the title of F.R.C.P. is chiefly attained
by the payment of a sum of money, aud the being acquainted
with somo of the already created Fellows. And I would not
complain much about this, were I not to compare the comfort
and utility of the College of Surgeons* library with the bare
and wretched accommodation provided for us members in our
College in Trafalgar square. Iu the name, Sir, of modern
common sense, is it not time that such invidious distinction,
based on money qualifications chiefly, should cease, and ex¬
amination be, as iu Paris, the only way of rising a step higher
in any branch of our beloved profession ?
I remain, Sir,
Yours faithfully,
CharlesDrtsdale, M.D., M.R.C.P.L., F.R.C.S.E.
MEDICAL REPRESENTATION IN PARLIAMENT.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Dear Sir,—I have been very forcibly struck of late with
three significant circumstances connected with the above
subject.
The first is from a speech of Sir E. Grogan at the city elec¬
tion. When proposing his friend. Sir Arthur Guinness, in
which he says, referring to Sir Dominic Corrigan’s claims, to be
returned for his native city.
44 I think a medical representative in Parliament would be
fatal to the profession, and I am not singular in the opinion
because the, heads of the profession, including men , perhaps as
eminent as himself (Sir Dominic), have pronounced against it
they dislike it and they disown it .” ( Cheers , dc.)
Do not these words demonstrate to the most obtuse intellect,
that these gentlemen in opposing Sir Dominic Corrigan, these
“ Heads of the profession whose confidence Sir E. Grogan it
appears, enjoyed, and whose private reasons for their opposi¬
tion to a professional brother of high character and attain¬
ments, must have been known to him when he made use of
these words, as otherwise, a gentleman of his position would
not do so. I ask does not this circumstance prove that the
go-called “ Heads of the Profession ” have put forward “ the
Church Question ” as a pretext only for their opposition; their
real motive being to prevent our having any medical represen¬
tation in Parliament, and, at all events, that Sir Dominic Cor¬
rigan should not be the man ; and this brings me to the second
circumstance that attracted my attention lately.
I find a reprint from Dr. Duncan’s speech, made before an
aggregate meeting of Conservatives in the city of Dublin, on
the 32th ult., published in the Association Journal of the 25th
ult., Dr. Duncan says :—“ He agreed with Sir Dominic Cor¬
rigan in many of his views in relation to the improvement of
the medical profession. . . . There were other views also
in which he probably agreed with Sir Dominic, but there was
one point on which he did not agree with him, even as represen¬
tative of the medical profession .
I will not ask Dr. Duncan what that one point ” was, but
it is clear that it was not 44 the Church Question.” For he
says, it was a point that he did not agree with him on, “ even
as Representative of the medical profession,” and yet Dr.
Duncan’s name is to be found attached to a document, which
assigns “ the Church Question,” as the sole and only reason
of the subscribers for opposing the only member of their pro¬
fession who ever offered to become the advocate of the interests
of their less favoured provincial brethren in the Imperial Par¬
liament, and whose able aid and willing advocacy of their
cause were gratefully acknowledged by over five-hundred of
the profession chiefly interested on the subject.
What their verdict will be on the course adopted by those
who have ignored both their wishes and their interests for
their own private reasons, I will not foretell, but I opine that
the empty benches at the next meeting of the Irish Medical
Association will be a sufficient answer, or elucidate the
problem.
I now come to the most painful of the circumstances alluded
to above, I allude to Dr. Mackessy’s approval certificate of the
conduct of the Council of the Association or a late occasion,
as published in the last issue of the journal of that body, and I
verily believe that nothing has occurred yet in this strange dis¬
union of the members of the Association more likely to be fatal
to it than that 44 certificate.” I had hoped that the veteran ad¬
vocate of Parliamentary representation, if he did not think it
prudent to censure the conduct of those who by the course
they pursued ignored all his teachings on the subjects to the
loss and injury of the parties concerned, would, at all events,
have maintained a dignified silence ; but I have been disap¬
pointed and I regret that I cannot accept as a sufficient
cause for the censure which his letter has put on me
and all the other supporters of Sir Dominic Corrigan for
endeavouring to carry out what we fancied was the aim
and object of the Association for years— viz.. Medical
Parliamentary representation by his now saying : 44 1 have
advocated that our Parliamentary representatives should be
elected by Medical Constituencies,” for I find so far back as
the year 1862, that the first resolution proposed at the annual
meeting of that year by Dr. Armstrong and seconded by Dr.
Smith was, “That the profession had reason to regret the
want of (medical) representation in Parliament, Ac., Ac. Surely,
at that time, there was no prospect of having a medical Con¬
stituency in any of the three Kingdoms, and now when we
have medical Constituencies in Scotland, Ac., everyone knows
that the candidates, when soliciting their votes, did not confine
themselves to medical subjects.
I regret therefore, and for many other reasons find that Dr.
Mackessy should have felt himself called upon when defending
one section of the Association, to give expression to language
condemnatory of another and a more important section of the
body.
I have the honour to be
Your obedient Servant,
Kin vara, Dec. 1863. Dennis J. Hyne.
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498 The Medical Press and Circular.
LITERATURE
December 9,1968.
fensartimis rrf Emetics.
THE ST. ANDREW’S GRADUATES’ ASSOCIATION.
The aunual Session of this Association was commenced by
a meeting held this day week at Willis’s Rooms, at 7.30 p.m.
The chair was occupied by the President, Dr. Richardson,
F.R.S.
After several members were elected associates, Professor
Owen, Dr. W. Farr, F.R.S., and Mr. Froud, Lord Rector of
the University, were elected members of the Association.
The report was then read, and unanimously adopted on the
motion of Drs. Pike and Watson. The officers and members
of the Council for 1869 were then olected, and after the usual
business was completed, the consideration of scientific subjects
was commenced. A report was read by Dr. Sedgwicke on the
Parasitic Theory of disease. This was followed by an animated
discussion, after which the meeting adjourned.
On the next day the Association met again. There was a
large attendance of gentlemen and ladies. Several papers were
read, the chief one by Dr. Richardson, who selected as his
subject, “The World of Physic and the World.” We have
not time even to analyse the different topics which were dis¬
cussed. He concluded a powerful and interesting lecture by
expressing his belief that in time the world of physic would
reveal the mysteries of life with a clearness and simplicity
which would only render more wonderful the wisdom of the
“uncreated, super-essential, and all-beauteous mind.”
THe remarkable merits of the discourse were recognised by
all present, aud there was much applanse at its conclusion.
Then Sir Edward Belcher moved a vote of thanks to the
President, which was carried by acclamation.
Dr. Richardson responded in very modest terms, and, before
he sat down, proposed a similar compliment to Dr. Leonard
Sedgwick, M.D., the Honorary Secretary to the Association,
in acknowledgment of whoso services a testimonial has been
subscribed for by a largo body of members. The present,
which was exhibited in the room, consists, of a handsome
writing table in carved oak, and a silver inkstand. It was
duly made over to Dr. Sedgwick, with a complimentary ad¬
dress ; and the recipient having returned thanks in very plea¬
sant spirit, the proceedings came to a close.
-♦-
POOR-LAW REFORM.
The first meeting for the present session of the Health De¬
partment of the Social Science Association, was held on the
30th of November, at the Society’s rooms, Adam street,
AdelphL Dr. Brewer presided. Dr. Richardson had prepared
a paner on the subject, which, in his absence, was read by Dr.
Hardwick. It referred to the four propositions which had
been made in respect to the amendment of the Poor-law in
this country ; first, that the present laws should be repealed
and the Elizabethan code adopted ; next, the modification of
the present law ; then a national iustead of a local rate ; and
lastly, that all support of the poor should be self-support—
or, as Dr. Farr expressed it, a proportion to the money which
the applicant had contributed himself to the rates. The eirors
connected with the present Poor-law system of management
were fully discussed and exposed in the paper, and suggestions
were made as to the modes of future regulation, showing that
the poor should be divided into classes and treated accordingly
—that the helpless should have comforts and amusements—
that the able-bodied should be set to work—the children edu¬
cated—and that under a revised system we should not have
any such word as pauper. The lecture was an able one, and
was foliowod by a discussion, after which the meeting sepa¬
rated.
-+-
Barton oh the Nature and Treatment of Syphilis.—
Perhaps no subject has attracted so much attention, and been
the source of so many essays of late years, as that of syphilis.
A new work, therefore, on its “ nature and treatment,” must
interest the profession, and especially those who are concerned
in the intricate and puzzling question of the various and ob¬
scure form of its development, and constitutional manifesta¬
tions. Dr. Barton, to the credit of the Dublin school, has
undertaken a work in which he proposes to give the latest
gleanings and information in the form, as he mentions in his
preface, “ of one book of moderate compass which would give
a clear account of the whole matter,” and one not only suited
to the practitioner, but to the student especially.
We are happy to bear testimony to the carrying out of the
intention here expressed by the author, the work being com¬
pact, well written, and without that craving for ostentatious
book-making unfortunately so prevalent in the present day.
The introduction is devoted to a general and brief consi¬
deration of the varieties of venereal poison, the usual plan
being adopted of trifold division as gonorrhoea, simple or
chancroid sore, and syphilis.
Dr. Barton, admitting that he “ has occasionally met with
cases in which it was impossible at the first examination to
decide, but these are exceptions to the general rule,” proceeds
to the consideration of “ Byphilis,” or true infecting sore in
contradistinction to the chancroid ; he is a believer in the
duality of the venereal poison and thus characterizes the
third form of venereal disease true syphilis, the name men¬
tioned as the basis of his work, and for the elucidation of
which it was doubtless chiefly intended.
“We pass from the consideration of local sores and other
complications to that of a disease affecting the whole system,
from which no tissue or organ of the body is exempt, a disease
apparently produced by a subtle poison, which gaining admis¬
sion into the blood is by it carried to every part. This vim*
or poison has been as yet detected by no process, but we infer
its presence from its effects, which sometimes continue to be
produced when twenty or thirty years have elapsed since it
entered the system.”
The consideration of this sore in all its bearings is then criti¬
cally entered into by the author, who not only collates die
most recent information on this question, but adds some results
of his own experience and observations. We find him (p. 99)
rather inclined to revive the theory propounded in the Dublin
School by Carmichael as the result of his very wide observa¬
tions that there exists a plurality of poisons, each charac¬
terised by its train of constitutional symptoms, and following
the remark of Bassereau amongst the French syphilographers,
who states “ the benignity of a chancre announces that the
constitutional symptoms will be of little severity, its malignity
on the other hand tells us that the patient will be attacked
with consecutive symptoms of great gravity,” the author adds
as his opinion “ that we should be guided not so much by
the amount of induration present as by the ulceration ; if the
chancre has a deep ulcer with a sloughing surface or high in¬
durated edge, it is a severe case, but if there be simply an in¬
durated nodule without any, or scarcely any ulceration, that
is not a bad case.” Though this proposition may hold good to
some extent, we doubt if it will be generally adopted without
modification ; for instance, in case of maternal infection by
childbearing where no primary existed, what inveterate symp¬
toms will affect the one case and not another, or why two
men contract a sore from the same woman (who never were
before affected), yet one suffers pain, the other escapes with
comparative immunity. We fear the ground upon which the
seed is sown modifies the after crop, and that peculiarities of
constitution have most powerful, it not the chief influence in
the after consequences.
The constitutional symptoms are grouped and considered in
an effective and simple way as “ The Second Stage of Syphilis,”
characterized by the syphilodermata; mucous patches, and
the “ Third Stage of Syphilis,” or stage of deposit, which are
divided into the earlier or lymphy deposits, which the author
names sthenic , and the later “ gummy” or asthenic.
The whole history of the third stage is considered fully and
practically, not only with regard to the external manifesta¬
tions, but to the minute and often intractable changes that
take place in the viscera and internal structures.
We would have wished for a more copious allusion to the
painful and interesting class of nervous and paralytic affec¬
tions, but as the book is intended to be rather a class-book, we
may excuse a more detailed consideration of these cases.
As to the treatment, the author is neither a mercurialist or
non-mercurialist; he uses the “ two edged sword” with judg¬
ment. believing “ that it may be so given as to tell upon the
syphilitic lesions while the system will scarcely feel its pre¬
sence,” inunction being the form which seems most advisable.
The subject of syphilization is considered, and its details,
which have found as yet but little favour in this country;
so that, as the author laconically observes, “ It is probable that
Christiania will continue to be the stronghold of this mode of
treatment,” more particularly as the proofs of its superior
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NOTICES TO CORRESPONDENTS.
December 9,1868. 499
efficacy should be strong indeed,” before the profession or the
public would overcome their repugnance.
The important question, interesting not only to the pro¬
fession but to the State, of infantile syphilis is largely con¬
sidered, being divided into the stages of early symptoms,
intermediate stage and second stage, extending as far os
puberty ; the author coinciding with the practice generally
adopted in this country of a careful mercurial treatment.
On the whole we may class this work as one coming up to
the mark indicated by the author as “a guide and a book of
moderate compass, giving a clear account of the whole matter. ”
It shows much research and careful reflection, and will suc¬
cinctly indicate the way to the inquirer in this important and
intricate branch.
We regret the want of illustrations, and would be glad to
have seen more of the author’s own cases and results of his
treatment.
-♦-
(LMimnr.
DR. EDWARD PHILLIPS, OF COVENTRY.
We have to announce the death of Dr. Edward Phillips,
of Coventry. He was Physician to the Coventry and War¬
wickshire Hospital, and Senior Magistrate for the City of
Coventry. It appears that he was highly respected, and his
death will be widely lamented.
DR. HOBSON, OF LEEDS.
On Monday week Dr. Hobson, of Leeds, was found dead in
his bed. Some months previously he was thrown out of his
carriage and slightly injured. Another accident occurred
shortly after in his own house. His foot caught the carpet,
and he fell, by which his thigh was broken. He was conse¬
quently confined to his bed for some months, but had so far
recovered as to be out for a drive on the Sunday before the day
on which his death took place. He was advanced in life, beiDg
seventy-three years of age.
DR. CHARLES COWAN, OF READING.
It is our painful duty this week to record the death of Dr.
Charles Cowan, of Reading, which took place on the evening
of November the 29th. Dr. Cowan had for many years filled
the post of Senior Physician to the Royal Berks Hospital, and
enjoyed an extensive consulting practice in and around the
town of Reading, his opinion being often sought by practi¬
tioners at Newbury, Basingstoke, Abingdou, ana other places
at some distance from Reading. Dr. Cowan took his M. D.
degree in the University of Edinburgh in 1833, and a year
after he graduated in Paris. In 1835 he published a transla¬
tion of “ Louis on Phthisis,” which gave him at once celebrity
as a thoracic pathologist, and some of his medical friends were
anxious for him to establish himself iu London as a consulting
physician. He was not, however, one of those who fiua
London alone to be a place worthy for the display of their
talents, and after bein^a short time at Bath, Dr. Cowan even¬
tually settled at Reading and soon took a prominent position
there, and acquired a large practice, the experience gleaned
from which was often made to serve a useful purpose by pub¬
lication in the journals.
Lately, Dr. Cowan had beeu failing a good deal in his
natural energy and vigour, and, by the advice of his friend,
Mr. May, of Reading, he went for a short holiday to the Isle
of Wight. From thi9 he returned much improved ; but un¬
happily the improvement did not continue, and soon symptoms
of great nervous exhaustion and depression came on, so that,
despite the kind and constaut attendance of his friends, Dr.
McIntyre, of Odiham, and Messis. May and Maurice, of Read¬
ings subsequently aided by the skilful advice of Dr. Hyde
Salter, this truly excellent and accomplished physician at last
sunk, and eventually was carried off, os he himself predicted,
by an internal hremorrhage.
The funeral took place in the cemetery at Reading on Fri¬
day, December 5th, and the day was quito one of general
mourning in the town.
♦
O’SULLIVAN AGAINST THE LIMERICK
GUARDIANS.
The trial of this case, of which we informed our readers
some time since, has commenced in the Court of Queen’s
Bench, Dublin, and is expected to occupy many days. It
is an action for wrongful dismissal, Dr. O’Sullivan having
been removed from the Resident Surgery of the Limerick
Union Workhouse, though admittedly a most valuable
officer, because he did not succeed in maintaining harmo¬
nious relations with the Sisters of Mercy who had been
placed in charge of the wards.
The reports of repeated and angry discussions in the
Board of Guardians, have appeared in the Journal many
months ago.
Dr. O’Sullivan has been, in our opinion, absolutely
offered as a sacrifice to the narrowest religious bigotry,
and we most earnestly hope that he will succeed in com¬
pelling the guardians to pay for the exercise of their
grossly unjust prejudices.
OPERATIVE SURGERY.
The regulations which we publish elsewhere, as
having been recently adopted by the Council of the Royal
College of Surgeons in Ireland, will, we understand, apply
to all students from this date.
ILLNESS OF DR. R. B. GUINNESS.
The Irish profession will learn with much regret of the
dangerous illness of Dr. B. G. Guinness, of Dublin, the
recently-elected Registrar of the King and Queen’s Col¬
lege of Physicians. The malady under which Dr. Guinness
suffers is aggravated erysipelas of the head with cerebral
complications. On Saturday last bis medical advisers had
little hope of his surviving many hours, his respiration
having risen to 60, and a state of semi-coma having super¬
vened. On Sunday some amelioration had shown itself,
and the respiration was at 48. On Monday, however, his
attendants were of opinion that having passed a restless
night he was not so well. Through the urgency of all
these symptoms the patient has fortunately been able to
partake of nourishment, and hopes are entertained of his
recovery. Dr. Guinness is surgeon to the County Dublin
Militia, and an ex-assistant physician of the Rotundo
Hospital.
The New President of the Poor-law Board.—
Notwithstanding many conflicting statements now in cir¬
culation, we have reason to believe the Presidency of the
Poor-law Board will be conferred upon the Right Hon.
G. J. Goschen, M.P. for the City of London, who held
office under the Government of Earl Russell in 1865.
The Siamese Twins are reported to be on their way to
Europe. Before the surgical separation, for w r hich pur¬
pose they have undertaken the voyage, takes place, they
will exhibit themselves for a few weeks to the British
public, on account of the lowness of their exchequer.
Those of the profession who were unable to see this
monstrosity when in this ^country before, will now have
the opportunity of so doing.
NOTICES TO CORRESPONDENTS.
Dr. Isaac Ashe.— " Letter* on Medical Reform see notice in ‘ The
Journal of the Irish Medical Association.”
Medical Ci.ub.
To the Editor of the Medical Press and Circular.
Sir,
I hope you will allow me, through the medium of your columns,
to state in reply to numerous correspondents, that it was decided at the
general meeting, not to increase the subscriptions of the original mem¬
bers.
The formation of the Guarantee Fund will prevent the necessity of any
increase of subscription, and if every member could, during the ensuing
year, introduce one new subscriber, the Guarantors would not require to
be called upon for any portion of the sums they have kindly promised to
subscribe in addition to their annual subscription, should such be found
necessary.
I am, Sir,
Your obedient servant,
Lory Marsh, Hon. Sec.
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BIRTH AND DEATHS-
December 9, INI.
Dr. Andrew Wilson (New Subscriber).—Thanks for your note. Your
request shall be attended to.
W. H. Sand ham —Your paper on “ Ice and Electricity ” is postponed.
You will receive a private note.
The name of Dr. H. MaeNaughton Jones is interpolated in every second
paragraph, accompenied with the most extravagant laudation, and with
statements of fact which no other person than Dr. MaeNaughton Jones
himself could have supplied
The Cork Daily Htrald elevates Dr. Jones to the “ top of his profes¬
sion,” and maunders about his “ headwork and long study/’ and the
“hundreds of pounds ” he has spent on this venture. A more indecent
puff, or one which makes less concealment of its authorship, we have
never seen, at least in any part of a respectable journal than its adver¬
tising columns.
- » -
BOOKS, PAMPHLETS, Ac., RECEIVED.
Bible Animals. By Rev. J. G. Wood. Part XV. London: Long¬
mans, Green, A Co.
Hardwicke's Science Gossip for December.
The Pharmaceutical Journal for_December.
The Public Health.
The Practitioner for December.
Cases in Surgery: The Wire Ligature in Compound Fractures of the
Lower Jaw. By Hugh Owen Thomas, M.R.C.S. London: John Churchill
and Sons.
Conspectus of the British Pharmacopoeia. Second Edition. By O.
Davies Owen. London : Longmans, Green, & Co.
The New York Medical Gazette.
Boston Medical Journal, Ac., &c.
♦
APPOINTMENTS.
Charterib. M., M.D.—Assistant-Physician to the Glasgow Royal Infir¬
mary Dispensary.
Dowse, T. 8., M.D., L.R.C.P., M.R.C.S.—Registrar to Charing-cross
Hospital.
Dunlop, J., M.D.-Assistant-Surgeon to the “ Impregnable,” training
ship for boys.
Ellis, T. S., M.R.C.S.E.—Surgeon to the Gloucester Infirmary, vice C.
Barrett, F.R.C.S.E., resigned.
Gabriel. J. T., M.R.C.S.—Promoted toH.M.S. Scorpion.
Henry, Dr.—P hysician to the Suffolk General Hospital, Bury St. Ed¬
munds, vice \V. Cooper, M.D., resigned.
Inman, W., M.D. -Assistant-Surgeon to Greenwich Hospital
Kryworth, H., M.R.C.S.E. —Medical Viaitor of Private Lunatic
Asylums, in the District of York, vice YT. E. Swaine, M.D., de¬
ceased.
Nortos, G. E.. L.8.A.L.—Senior House-Surgeon at the Middlesex Hos¬
pital, vice H. Case, M.R.C.S.E.
Rinoland. J., M.D.—President of the Obstetrical Society, Dublin, vice
8. L. Hardy, M.D., deceased.
Salmon, J., M.D.— Promoted to the rank of Inspector-General of Hos¬
pitals and Fleets.
Sims, Mr. F. M, Surgeon to St George, Hanover square, Dispensary, has
been appointed Assistant-Surgeon to the Hospital lor Diseases of the
Skin. Blackfriars.
Soper, Mr. W., of Clapham Rise.—Medical Officer te the Stockw.ll
Orphanage.
White, R. P., L.K.Q.C.P.I.—Surgeon to Meath Hospital, vice J. W.
Strong©, M.B., deceased. *
VACANCIES.
City Dispensary, Watling street—Physician.
Hospital for Women, Soho square—Assistant-Physician.
Jervis Street Hospital, Dublin—Surgeon.
Leeds Hospital for Women and Children—Consulting-Physician.
St. Pancras—Medical Officer of Health.
South Staffordshire General Hospital, Wolverhampton—Physieian.
Steevena’s Hospital, Dublin—Physician-Accoucheur and^Lecturer on
Midwifery in the Medical College.
University College Hospital—Physician to the Skin Infirmary.
Westminster Hospital—Resident House-Physician.
♦
\vti\ mrtr
BIRTH.
Jacob.— On the 4th inst., at 23 Ely place, Dublin, the wife of Archibald
Hamiltou Jacob, MD., T.C.D., F.R.C.S.I., of a son.
DEATHS.
Barrett.— On the 29th ult., T. Barrett, M.D., of Bath, aged 53.
Batlute.— On the 19th ult., Chas. S. Bayliffe, M.R.C.S.E., of Chippen¬
ham, Wilts, aged 35.
Cowan.— On the 29th ult., C. Cowan, M.D., of Reading, Berks.
Fraser.— On the 27th ult, at Inverleithen, James Fraser. M.D.
Herbert.— On the 14th ult., J. L Herbert, Surge m, of James street,
Bangor, aged 59.
Hobson.— On the 29th ult., R. Hobson, M.D., of Leeds, aged 73.
Leetb.— On the 2nd inat., after a short illness, John Griffith Leete,
F.R.C.8., L.S.A., of Thrapatone, Northamptonshire, aged 62.
Established 1848.
PROFESSIONAL AGENCY AND MEDICAL TRANSFER OFFICE.
60, Lincoln’s-inn-flelds, W.C.
WE. J. BAXTER LANGLEY, MR.C.S., ELS,
&c. (King’s Coll.), has always upon his books a large
number of desirable investments and available openings for Medical
Men commencing their professional career. Gentlemen wishing to re¬
linquish practice can be introduced without delay to competent succes¬
sors with means at their disposal.
Mr. Langley devotes his prompt personal attention to the negotiations
entrusted to him, and treats confidentially and with care all matters re¬
lating to professional business. The strictest reserve willbepractisedin
all the preliminary arrangements and no expense incurred (except in
special cases) unless a negotiation be completed.
The business of the Professional Agency is based upon the general
principle that no charge is made unless work has been done and services
rendered.
A prompt and just system secured a large measure of success to the
General Partnership and Commercial Agency Business formerly eon-
ducted by him at his City offices : this has for some years been trani-
ferred to Lincoln’s-inn-fields, and he has invariably adopted the same
equitable policy in the more professional matters placed in his bauds.
Thus his experience in the management of large commercial under¬
takings, combined with his medical, scientific, and literary acquire¬
ments, enablo Mr. Langley to guarantee that all matters of business
placed in his hands will be carried out without delay, and with an equi¬
table regard to the interests of all the parties concerned. As as
arbitrator on matters of dispute between professional men, Mr. Langley
has had great experience, and he can refer to numerous cases in which
he has been the means of preventing expensive and tedious litigation,
and in which his awards have been made rules of her Majesty’s Courts
at Westminster.
Mr. Langley can also refer to the Professors of his College, Members
of Parliament, Clergy, Merchants, Bankers and others, as a guarantee
of his integrity and honour in all negotiations entrusted to him.
Full information as to terms, Ac., seat free on application.
Office Hours from 11 till 4; Saturdays from 11 till 2.
M R. LANGLEY’S Quarterly List of Selected
Partnerships for Transfer, in town and country,
Free by post for two stamps. Address as above.
Practices sod
is now ready.
P HYSICIAN’S PR ACT ICE.—The succession to an
excellent Consulting and Visiting PRACTICE in one of the best
country towns is open to negotiation. A valuable Hospital Appoint¬
ment is associated with the'prartice, and could be transferred to a suit¬
able successor. Application to be made immediately to X 425, Mr.
Langley, as above.
01 QAA A*YEAR.—In a very fashionable and large
dt A • 0 UU Watering place in Yorkshire, a good Family PRACTICE
for TR ANSFER. Receipts steadily increasing each year. An intro¬
duction as Partner will be given. The residence is beautifully situated,
and the practice is easily worked. Address X 391, Mr. Langley, asabove.
D ENTAL. — Mr. Langley has upon his Register some
excellent Dental Practices for TRANSFER, requiring invest¬
ments from £500 to £1500. Address as above.
D EVON.—An unopposed PRACTICE for TRANSFER in
a pleasant locality, where there Is great scope for increase.
Receipts over £300 a-year ; expenses small. Appointments bring ii
£60 a-year. Residence commodious, well situate, with stabling, kt
Premium £100 in cash, and £160 by instalments properly •ecurei
Satisfactory reasons given for leaving. Address, X 482, Mr. Langley,»
above.
F IRST-CLASS PARTNERSHIP for NEGOTIATION. -
A very old-established connection in an improving country town.
Clubs and Union have been declined. Patients of the best class. Pro*
sent income £300 a-year, but capable of great increase by the co-ope¬
ration of a suitable partner. The junior partner could reside in the hotaa
of the senior if ^desired. A local Hospital is about to be establish^-
Terras moderate. Address, X 426,. Mr. Langley, as above.
A WELL-ESTABLISHED PRACTICE in a Midland
District for TRANSFER. The present average receipts are stoat
£300 a-year, but capable of great increase. The patients are of a food
class, and there are educational opportunities in the vicinity. The horn*
is commodious, with garden, greenhouse, stabling, and land. An sea-
dent compels the vendor to retire. Reasonable terms would be con¬
ceded, and the whole connexion is believed to be transferable. Address.
X 422, Mr. Langley, as above. ___
S OUTH COA3T.— For TRANSFER, a good MIDDLE-
CLASS PRACTICE, In an improving town. Preaent
average £300 a-year, but there is scope for almost unlimited incwM*-
Clubs and appointments have been declined. House detached and cea*
m odious, with garden, greenhouse, Ac. Rent £45. Partnership intro-
dnetion If desired. Address, X 421, Mr. Langley, as above. _ _
L ONDON, W.—FOR TRANSFER, with complete intro¬
duction, an old-established PRACTICE, held by the Vendor far
upwards of twenty years. Average receipts during last four years to¬
wards of £1,300; last year, £1,250. Midwifery fees from £1 la. to £4 «*
One brougham and horse do the work. A dispensary assistant «»*
ployed. A valuable public appointment associated with the Froog*-
Largo house, in complete repair, on beneficial lease. Rent £190.
whole connection is transferable to an active suitable successor.
d ress X, 399, Mr. Langley, aa above. __
COMPETENT ASSISTANTS Provided
^ without delay, free of expense to the principal. No ge®***®*
recommended whose antecedents hare not been inquired into. AP rJ
to Mr. Langley as above.
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“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, DECEMBER 16, 1 868.
OONTENT8.
PAOK
ORIGINAL COMMUNICATIONS.
The Influence of Temperament on the Dis¬
eases Peculiar to India. By Dr. S. E,
Maunsell, R A. 601
Case of Melaneholia Treated by Ice to the
Spine. By W. H. Sandham, M.R.C.&E. 60S
HOSPITAL REPORTS.
Mrrceb's Hospital—
Case t under the Care of Mr. Morgan.... 604
Dropsy and its Pathology. Under the care
of E. P. Sharkey. L.RC.8.Edin., Arc .. 505
CORRESPONDENCE.
Edwards Crisp on Medical Reform. 506
“ Dermatologist ” on an Historical Sketch
of Dermatology . 600
Henry Pitman on aHlatory of the Licens¬
ing System. 500
Dr. Barton on the Nature and Treatment
of Syphilis. 607
Henry ICaoCormac on Ventilation. 507
LEADING ARTICLES.
Educational Repos*.—No. Ill. 508
Wintes Climates. 509
ScAELAT 1 XA, OK SCARLET FEVER. 500
NOTES ON CURRENT TOPICS.
Ths New Sanitaty Act, 1868 . 510
Spanish Quarantine. 511
Royal College of Surgeons ef England_ 511
The St Pancras Medical Ofllcer of Health. 511
Disinfectants... 511
Dry and Damp Soils. 511
Twice Lord Mayor of Dublin. 512
Prevalence of Scarlatina. 512
The Evils of 8ewing Machines Prevented.. 512
Dublin Hospital Reports. 512
The Under Secretaryship. 512
Health of Dublin. 512
Turkey and Greece. 518
The Registrar Chief of the King and
Queen's College of Physicians of Ireland 518
pao«
Medico-Social Pencilling*! of .London Life
and Practice. No. III.../. 614
LITERATURE.
Water Analysis. By J. Alfred Wanklyn,
M.R.C.S., Ac. . 515
GLEANINGS.
Length of the Colon in Young Children .. 610
Fractures of the Elbow-Joint. 516
TRANSACTIONS 07 SOCIETIES.
Junior Surgical Society of Ireland. 51T
The Dublin Obstetrical Society. 618
Army Medioo-Chirurgic&l Society of Ports¬
mouth . 619
Medical Society of London. 519
8t Andrew's Graduates* Association. 510
OBITUARY.
SCOTLAND.
Edinbuigh Royal Infirmary. 518
Glasgow and Aberdeen Universities. 513
Edinburgh University. 518
Death of Slchel. 620
Death of Dr. Jeremiah Donovan. 620
Notices to Correspondents, Ac. 62 0
THE INFLUENCE OF TEMPERAMENT ON THE
DISEASES PECULIAR TO INDIA.®
By Dr. S. E. Maunsell, R.A.
The subject of the influence of temperament on diseases
peculiar to India, which I beg to bring to the notice of the
Society, is of considerable importance to medical men,
whether in civil or military life. The civilian medical man
is frequently, in the course of his practice, called upon to
attend invalids returning from tropical climates suffering
from various diseases, and in all stages of those diseases ;
and when his patient happily recovers, he is frequently re¬
quired to decide for him how soon—or if at all—he may
return with safety to the climate in which his malady origin¬
ated. He has an opportunity of seeing how the native of
our more temperate climate is affected by residence abroad,
and to what extent, and he can judge whether the diseases
thus brought under his notice are at all affected, and to
what degree, by temperament. In the same manner, in
military life, it must occur to medical men that soldiers
are affected more or less by the diseases peculiar to foreign
climates according to their special temperament. Take,
for instance, an officer in medical charge of a regiment
about to proceed to India. He has to inspect every man
in his regiment prior to embarkation, and regularly weed
it, taking from the ranks those men whom he thinks are
unlikely to bear up against the debilitating effects of the
climate of the East; and while abroad he has to be always
on the alert, selecting such men for home and such for the
different Hill Sanatoria as he may in each case think most
likely to be benefited by a change ; and if he returns with
his regiment to England after a residence abroad of ten
years, he will find very few men returning who originally
went abroad with him.
In going to a climate such as India for the first time the
European is placed in a position which he can hardly
realise—climate, mode of life, and means of exercise are
all changed ; there is a want of occupation such as he has
hitherto been unaccustomed to, and it takes him some time
* Read before the Army Medloo-Chirnigical Society of Portsmouth.
to give up his English manners and customs in the matter
of eating, drinking, sleep, and exercise, and to make up
his mind to the fret that he most suit himself to the
country or the country will never suit him.
Of the various temperaments which are mentioned in
systematic works, those which come most prominently for¬
ward as influencing disease, have been in my experience
the “ sanguine ” and “ bilious,” and in watching cases of
“ insolatio,” or sun-stroke, fever of intermittent type, dys¬
entery, and hepatitis, it appeared to me that the severer
cases occurred among men of bilious temperament, with
sallow skin, dark hair and eyes, and that men of sanguine
temperament, light hair, light blue eyes, and fresh com¬
plexion, though very frequently attacked by the diseases of
the country, yet the affections from which they suffered
were of a much less severe nature, and more transient,
and that among invalids from tropical climates men of the
latter temperament made a much more rapid progress to¬
wards recovery in this country than those of the former—
that men of a dark bilious temperament were more liable
to acute dysentery, especially that sort accompanied by
profuse discharges of olood from the bowels, nepotic in¬
flammation running on to abscess, and the severer forms of
remittent fever. With length of residence, I came to the
conclusion that the diseases first mentioned, dysentery and
hepatitis, were not influenced by temperament alone—that
they are of more frequent occurrence among the older sol¬
diers, men whose constitutions had been affected by climate
(exposure), intemperance, or repeated attacks of fever—
ana this especially in cases of hepatitis, whereas the
younger soldiers, though very subject to intermittent
fevers, were more or less exempt from the graver diseases
mentioned, which I explained to myself in this manner:—
The European when he lands in India has no dread of
the sun. You see a young soldier lately landed from Eng¬
land, full of fresh blood, going about in the mid-day sun
with a small cap on, or very likely no covering on his head
at all: he is careless as to consequences, because he does
not feel the effects. In the same way young offioers spend
the hot weather shooting in the district, with no protection
from the heat of the sun but that afforded by the thin
walls of their tents, and equally regardless of the extremes
of heat and cold, as long as they nave a liberal supply of
beer. They come out from home with a stock of nervous
energy and vital force which at first leads them to ignore
the Sects of heat; by degrees, if an attack of hepatitis or
dysentery does not make them more careful, they find tha
h
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as each succeeding hot weather comes on they are less able
to bear the exposure ; the sun, which they at first thought
nothing of, now becomes very irksome ; they feel languid
and exhausted, and are obliged to keep in* doors during the
heat of the day, and find they must follow the example of
the “ old Indian ” and take to early hours, exercise in the
cool morning and evening, and light food and drink. The
high temperature in which Europeans live in India take3
effect in proportion to the amount of nervous energy or
the inherent vitality which each possesses in varying pro¬
portion, and which has a tendency to deteriorate with length
of residence ; and as at first the balance is in favour of
the new arrival, and the diseases which affect him are of
the sthenic type, so, the longer he remains in the country,
the more his nervous energy becomes exhausted, the balance
is more easily turned, ana the diseases with which he is
affected assume a low asthenic character. Take the cases
of heat apoplexy, or sun-stroke, by which name a common
form of disease in India is inadequately expressed. Some
authors on diseases of India mention two forms, sanguine¬
ous and cerebro-spinal; the latter form, which is one
marked by intense depression of the nervous system, col¬
lapse, diarrhoea, and vomiting, I have most frequently seen
—and almost every case in the older soldiers. Men whose
nervous system is depressed by exposure to high tempera¬
ture for a long time are very liable to be so affected in
cloudy, damp, and oppressive weather, when the heat gene¬
rated in the body cannot be radiated. Intermittent fever
is very common among all classes of new arrivals, but I do
not think that men of sanguineous temperament are so
subject to the organic affections which so often follow re¬
peated attacks of this disease, such as enlargement of
liver and spleen, and that peculiar bronze or slatey colour
of the skin, owing to a black pigment deposited in it from
the blood, well described by Frerich as “ pigment granule.”
I have remarked these changes more frequently among men
of bilious habit, and that they retain the poison longer in
their system ; and whatever may be its origin, whether
malarial or crvptogamic, it first attacks the nervous system,
then the circulation becomes disordered, and if the disease is
not checked the patient is left in a state of exhaustion
and anaemia, so often seen in invalids from India in the pale
sallow face and expression indicative of great loss of
nervous energy.
The most severe forms of dysentery which I have seen
in malarial districts in India accompanied by profuse dis¬
charges of blood from the bowels occurred in men of long
servioe, bilious temperament, and especially if they have
suffered previously from intermittent fever. In the same
places and at the same time I have seen the younger men
suffer from frequent attacks of dysentery and dysenteric
diarrhoea, but not to the extent of the older soldiers.
In none of the above-mentioned diseases, I regret to say,
can I produce any statistics which would help to elucidate
the subject I can, however, in the next which I would
bring to your notice—viz., hepatitis. I have got here a
list of sixty-two cases admitted to hospital at different
stations in India from the same regiment (H.M. 10th regi¬
ment), the admissions extending over fourteen years:—
No. of Caw. A ™r*
Age.
Duration of
Cue.
y. in. d.
21 Bilious 6 7 7
28
20
41 Sanguine 6 1—6
30
82
We Bee in both cases the length of servioe has been
nearly the same ; there is a difference in the age, which
would be rather in favour of the bilious, I think (28—30);
bnt the greatest difference is in the duration of the cases,
in the bilious averaging twenty days, in the sanguine eighty-
two days, a difference which will not be accounted for, 1
think, by the disparity of age alone. I take it as more an
argument in fevour of the superior vital energy with
which the patients of sanguine temperament are endowed.
It would appear to be unnecessary to draw any com¬
parison between the two temperaments here specified, as of
sixty-two cases terminating fatally forty-one appear to have
been of a sanguine temperament (blue eyes, fair hair, fresh
complexion, &c., &c.), and twenty-one of the opposite, or
bilious ; and these numbers appear in evidence against
any preconceived ideas of mine on the subject, as apparently
the men of bilious temperament were least affected by
hepatic disease. But I do not think we can judge from
these few cases what the chances are in favour oi or against
an individual of either temperament being attacked by
inflammation of the liver, because I think that the tem¬
perament takes a conspicuous place in, and must be con¬
sidered in our prognosis and treatment of this and all other
diseases of India ; still I think it holds a secondary place
to length of residence, and if we examine this list we will
see under the heading of “ days in hospital ” there are
opposite to names of men who have been a short time in
the oountry, «>., from one to jive years, high nnmbers such
as forty-four, fifty-two, ninety-six, and ninety-seven dap,
their treatment extending over a long period ; while in
the other cases of five and over years' service, the number
of days under treatment diminishes with the length of ser¬
vice abroad (such as thirty-nine, twenty-three, seventeen,
and even eight and four days), all cases ending fatally. Of
men under five years' service we find one case mentioned
as being only two days in hospital. That appears to be s
very short period indeed, and was probably complicated
with some other affection.
Next to length of residence I would take the history of
former disease as being the most likely predisposing cause.
Numbers of fatal cases of hepatic inflammation which I
have seen in India, did not appear to start suddenly
into existence, as we see cases of pneumonia and peri¬
tonitis, but evidently came on slowly and insidiously.
The patient feels he is gradually losing health, strength,
and appetite ; he has a feeling of general malaise ; he may
or may not, most likely not, complain of pain in the
hepatic region ; he suffers from a peculiarly offensive
diarrhoea or dysentery, which is very difficult to get rid of,
and probably quick pulse, elevated temperature of body, and
hectic fever. There may be no symptoms which he can
refer directly to the liver, and so he may oontinue till at
last the abscess which has formed makes its way through
the lungs or some of the natural passages, or the patient
dies, the extent of the mischief being undetected till
after death. The greater number of suen cases are in old
soldiers who have suffered from attacks of intermittent
fever, and there are very few men of any length of service
in India who have not been repeatedly laid up with this
affection. To young soldiers it is frequently a bugbear
following them about from place to place. Take up the
medical history sheet of any soldier who has returned from
India invalided with hepatic disease, and you will see a
long list of entries of febris inter, against him, until it
last a graver affection has fastened itself upon him, and he
is obliged to come home. It is difficult to suppose that a
disease like feb. inter., affecting as it does to so great an
extent both nervous and circulating systems, could be
shaken off without causing more or less organic discess.
French, one of the best authorities on affections of the
liver, describes a regular form of disease which he calls the
pigment liver, fer illustrations of which in its post-morkn
appearances vide Atlas of Path . Anal., p. 9, 10, 11
(French), the peculiarities of which are certain alterations
found to exist in the liver in fetal cases of feb. inter., sock
as congestion, softening, atrophy, and obliteration of the
capillaries and cells. In these changes I think many fetal
cases of hepatitis have their origin; and, as I have already
said, men of dark, bilious temperament appear to me to be
most liable to such changes and complications, which, when
combined with length of exposure to the exciting cause,
may sooner or later terminate in suppurative inflammation.
In short, the diseases of young soldiers in India are not so
much affected by temperament as is the case in the older
soldier. In the former the good constitution, unimpaired
nervous energy, and oool blood, tend to lead on the ana
to a favourable termination, and resolution follows. The
ulcerated intestine beoomes cicatrized, and the liver
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December Id, 1668. 503
resumes its normal size and functions. In the latter the
blood is deteriorated, the tissues of the organ deranged and
perverted, the vital energy impaired by exposure or length
of residence. It is among suen, I think, when the balance
is once turned, and disease fastens itself upon any organ—
especially the liver—the affection more usually runs on to
a fatal issue ; and this the more quickly and more surely
in proportion as the man’s temperament approaches the
bilious, and men of this temperament appear to me to
suffer more than any other from the effects of climate and
disease in India.
CASE OF MELANCHOLIA TREATED BY ICE
TO THE SPINE.
By W. H. Sandham, M.R.C.S., Eng.
A. D. S., set. seventeen, a well-looking, healthy young
man, about the beginning of July last, became much de¬
pressed in spirits, and was often found by himself crying,
and would sometimes exclaim “ What will become of me !”
u Can nothing be done for me !” &c. I put him on open
air exercise, quinine and sal volatile, and a cold bath every
morning. This appeared to battle off the attack, but on
Monday, 14th September, he broke down again and be¬
came much worse. His mind gave way. He took it into
his head he was eternally lost; then that his family and
friends were forsaking him ; and so wandered off from
one silly idea to anotner. I found that he had not slept
for nights ; his appetite good ; pulse normal and ninety-
six ; tongue perfectly clean and skin natural. Bowels
confined from this date to Thursday, 1st Oct Daily and some¬
times twice daily, enemas were administered with no effect
whatever, further than that the first completely unloaded
the rectum. From the 14th September to 4th October,
there was no satisfactory alvine evacuation. On this
evening I commenced treating him with a 'view to procure
sleep. I must state he could not be got to speak during
that time, and nourishment was thrown down his throat
by main force. I gave him repeated doses of acet. mornhia,
tinct.opii, tinct.opii and emetic tart., and last, half dr. closes
of chloroform every twohours for three or four doses, nightly,
for several nights, without any narcotic effect that I could
appreciate. At this time I consulted my friend Dr.
Harvev. He agreed with me that the indication was, if
possible, to procure sleep and to restore the healthy func¬
tions of the bowels, and recommended persevering
with the chloroform, which I did. On the night, Thurs¬
day, 1st October,, after having read in the Medical Press
and Circular of same date, the report of three cases of
delirium tremens of a severe character cured by ice to the
spine, and having myself had satisfactory results from ice
applications in a case of epilepsy I treated some time be¬
fore, I determined on trying ice in the present case as
directed by Chapman, to whom be all the honour he so well
deserves; but as it was late at night I could not then pro¬
cure the ice. My patient was in a low state, unconscious,
his eyes fixed and vacant, frighteniDgmyself and his family,
as I feared a fatal termination of the case before morning.
It occurred to me then, as a good way to cool the spine,
to try Richardson’s spray apparatus, which I did. He
appeared to become sensible of, and roused by the ether
application, particularly when applied along the lumbar
region* After this I placed him in bed, for it was while
on the close stool I applied the spray. He got a quiet
night and considerable sleep. Next morning he was
rather wild and cross, but encouraged by this result I
forced him into bed and put a Chapman’s twenty-two inch
ice-bag along the spine for an hour and a half. In twenty
minutes the pulse was lowered twelve pulsations. He
soon said, “ I am very hungry and would like some break¬
fast,” though it was oy force he was made to drink any¬
thing before; He oi his own accord buttered his bread,
and ate and drank very like a man who was some days
starved. He had a perfectly lucid interval of au hour
and a half, and then lapsed into his former condition.
Ice in the evening again, one and a half hours;
before the bag was removed he was asleep. Had
another fine night’s rest. — Saturday, 3rd October.
Morning, ice applied; took another hearty breakfast;
at five p.m., without any ice fell asleep ; at half¬
past eight p.m. I roused him up to give him food, which
he took. Applied the ice for one hour, but he was fast
asleep before I removed the bag, and the act of removing
it and settling him in the bed did not awake him ; he was
literally tl dead asleep ” and he lay fast asleep in the same
position as I placed him until I took his hands from under
the clothes at half-past nine, a.in., on Sunday. Pulse
eighty-four, full, skin perspiring profusely, tongue clean,
and his face looking the picture of health. He was not
more rational. I administered a dose of castor-oil andtinct.
senna co., bowels not having yet acted. He took his
breakfast while the ice-bag was now on for three quarters
of an hour. A turpentine and assafoetida enema in the
evening brought away a quantity of caked matter, the
first satisfactory alvine discharge since he lay down. The
enema appeared to excite him much, and although the ice
was applied lie only had quiet, not much sleep. Monday,
treated by ice same way, another good night. Tuesday,
bowels responded to (soap) enema ; intellect still astray,
pulse excellent, tongue quite clean, eyes perfect, takes his
food without force. Tuesday and Wednesday, slept with¬
out ice. Thursday, looks well after his sleep, took hearty
breakfast, out of bed all day. Sunday, 11th September,
slept every night siuce application of ice on Monday
evening last; intellect better; bowels respond to enetnata.
October 25th, to this date my patient eats, drinks, and
sleeps well; the bowels only act byenemata. No ice applied
since the day last named; mind is better, but far from
right yet.—November 25. He is very nearly mentally and
bodily as well as ever. So far the treatment by ice with a
view’to procure sleep was a complete success, proving the ice
application recommended by Chapman to be an invaluable
therapeutic agent. I wmdd highly recommend, when ice
could not be procured, Richardson’s ether spray application
as a substitute. I used it iu a receut epileptoid seizure with’
apparent benefit ; I applied it twice a day for three or
four days, aud although it was the third attack in which
I tried it—having treated the patient otherwise in the
two first attacks—she has not had an attack since the
spray treatment, and it is eight or nine months ago. The
value of cold to the spine cannot be over-estimated.
-+-
TURPENTINE AS AN ANTIDOTE TO PHOS¬
PHORUS.
The Archives Gen. de Medecine calls attention to the custom
of the workmen in a match factory at Stafford, who apply
phosphorus to the matches, of carrying on their breast a tin
enp, containing essence of turpentine. This precaution is said
to be sufficient to prevent any ill effects from the action of the
phosphorus. It was previously known that the vapour of
turpentine prevents the ignition and even the phosphorescence
of phosphorus, but the practical application of this knowledge
is not so generally adopted mb it should be*
ENTOZOA IN CARBUNCLE.
The Paris correspondent of the Leavenworth Medical
Herald contains the iollowing interesting item :—“Dr. Da-
vaine, in a paper on Carbuncle, states that the blood of an
animal that bad died from this disorder was found to be filled
with microscopic filiform animalcules, belonging to the vibro
or bacterium kind. This is not the first time such a faCt has
been ascertained; but the question is, whether the animal¬
cules are the cause, or only the effect of the malady, or, again,
whether their presence is a mere aecident. From a series of
experiments made in order to throw some light on the subject,
Dr. Davaine concludes—1. That the animalcules in question
are constantly found in the blood of animals attacked with
carbuncles. 2. These animalcules appear in the spleen, the
liter and blood bejort the symptoms of the disease make their
appearance ; and, 8. The blood of infected subjects ceases to
be contagious as soon as the animalcules have disappeared.”
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HOSPITAL REPORTS.
December 16, 1868.
MERCERS’ HOSPITAL.
REMARKABLE FISTULOUS COMMUNICATION WITH THE
KIDNEY IN THE LUMBAR REGION, AND DISCHARGE OF
SEVERAL CALCULI THEREFROM.—LATERAL LITHOTOMY
PERFORMED NINE YEARS AGO.
By Mr. Morgan, F.R.C.S.I., Surgeon to the Hospital,
and to the Westmoreland Lock Hospital.
W. C., aged 17, mes¬
senger, admitted to
Mercers* Hospital Sep¬
tember 11th, 1868, com¬
plaining of symptoms
of calculus in the blad¬
der and much irrita¬
bility of urination.
Has had a venereal
sore and double sup¬
purating bubos during
the last three months,
and is in a cachectic
condition. He gives
the following history :
—About seven years
ago he got a fall, and
in consequence a swell¬
ing “ like a red lump ”
formed in the left lum¬
bar region, for which
he was admitted to
hospital. This swell¬
ing increased, and after
some months gave way,
and about a quart
of matter made its
escape. He was dis¬
charged from hospital
much relieved, but
with the fistulous open¬
ing continuing : from
time to time small cal¬
culi have made their
way through this track.
At* least six in number
have passed. There is
no stone to be felt in
the bladder after the
most careful explora¬
tion, but at the lom the
fistulous opening, with
a puckering of the skin
around, is to be seen,
and on passing in a
probe it passes upwards
and towards the spine.
On cautious examina¬
tion a rough calculus is
to be felt, deeply seated.
There is no great uneasi¬
ness, and the chief in¬
convenience is caused by the discharge, which is, however,
not in sufficient quantity to be collected to any practical
amount. Its reaction is acid, and on microscopic examina¬
tion appears to be pus and urine. There are a few tube
casts to be seen in it. On September 16th, 1868, I
with some difficulty extracted a small calculus which
was lodged about one inch from the surface. It is
rough and hard, the size of a small bean, longer than
round.
The boy had been lithotomised nine years since by Mr.
Be van, and a large-sized stone removed. Mr. Bevan has
also a calculus in his possession the size of a large marble
extracted from the fistulous opening about four years ago*
The woodcut shews the situation of the fistulous track)
and the peculiar indented puckered appearance at its
orifice.
THREE CALCULI IN THE BLADDER AND 8EVERAL IN THE
PROSTATE GLAND.
1 On August 26, 1868, an elderly man, aged seventy-
1 three, was sent up to me from the country, suffering from
severe irritation of the urinary organs and retention. He
stated that several attempts had been made to pass an
instrument, and the appearance of the patient indicated
his having suffered much pain and irritation. The
bladder was found to
be very distended. A
large pliable catheter
was passed after some
manipulation. On
doing so it could be
felt to grate over cal¬
culi in the prostatic
part of the uretiira, and
when introduced folly,
other calculi could be
felt in the bladder. He
was given an anodyne,
and warmth was applied
over the hypogastric
region, procuring for
him a fair night’s rest.
The next day, on
making a careful exami¬
nation, I found the
prostate enormously en¬
larged, and encroaching
considerably on the
rectum. The usual
symptoms of vesical
calculus in an aggra¬
vated form were pre¬
sent, with much debi¬
lity and prostration
caused by loss of sleep
A good deal of blood
also had been lost from
the urethra during the
previous week.
The patient’s strength
was much broken by
the continued suffering
for the last eight
months or more.
Tonics, Pereira brava,
with moderate stimuli,
were given, and the
bladder was washed
out with a solution of
watery extract of opium
(two grains to six
ounces of warm water),
to alleviate his suffer¬
ing, as the patient’s
strength was too loir
to list immediate ope¬
ration. After 10 day3
he was unfortunately attacked by diarrhoea, the strength
already failing gradually gave way, and death took place.
A post-mortem examination was made ten hours after
death. The prostate was found as large as a large orange,
with the venous plexus around it immensely distended
and varicose. On making a section into its substance as
in the lateral operation, a large quantity of fluid blood
escaped even at this period after death. The bladder
was contracted and had been long diseased. It contained
, three large-sized calculi, and along the urethral portion
I of the prostate there were several calculoid oonoetiona
I The contracted state of the bladder and the large m* of
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CORBB6PONDENCB.
December 16,18M. 505
the prostate precluded the use of lithotrity, and section
of the varicose and dilated veins of the prostate in the
E erformance of the lateral operation would, I doubt not,
ave been a very serious, if not fatal, complication.
DROPSY AND ITS PATHOLOGY.
Under the care of E. P. Sharkey, M.B. Dub.,
L.R.C.S. Edin., &c.
The following cases of dropsy, differing in their etiology,
treatment, and termination, may not, perhaps, be devoid
of interest, though occurring in the desultory practice of a
rural dispensary, in which the opportunity is not enjoyed
of testing diagnosis by the results of microscopic investi¬
gation.
Mrs. T., set. fifty-six, has been for many years an in¬
valid, and during the seven last she has been affected with
dyspnoea on walking fast, and for four years has been con¬
scious of a “ double beat ” of her heart. Her bowels are
habitually torpid, for the relief of which she has been ac¬
customed to the use of drastic purgatives. Her complexion
is pale and waxy, and she is much debilitated. I pre¬
sented pills consisting of the following—viz., ext. fell,
bovini, gr. ij. ; pulv. rhei, gr. i.; quin, sulph., gr. ss., in
each ; one to be taken every third hour till bowels were
affected. She derived much benefit from these ; but on
the 30th I was sent for, and found her labouring under
great dyspnoea, preventing her from lying down.
Physical signs, —Percussion dull in lower part of chest,
especially in inferior posterior right, with the crepitus cha¬
racteristic of oedema. Legs and thighs anasarcous ; some
fluid in abdomen also ; urine scanty, and high-coloured ;
no traces of albumen in it. Heart's action tumultuous
and irregular, with evident signs of dilatation. Ordered
the following pills—viz.:
R Mass. pil. hydrarg.,
Pulv. sciliss, a gr. i.,
Digitalinae* granulam, L M.
Fiat pil., ter die sumenda.
On the 8th October there was very great improvement.
Decided diuresis has been produced, with relief of the
dropsical symptoms. She can now lie down with ease,
and sleep, which she could not do before. Pulse 40.
Ordered ner to take only one of the last prescribed pills at
night, and those first prescribed as occasion required,
omitting quinte. sulph. and substituting pulv. zinzib. for
relief of flatulence. The report on 26th of November is
as follows :—
She has continued free from dropsical symptoms gene¬
rally, but when any threatening arises she takes one of
the diuretic pills at night, which at once relieves them.
The physical signs of hypertrophy and dilatation are well-
marked. Pulse 70. Bowels regulated satisfactorily by
the electuary of sulphur and cream of tartar. This pa¬
tient had similar threatenings of dropsy throughout 1863
and 1864, one of the pills always sufficing to relieve them.
Her disease, however, gradually gained ground in 1865,
and she sank under it at last, after a protracted struggle,
in 1866.
bth March , 1867.
Edward P., set. sixty-five, a mason, has for some time
past had anasarca of lower extremities. Says that before
he observed this the renal secretion was rather excessive
than otherwise. Present state : General health not much
affected, except that his appetite and strength are some¬
what impaired. Has slight uneasiness in the renal region.
Urinary secretion diminished; specific gravity, 1020°;
coagulable by heat, nitric acid, and corrosive sublimate.
He was put on comp. powd. jalap, imperial drink, and the
* Prepared by Mesaw. Homollc and Quevenne, Paris, a form of the
drug of which i cannot apeak too highly for its purity, uniform strength,
and facility of dispensing with accuracy.
following mixture: R Tinct. sc ill. Jss.; apt. jump,
c. 5 iis 8 . ; aquae ad Jviij.
On the 11th of March the quantity of urine had in¬
creased.
March 5th.—The mixture was repeated, adding pot. nit.
3j., and spt. eth. nit. Jj.; and he was directed to take the
following pills: R Extract, nucis vomicae, gr. x.; mic.
panis oq. s. ut fiat pil. xx., quarum sumatur i. ter die ; rep.
electuar. These pills were repeated on the 9th.
20th.—The pills were now stopped, specific gravity of
urine having fallen to 1010° ; but the electuary and diu¬
retic mixture were continued. The anasarca gradually left
the lower extremities. His appetite and strength im¬
proved, the urine became normal, and I saw him engaged
at his trade yesterday, looking hale and well, and express¬
ing himself as in reality so.
October, 1868.—Has continued well up to this time.
-*-
(&Qxxn$fsn'inntt.
MEDICAL REFORM.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sir,— As the subject of Medical Reform has been mooted of
late by several of your correspondents, yon will probably have
no objection to insert a view of my own which I propounded
in 1850, and which I copy from my London Medical Examiner
and the Faculty Journal of that date, voL 1 page 30. Now,
let us suggest a remedy for this monstrous evil, which we ven¬
ture to assert no man unconnected with the corporations dares
openly to defend.
1. That a Faculty of Medicine shall be formed in England,
Ireland, and Scotland, and that each Faculty shall be oomposed
of all the legally qualified practitioners who belong to the
Universities, Colleges or Halls of the respective countries.
2. That al who enter the medical profession shall, after
Jive years , undergo a preliminary examination in mathematics
and the English, Greek, and Latin languages. The examiners
to be appointed by government, and not all members of the
medical profession.
3. That the Medical Senate, or Exa mi n ing Board, shall be
at once formed of eighteen members, who shall be elected in
the following manner. The Bix examiners in the practice of
Medicine, Pathology, and Medical Jurisprudence, by the fel¬
lows, members, licentiates, and extra licentiates of the College
of Physicians, and all the graduates of British Universities who
practise as physicians. The examiners in Anatomy, Physiology,
and Surgery, by the members of the College of Surgeons of
London, and the graduates of the University of London. Six
examiners in Chemistry, Materia Medica, Botany, Midwifery,
and Diseases of Women and Children, by the gradu ates of the
University of London, the members of the Apothecaries’ Com¬
pany, and all in practice before 1815, who register as general
practitioners, excepting those who keep shops and openly trade
in drugs.
4. That the examiners shall not be teachers, and shall
receive a fixed salary.
5. That every candidate for the diploma of the Faculty
shall undergo four examinations, and that there shall be an.
interval of six months between each. The first examination
in Anatomy and Physiology; 2nd. Chemistry, Materia
Medica, Midwifery, Diseases of Women and Children, and
Botany; 3rd. Practice of Medicine, Pathology, and medical
Jurisprudence ; 4th. Surgery.
6. That no candidate shall be allowed to present himself
for the first of these examinations until he is twenty years of
age, and has undergone such preliminary examination and
course of study, as the said Faculty shall direct.
7. That the verbal examinations shall be open to every
legally qualified practitioner.
8. That al) persons examined and admitted members of the
said Faculty, snail receive the title of Doctor of medicine and
surgery.
9. That the six examiners appointed by government for
the preliminary examination, and the eighteen last mentioned
examiners, shall constitute the Senate of the London Faculty
Of Medicine.
10. That the Faculties of Ireland and Scotland shall be
elected &9 before mentioned, and that all members of these
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506 Ths Medical Press and Circular.
CORRESPONDENCE.
DtetetovlAU*
Faculties shall be privileged to practice in any part of Her
Majesty’s dominions.
11. That the said medical Senate shall regulate all matters
relating to the price of the diploma, the charge for attendance
upon lectures and hospital practice, subject, however, to the
control of government.
12. That the Senate shall bo empowered by law to enforce
a general registration of all legally qualified practitioners, and
to prosecute all those who practise illegally.
The above is only an outline of the plan which we believe
could be easily carried out. Many modifications and improve¬
ments may be effected, but let the representative system be
once established, and the matters of detail are of little im¬
portance. Some would prefer the election of a general council
who should choose the examiners ; but this we think would
make the matter more complicated and expensive, and might
also give rise to favouritism. It is important to bear in mind,
that the Apothecaries’ Company agreed to relinquish their
present powers as an examining body, provided their mem¬
bers had a proper share in the formation of the new Institute.
According to the proposed plan we think they will be fairly
represented.
This plan differs in many respects from that of the British
Medical Association, 1837. An association that should not
be confounded with the present British Medical Association,
which only took this name about ten years since.
In my letter to the Medical Council on the increase of half-
qualified men on the Register the report on which by the
Council is mentioned in your number of July 8, p. 45. I
appended the following query to my letter which I also sent
with my printed plan of reform to oach of the twenty-four
councillors.
May I, in conclusion, beg of you to oondescend to turn from
this death drama, to my plan of Medical Reform, 1850, and
ask yourself what a stimulus might have been given to medical
science—what an amount of misery might have been averted—
what a salvation of human life might have been gained, if the
plan I suggested eighteen years since, and which 1 take the
liberty of appending, had oeen carried out ?
I am Sir, yours obedieutly,
Edwards Crisp.
29 Beaufort Btreet, Chelsea, July 1, 1868.
HISTORICAL SKETCH OF DERMATOLOGY.
TO THE EDITOR 0F THE MEDICAL PRESS AND CIRCULAR.
Sib,—N ow that so many classifications and papers on skin
diseases are appearing, the following brief historical sketch of
dermatology may not be uninteresting.
Hippocrates divided cutaneous diseases into local and con¬
stitutional. Galen classified them according to their situation,
viz., into those affecting the head and those affecting the
body. Many skin diseases were described by the Greek and
Arabian physicians, and some of the terms still in use are
those that nave been adopted by Hippocrates, Celsus, and the
celebrated Arabian physician Avicenna. During the early
part of the seventeenth ceutury Hafenreffer published a rude
classification, which was followed by another from Jerome
Mercurialis, an Italian physician. Turner was the next writer
and in 1736 published a “Treatise on Diseases incident to the
Skin, ” this author’s classification being grounded on diseases
produced by internal and external causes. Loriw modified
this arrangement, and was followed about 1790 by ftetz. The
next writer was Plenck, who classified skin diseases according
to their external appearances; the groundwork of Will ail’s
subsequent arrangement. In 1804 Derier classified these
diseases into essential and symptomatic, but we must give to
Willan the credit of arranging Plonck’s artificial system to a
tangible form. Now Willan s classification, which is based on
the primitive forms of cutaneous eruptions, is extremely
simple although naturally imperfect; diseases having no con¬
nexion whatever, except in external appearances, are fre¬
quently grouped together, as for example, we havo scabies in
tne same order as variola. Again, the eruption may change its
nature and character in its development, as when a veside by
augmentation of inflammation becomes thickened and hard at
itsbase, beginning to be white and opaque, instead of con¬
taining a clear fluid, thus being transformed into a pustule.
About the year 1819, Bateman adopted Willau’s arrangement.
Mr. Plumbe, in 1824, made a step in the right direction,
and classified skin diseases according to the morbid anatomy
of the affected parts. Dermatology found in M. la Baron
Alibert one capable of elevating it to a proper station. This
dermatologist Arranged cutaneous diseases into natural families
of which he founded twelve, as eczimateuses, exanthlmaieuses,
Uigncuses, darte ernes, cancer eases, Upraises, verole uses, stru-
menuses, scabicuses, hamateuses, dyschromateuscs, and. hSMro*
morphes. In this classification, Alibert copied Linnaeus and
other botanists in their arrangement of natural history. In
the family cczfmatcuses all diseases related to eczema are con¬
tained. Payer's classification was based on that of Willan, he
made, however, several improvements in the arrangement of
the genera, and included such affections as neuralgia, cyanosis,
icterus, Ac. In the work of Cazenave and Schedel the classifi¬
cation of Willan is more strictly adhered to, various diseases,
as purpura and syphilitic eruptions, being omitted. M. Biett
ana Dr. A. S. Thompson have also contributed to the study
of these diseases.
Hardy, of St. Louis’ Hospital, has given us a classification
in which he divides skin diseases into—ls£, macules and do
fortuities; 2nd, inflammations; 8rd, parasitic di seas es ; 4 th,
eruptive fevers ; 5th, symptomatic eruptions ; dth, dartres er
Utters; 7th, scrofulidia ; 8 th, syphiUdes ; 9th, cancers; lfiti,
exotic diseases. This last olass includes those affections which
do not occur in France, and the “dartres’* contains eczema,
pronasis, lichen, and pityriaris. Hebra’s arrangement is
founded on the pathological phenomena exhibited, and the
following are the most important groups :— hypercemias,
ancemias , hypertrophies, atrophies, <Lc. Baumes, in 1742, pub¬
lished a classfication in which he repudiates pathological facts
altogether. Bazin divides skin diseases into two grana divisions
—diseases in the course of evolution and those arrested in
evolution. Dr. A. B. Buchanan, of Glasgow, published in the
Edinburgh Medical Journal, January 1863, an excellent clas¬
sification of these diseases, as 1st, inflammations, including
erythema, eczema, Ac.; 2nd, new formations, subdivided into
—1st, hornologons, including epidesmic, pigmentary, desmio,
and 2nd, heterologonas pseudo plasms and neoplasms, and
diseases of accessory organs, Ac. Mr. E. Wilson divides
cutaneous diseases into four chief groups, viz., 1$£, diseases of
the desma; 2nd, diseases of the sudoriparious glands; 3rd,
diseases of the sebiparous glands; 4th, diseases of the hair .
He has also published a clinical classification.
Before concluding these brief remarks 1 cannot pass over
the name of the late Dr.. J. M. Neligan, of Dublin, who by
his published works, Ac., contributed so much to the advance¬
ment of dermatology in Ireland.—I remain, Ac.,
Dermatologist.
HISTORY OF THE LICENSING SYSTEM.
TO THE EDITOR OF THE MEDICAL PRESS AJTD CIRCULAR.
Sir,— From the recent declarations of Mr. Gladstone, Mr.
John Bright, Mr. Stansfeld, and other leading statesmen, it
is evident that the revision of the licensing system will be one
of the questions to come before the new Parliament. Every¬
body is of opinion that “something must be done * to remedy
the evils of the ever-increasing traffic in intoxicating liquors.
What is to be that remedy? Preparatory to considering pro¬
posals of a remedial character, let me review the origin and
history of the licensing system.
Before the reign of Henry YIL, the apothecary, I believe,
was the sole dispenser of ardent spirits; and as alcohol is a
poison, it is right that its sale should bo regulated as strictly
as the sale of opium or arsenic. Judged by its effects, akohm
is the deadliest of poisons, for tens of thousands of human beings
are, by its use ana abuse, destroyed annually, the majority of
whom are victims of a delusive belief, or custom, and a leo-
lised system of temptation, for which the State and those who
make the laws are responsible. Hence the importance of
examining this question in its legislative aspect.
For nearly a thousand years the laws of England have en¬
deavoured to curb this traffic. As early as the reign of Edgar
(a.d. 959) it was enacted that no village should contain more
than one alehouse. A curious precaution was taken against
drunkenness. Measuring pegs were fixed in the drinking
cups, and no one was to drink more than the moderate
draught of liquor between two of these pegs I We may he
sure that such a law was evaded and abused, and it aetnaRy
led to wagers as to who could swallow the most at a breath.
This bibulous emulation disgraces Eton College to the peasant
day.
During the middle aged the tele of liquor ww not
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COBRESPONPENCE.
December ltf, 1M8. 50 ^
restricted. Brewers were allowod to retail their ale, after it
had been inspected—(a precaution required still more in those
days of adnlteratiou); and the tala was prohibited after cur¬
few—eight o’clock. If modern tippling shops wore closed at
that hour, there would not be half so much drunkenness.
In the reign of Henry VII., in order to check inebriety, a
surety was required from ale sellers for their good behaviour.
This was the beginning of the present licensing system. It
was already apparent that the free sale and general consump¬
tion of fermented liquors was dangerous to the common weal,
for, iu the words of a trustworthy chronicler (Hovenden), the
land was “filled with tipplers,” and the alehouses had become
“ nurseries of in temperance.”
Fifty years later (1562) nn attempt was made to lessen these
evils by requiring, a licence for the sale of ale, no person being
permitted to open a drinking house without the consent of
the justices. This celebrated Act (5 and 6 Edward VI.) had
for its preamble these suggestive words :—“ Forasmuch as
intolerable hurls and troubles to the commonwealth of this
realm doth daily grow and increase through such abuses and
disorders as are had and used in common alehouses, called
tippling houses,” Ac.; and justices were empowered “ to re¬
move, discharge, and put away common selling of ale and
beer in the saia common alehouses and tippling houses in such
town or towns and places where they shall think most meet
and convenient.”
Iu the following vear auother Act was passed to avoid
“excess of wines,” by limiting the number of inns iu the
larger towns. The increase of taverns, and the evil practices
of their frequenters, were assigned as the reasons for prohibit¬
ing the retail sale of wine, except under magisterial licence.
This Act recited that not more than two wine licences should
be granted in any town, with the exception of London and
about twenty other places. Queen Elizabeth’s Government
acted with commendable vigour, and hundreds of alehouses
were closed. Lord Keeper Egerton charged the judges to
ascertain “ how many alehouses the justices of the peace had
pulled down, so that the good justices might bo rewarded,
and the evil removed.”
In 1597 (39 and 40 Elizabeth) the justices were directed by
Parliament to diminish the number of malsters, and to pre¬
vent, according to their discretion, the converting of barley
into malt. Fines were also imposed upon disorderly houses.
In the reign of James I. Acts were passed to “ restrain the
inordinate haunting and tippling in inns,” and for preventing
“ the odious and loathsome sin of drunkenness.” It is on
record that a Member of Parliament stated that the people of
Bath, who desired that the inns of that city might be limited
to six, complained that fourteen others h&a been thrust upon
them.
I reserve for a future letter the history of licences from
Charles I. to Victoria, and remark, in conclusion, that the
more and more frequent enactment of laws to regulate the
liquor traffic is proof of its inherently dangerous character, and
presumptive evidence of the necessity ana wisdom of the Per¬
missive Prohibitory Bill proposed by the United Kingdom
Alliance. Henry Pitman, Manchester.
DB. BARTON ON THE NATURE AND TREATMENT
OF SYPHIL18.
TO THU EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sin,—In the notice of my book upon “The Pathology and
Treatment of Syphilis, Chancroid Ulcers, and their Complica¬
tions,” which appeared in your issue of the 9th inst., my
views are so greatly misrepresented upon some points, that I
must ask you to accord me a little space to set myself right
with your readers.
The first point to which 1 wish to refer is, the statement
that I am “ rather inclined to revive the theory propounded
in the Dublin School by Carmichael, os the result of his very
wide observation,—that there exists a plurality of poisons,
each characterised by its train of constitutional symptoms.”
Your reviewer here entirely misrepresents me, having evidently
failed altogether to comprehend the nature of the question
which is discussed at pages 98 and 99, where he supposes
1 favour the views of Qirimchael. The important and practical
points which I am engaged with there, is, that the cnaractere
of the syphilitic chancre indicate the mildness or severity of
the subsequent symptoms, a very different matter from the
theory of the plurality of syphilitic poisons, a doctrine which
is referred to upon three different occasions—pages, 8, 12, and
97 —each time with au express statement of its being untena¬
ble, and abandoned by its former advocates.
Aware, however, how liable those who are ignorant of the
subject are, to confound together the question of the plurality
of venereal poisons with that of the plurality of the syphilitic
poison, I have been specially careful, and to avoid tne possi¬
bility of mistake, I say at page 12—“The question at issue,
it must be clearly understood, is not the duality of syphilis,
not the eduality of veneral ulcers, some being syphilitic, others
notso that your reviewer has no excuse for tuns misrepre¬
senting the teaching of my book.
The second point I would refer to, is the remark that “We
would have wished for a more copious allusion to the painful
and interesting class of nervous and paralytic affections.” I
have only to state the fact that these important lesions are
considered under the several heads of their pathology,
diagnosis, prognosis, and treatment; in the latter, from my
own observation, I am led to differ from some received autho¬
rities. The subject occupies twenty-five pages, and is illus¬
trated by ten cases, while upwards of twenty authors are
specially referred to for the benefit of those who desire more
detailed information.
In the third place, I have to complain that my words are
twice misquoted in this short notice. Your reviewer quotes
me as saying, “ we pass from the consideration of local sores
and other complications, to that of a disease affecting the
whole system.” What I really do say (page 60 ) is, “ We pass
from the consideration of local sores and their complications,
&c. this error confounds the meaning of the eptire passage.
The second misquotation is from thd preface, where I am
made to fix the standard of my book as a “guide,” a word
which is not employed by me at all.
Iu conclusion, Sir, I appeal from your reviewer to the ver¬
dict of the members of the profession who may honour my
book with their perusal,—in the first place, as to the suffi¬
ciency of the numerous original cases which appear in the
book, and secondly, as to whether I am a mean copyist or an
independent observer.
Your obedient servant,
John K. Barton.
VENTILATION.
TO THE EDITOR OT THE MEDICAL PRESS AND CIRCULAR.
Sir, —The supply of pure heated air by means of air wanned
in a chamber behind the fire, communicating with the open air,
and with the apartment, was advocated, and I fancy first de¬
vised, by Cardinal Polignac, some two hundred years ago. It
is fully described both by Bernan and Tomlinson, as well as
by myself, page 105 of my treatise on “ Moral Sanatory Eco¬
nomy.”
By Cavendish, the chemist, it was advocated warmly, and
carried iuto practice. I suppose I cannot have been suffi¬
ciently explicit. And yet, if Mr. Griffith bad looked at the
beginning of the third paragraph, he could hardly have fallen
into his, I am sure, unintentional error. My expression is ;
“The second procedure, which maybe conjoined with^ the
first, has never in its entirety been set forth before.” This it
is—this entirety—to which I lay claim. I might, otherwise
just os well lay claim to the principle of ventilation itself as
to the proposal, never, however effectively or generally carried
out, of hot air ventilating chambers behind fire-places. It is
so hard to convey one’s meaning, even when set forth in the
very plainest terms, and to avoid misconstruction from those
whose habits and attainments might be supposed to place
them beyond the risk. I think I must get a little model
made, and send it round, then those who shall use their eyes
will, I hope, be satisfied.
Henry MaoCormic, M.D.
Belfast, 12th Deo. 1868.
Tee weekly bulletin of the health of the Prince Royal qf
Belgium has just been issued, which states that the improve¬
ment which has been observed during the past six weeks con¬
tinues, although his Highness’s condition is still precarious.
On Sunday morning another sad accident from paraffin*
happened on the South Coast Railway, whereby two guards
were enveloped in a sheet of flame from the burning liquid*
one of whom died almost instantly, the other being in a very
critical state in the Brighton Hospital
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every Wednesday morning . Price 5(2. Stamped 6d.
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Annual Subscription, post free, Ten Dollars.
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WEDNE3DAY, DECEMBER 16, 1868.
EDUCATIONAL REFORM.—No. III.
Before entering into a consideration of the means by
which the changes required in what is called by courtesy
our educational system must be effected, we propose to
pass in review the changes themselves. In our last article
we laid particular stress upon the desirability of having
one uniform code of regulations, issued by the Medical
Council, for an uniform minimum examination. This is a
prominent point in the Report of the Medical Teachers 1
Association, and nothing short of it will give general satis¬
faction. And what would such a set of regulations do for
the student ? Many things at which his heart would re¬
joice. In the first place, [it would be a death-blow to
schedules. The bare mention of abolishing schedules will
inspire some with pity or scorn for our hopeful credulity,
excite the antagonism of the Tories who consider schedules
as “ inevitable as Magna .Charta,” and take away the
breath of others on account of the ambition of the scheme.
Ceelum iptum petimus stultitid. And yet, calmly consi¬
dered, schedules]are as barbarous'as turnpikes. They are
nuisances to everybody, a source of interminable disquie¬
tude to students, a periodical set of thorns in the sides of
the lecturers, a load on the minds of Deans and Vice-
Deans, and the utter despair of Beadles. Whatever plan
is adopted for signing schedules, the amount of worry con¬
nected with them is enormous. Each schedule is divided
into a number of certificates, and each certificate requires
the signature of one, very often two, and sometimes three,
persons. Each certificate represents a certain quantity of
mental annoyance to the Dean, the Professor, the Student,
and the Beadle; Multiplying this by the number of certi¬
ficates, we get the amount of worry which one schedule
involves ; and when we think of the sum total which we
should obtain by multiplying this second amount by the
number of medical students, the idea becomes intolerable.
Sometimes the Beadle takes the schedules round to the
Lecturers, with or without the initials of the Dean; some¬
times the Professors meet in a particular room, on a parti¬
cular day; and sometimes no kind of arrangement is
adopted, but the unfortunate teacher suddenly finds him¬
self beleaguered by a band of importunate students, or is
waylaid promiscuously when he least expects it, or has his
morning practice interrupted by the applicants for his
autograph. These evils, we are happy to say, will be
mitigated by a recent regulation at the College of Surgeons,
according to which the signature of the Dean is to be re¬
cognised as sufficient.
This improvement, however, falls far short of a still
greater improvement effected by the same College, which
might serve as a model of that simplification which is so
devoutly to be wished in respect to certificates required by
Examining Boards. Before going up to his first examina¬
tion the student has merely to present a certificate that
he has completed, to the satisfaction of his teachers, two
winter sessions of anatomical and physiological study;
and as this may now be signed by the Dean, very little
trouble is involved. If this example were followed in re¬
spect to other examinations it would no longer be necessary
to have attendance on courses of lectures separately
vouched for, but one general certificate signed by the
Dean would be presented. Such a certificate should be a
guarantee of good conduct and satisfactory study on the
part of the student presenting it, but there would be no
occasion to embody in it any kind of voucher of attendance
on lectures. Lectures are only one inode of instruction,
and no student should be driven by central authority into
an uncomfortable room, to sit upon a hard bench, to
feel exceedingly ill at ease for sixty minutes, perhaps to
fall into a somnolent or semi-somnolent state, perhaps to
acquire mischievous habits of inattention and discourtesy,
perhaps to be more bewildered on his exit from the theatre
than at his entrance into it, and thus to imbibe the erro¬
neous idea that lectures are altogether a mistake Hence
the issue of one set of regulations means the abolition of
schedules, and through the abolition of schedules the
second boon to the student—namely, the reconsideration,
and if the reconsideration, the necessary abolition (in the
present state of opinion) of compulsory attendance on lec¬
tures, as part of a central code. The question of com¬
pulsory attendance would then be thrown upon the indivi¬
dual schools, which would be sure in the end to adopt those
methods of instruction which would do the most good to
the student Sufficient control would be kept up over the
students at the schools, because penalties, in the shape of
withdrawal of privileges, would be inflicted on any student
misconducting himself, and because it would be impossible
for a student to get his certificate signed unless he had
given satisfaction to his teachers by good conduct, and had
made sufficient progress in his studies to afford a reason¬
able prospect of success at his examination. Not that it
should be absolutely in the power of a Dean to prevent a
student going up for examination, because such a power
would be open to abuse, but that there should be such a
check upon the idle and vicious as would preclude their
damaging unfairly the reputation of any school which
might have the misfortune to be burdened with them.
The statistics which would be yearly published of the
number of students presenting themselves for examkutiofl
from each school, with the proportion of those who passed
to those who were rejected, would be liable to convey an
erroneous impression of the comparative value and effi¬
ciency of the methods of instruction at the various schools,
if there were no means of excluding the disturbing element
to which we have alluded.
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It is not uncommon for schools, from no special fault of
organisation or management, to be infested with students
of an inferior order of intellect and low moral character.
Such men haunt neighbouring public-houses, work inter¬
mittently, if at all, go up for examination against the
opinion of their teachers, who do not feel at. liberty to
withhold their signatures, are rejected, not once, but
several times, hang about their school, setting a vicious
example to the younger students, and bring unmerited
ill-repute upon the educational arrangements of which
they have not taken advantage, but which would have
carried them safely over the ass’s bridge. To get rid of
such men would be an equal benefit to teachers and to stu¬
dents. It is, of course, impossible to exclude the black
sheep altogether, but we are persuaded that the number
of them might be greatly reduced by making a voucher of
good conduct an integral portion of the certificate de¬
manded before each examination. It is a sad fact that
drink has many votaries among medical students, and
nothing can be a stronger disqualification for the profes¬
sion of medicine. We will not dwell upon a topic so
painful and delicate, but we should be shrinking from our
duty if we did not mention it as an evil which, as far as
possible, should be rooted out.
The remaining advantages which would arise from a
single set of regulations we must reserve for future consi¬
deration.
-♦-
WINTER CLIMATES.
When thousands of our countrymen seek every winter
either health or recreation in the popular resorts of
Southern Europe, it is rather surprising that so little is
generally known of the relative merits and defects of the
several towns that bid for the favour of the Englishman’s
patronage. Pamphlets enough have been issued, statistics
without end have been accumulated, guides, large and
small, are to be met with in every shop, and yet we question
whether half the practitioners, who send patients to dif¬
ferent health resorts, have any just notions of the places
they recommend. This is not as it should be. It is not
to be supposed that gentlemen who have never gone across
the Channel can form an accurate idea of the influences
that surround patients in Italy or Madeira, but they may,
by a little care, avoid recommending places that are likely
to do great mischief. On the other hand, it is not
always safe to accept the eulogies of practitioners who,
being settled in a place, are interested in its prosperity,
and must be, to some extent, influenced by the continual
praise that those who surround them bestow upon it.
The effects of various climates, and of mere change of
air and scene, deserve to be more carefully studied, and
wre trust that the few independent men who have the
opportunity of investigation will not be deterred from re¬
cording their observations by the apparent neglect that
others have met with. But they must emancipate them¬
selves from the tyranny of oft-repeated and long unchal¬
lenged statements, and should even be prepared to confess
to contradictions in their own feelings and opinions. Ex¬
perience teaches us that no two seasons are alike, nor can
the mind place itself in the same conditions, so as to ensure
the same sensations on any two occasions. What once
produced one impression may at another time give rise to a
very different one. Thus we have in ourselves, as well as
in the proverbial uncertainty of the weather and the
seasons, abundant reason for caution, and ample excuse for
contrariety, in the evidence obtained from our own senses.
How much more does this increase the difficulty of those
who have to judge from the descriptions of others !
It would, perhaps, conduce to a rapid progress on such
points were those who can spare the time and money, for
a holiday in winter, to run away to the South of France
or Italy, and see for themselves, once and again, the places
to which so many invalids are sent. Of course, a three or
four days’ journey involves great expense and fatigue, and
there would undoubtedly be considerable risk to those
whose health is indifferent returning to England in mid¬
winter. These facts have, no doubt, prevented many from
undertaking such a trip, but they add to the force of the
suggestion that such persons should scarcely undertake to
assist their patients in selecting a winter home. A much
more easy task would be an attempt to realise some of the
differences in the health-resorts of our own islands, by
spending a month at several. At the same time, we are
bound to say that even an intimate acquaintance with
British health-resorts would be of little use in studying
Continental ones, nor could it enable anyone to form a
distant idea of what these latter really are. Patients
would in all cases do well to ask the opinion of a physician
who has actually spent a few seasons ahread, and medical
men will find it wisest to give full weight to such experi¬
ence.
-4-
SCARLATINA, OR SCARLET FEVER.
The mortality occasioned by this exanthema has recently
caused considerable attention to be drawn towards it.
Even when there is no epidemic of the disease, it probably
proves as fatal ns any or all other acute fibrile diseases,
such as typhus and typhoid fevers. But scarlatina has,
like variola and measles, the further peculiarity that it is
by no means amenable, like cholera or typhoid fever, to
the ordinary means of hygiene, such as draining and atten¬
tion to ventilation and cleanliness. Like syphilis, scarla¬
tina never originates from filth or over-crowding. Like
small-pox, it was once probably unknown in this quarter
of the globe, having, it is said, arisen in some tropical
climate.
In the Transactions of the Epidemiological Society there
is a careful analysis of the returns of the Registrar-General,
in which the following information is found with respect
to scarlet fever :—
“ The Registrar-General’s returns of scarlet fever, for the
whole of England, include two periods of five and 16 yean
respectively. The first period extends from 1888 to 1842,
and the second from 1847 to 1862, inclusive. The total
number of deaths registered from the disease in the 21 yean
was 310,720 ; the annual average mortality for the whole series
of yean was 14,796. If a comparison be instituted between
quinquenniums, it is found that, in the fint (1838-1842), the
average yearly mortality was 12,582 ; in the second (1847*51)
it was 15,065 ; in the third (1852-56), 16,720; in the fourth
(1857*61 ), 14,080—or, to make a more accurate comparison,
in the first quinquennium, the yearly average mortality per
100,000 population, living at all ages, was 81 ; in the second
quinquennium, 84 : in the third, 89 ; and in the fourth, 74.
“ Four times in the 21 yean scarlet fever was epidemic.
The annual average mortality, per 100,000 population,
during the whole penod, was 82. The fint epidemic occurred
in 1840, when the death-rate reached 128—the highest morta¬
lity from the disease in the 21 years. In the year following( 1841)
the mortality was above the average. The second epidemic
oocurred in 1848, when the death-rate was 118. In the year
previous the mortality had risen slightly above the average.
The third epidemic occurred in 1852, when the death-rate
reached 103. In the three following yean, 1854,1855, 1856,
the mortality continued above the average. The fourth epi¬
demic occurred in 1858, when the death-rate was 121, the
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Deoemte 10, 1808.
highest which had happened since 1840. In the year follow¬
ing ( 18 £> 9 ) the mortality averaged 97 per 100,000 population.
“ The history of the progress of scarlet fever in the metro¬
polis differs from that of the entire kingdom in this, that it
shows a great augmentation of the mortality from the disease
in the last Quarter of a century. The annual average mor¬
tality from tne malady in London during the past 26 years was
88 per 100,000 population. The average varied from 82 in
1841 to no less than 174 in 1863. In the quinquennium 1889-
43 the annual average was 78 ; in the quinquennium 1844*48
it increased to 88 ; in the quinquennium 1859-63 it advanced
to 115. The death-rate of 1863 (174) was more than double
the annual average of the 26 years, 1838-64. Scarlet fever
was epidemic in London in 1839-40 ; 1848 (when the death-rate
reached 212, nearly twice the average), 1852,1854-55,1858-59,
and 1862-63. In fact, the disease was epidemic in London at
the same time as throughout the entire kingdom, except in
1862. In that year the mortality throughout the country was
much larger than in 1861. The deaths registered from scarlet
fever in England and Wales during 1863 numbered 30,475,
being at the rate of 148 per 100,000 population, the greatest
mortality recorded.”
Scarlatina seems, then, to have augmented in frequency
in the metropolis during the last twenty-five years, con¬
trary to what has been the case in the rest of the king¬
dom. We apprehend that the cause of this mnst be looked
for in the immense size of our giant city. This size gives
room for new foci of this most contagious disease to keep
constantly lighted ; and, whilst in smaller towns ana
villages tne contagion occasionally dies out for a time from
want of fuel to consume, in London it never dies out, but
at one time rages fiercely in the northern, and at othere in
the eastern districts, and perhaps quite as frequently in
the western or wealthier quarters. Were all febrile dis¬
eases of the type of scarlatina, the Mosaic plan of seques¬
tration would be the only feasible one, since the only chance
for an unprotected person, at least when young, of escaping
the contagion, seems to be summed up in not coming
within range of the emanation from the scarlatina patient.
How many times do we not see every child in a house,
one after the other, whether belonging to the same family
or not, becoming affected with scarlet fever 1 Indeed, have
we not great reason to believe that we have ourselves, un¬
fortunately, in some cases, after visiting the conch of a
patient with scarlatina, introduced the disease into the
house of the next patient we have visited ? It appears to
ns that there ought, in all likelihood, to be hospitals set
apart entirely—as the small- pox hospital is for variola—
for scarlet fever. In this way alone can we imagine that
the disease might be partially kept in check. A ckild
among the poor when attacked ought, if possible, imme¬
diately to be removed to such an hospital, and not to a
children’s hospital, as is sometimes done. Of course, in
well-to-do families, the patient is at present rigorously
sequestrated from the rest of the children in the boose,
and even from those adults who have not been attacked
by the disease. But in the dwellings of the poor the inva¬
sion of scarlatina into a crowded lodging-house is a dreadful
calamity. Such diseases show us, too, the evils of the
large-sized houses of Paris and other Continental cities,
and make us desire that our ground-rents were only mode¬
rate enough to allow of each fomilv living in its own house.
The following provisions of the Sanitary Act, 1860, seem
highly usefiu, but have not yet, we believe, been acted
on :—
* * 1. The sewer authority, or, in the metropolis, the nuisance
authority, may provide, for the use of the inhabitants within
its district, hospitals or temporary places for the reception of
the sick. Such authority may itself build such hospitals or
places of reception, or make contracts for the use of any exis¬
ting hospital or part of a hospital, or for the temporary use of
any place for the reception of the sick.
‘‘ Z. The nuisance authority in each district may provide a
proper place, with all necessary apparatus and attendance, for
the disinfection of woollen articles, clothing, or bedding which
have become infected, and they may cause any articles brought
for disinfection to be disinfected free of charge.
“ 3. Any persons suffering from any dangerous infectious
disorder who wilfully exposes himself, without proper precau¬
tion against spreading the said disorder, in any street, public
place, or public conveyance, and any person in charge of one
so suffering, who so exposes the sufferer, and any owner er
driver of a public conveyance who does not immediatly provide
for the disinfection of his conveyance after it has, with the
knowledge of such owner or driver, conveyed any such sufferer,
and any person who without previous disaffection gives, lends,
sells, transmits, or exposes any bedding, clothing, xag% or other
things which have been exposed to infection from such disor¬
ders, shall, on conviction of snch offence before any justice be
liable to a penalty not exceeding 51., provided that no proceed¬
ings under this section shall be taken against persons trans¬
mitting, with proper precautions, any such bedding, clothing,
rags, or other things for the purpose of having the same
disinfected.
“ 4. If any person knowingly lets any hones, room, er part
of a house in which any person suffering from any dangerous
infectious disorder has been, to any other person, without
having such house, room, or part of a house, and all articles
therein liable to retain infection, disinfected to the satiffaction
of a qualified medical practitioner, as testified fay a certificate
given by him, such persons shall be liable to a penalty not ex¬
ceeding 20 1. For the purposes of this section, the keeper of an
inn shall be deemed to let part of a house to any person ad¬
mitted as a guest into such inn.”
Were the provisions of this statute carried out, which
seems not to have been done as yet, much might be done
to diminish the ravages from scarlatina. Bnt the inter¬
ference with the usual habits implied in the carrying out of
the provisions above cited is sufficiently grave to make os
fear that public opinion is not as yet quite ripe to make
the Act anything out inoperative. Then, again, we doubt
whether any medical man would be able distinctly to pro¬
nounce a decided opinion as to the epoch at which a new
lodger might enter apartments in which there has recently
been a case of scarlatina. For our own part, we believe
the contagion lingers very long in snch apartments, and
we fear that the publie and juries would not support the
medical man in his laudable efforts to protect Urn public
health. Meanwhile let the snbjeot be agitated.
ifotes an Current Colics.
The New Sanitary Act, 1868.
This amends the former Sanitary Acts of 1865-66. A
great deal has lately been said about earth-closets instead
of water-closets, and accordingly we find the following
clause in the Act of 1868, as also a clause relating to dis¬
pensaries for the poor in large towns ;—
“ The local authority are empowered, if they think fit,
to substitute earth-closets for water-closets, and where ths
former are in use may dispense with the supply of water
required by any contract or enactment to be furnished to
the water-closets in such houses on such terms as may be
agreed upon. They are empowered to undertake, or to
contract with any person to undertake^ a supply of dry
earth or other deodorising substance, to any bouse or
houses within the district; and to construct aarth-doseU
or other such places in all cases where they might construct
water-closets or privies ; with this restriction, that no
person shall be required to construct an earth-closet if he
prefers a water-closet, or shall be put to a greater expense
by doing so.
“ The sewer authority, or in the metropolis the nuisance
authority, is to have the like power to make provision for
the temporary supply of medicine and medical assistance
for the poorer inhabitants, as it now has to provide hospitals
or temporary places for the reception of the sick, under
the 37th section of ‘ The Sanitary Act, 1668,* but such
power is not to be exercised without the san c tion of the
Privy Council/
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NOTES ON CURRENT TOPICS.
December 16,1868, 6U
Spanish Quarantine.
We regret to see, from the following extract from the
Times , that our Spanish brethren, from whom we now look
for so much assistance in sustaining the pure'flame of
liberty in Europe, are backward enough in their science to
wish to keep up quarantine between this country and the
seaports of Spain. It is rare, indeed, that such police regu¬
lations eon effect any good to a country; but, at the present
juncture, a quarantine against England is both useless and
may endanger the future of Spanish affairs, both by shut¬
ting out English ideas, as well as English goods, and also
by drying up the sources of revenue to which the future
republic or constitutional regime must look to for supplies.
“ According to an official notification published at Gib¬
raltar, Her Majesty’s Consul at Malaga reports that the
Provisional Government of Madrid have decreed that all
the liberal measures adopted in matters of quarantine by
the Provincial Juntas shall cease to have effect. The sani¬
tary direction of the port of Malaga has therefore resolved
to re-establish the quarantines which were in force pre¬
viously to the revolution, and consequently all vessels
arriving there from ports of the United Kingdom, Gib¬
raltar, and Malta will henceforth be dismissed to a lazaret
of observation for performance of three days’ quarantine.
The reason for subjecting British vessels-to the annoyance
of quarantine when no contagious disease prevails in the
United Kingdom is, of course, only known to the Provi¬
sional Government at Madrid. Quarantine, at a time
when contagious diseases are epidemic, may be considered
as a questionable good ; but at a period when infectious
diseases are totally absent it becomes a gratuitous annoy¬
ance. Even when contagions disease is prevalent experi¬
ence shows that the advantages gained by quarantine
amount to very little. Neither Spain, Italy, nor France,
where the quarantine has been in force, has ever escaped
the destructive influences of any epidemic of cholera.
These countries have suffered much more than England,
and up to the latest dates the epidemics in the quarantine
countries have shown no abatement of virulence. The
reason is doubtless owing to the fact that auarantine ab¬
sorbs all the attention of the authorities, and serves as an
excuse for the neglect of extensive hygienic measures of
water supply and purification.”
Royal College of Surgeons of England.
There is always danger lest action that is not immedi¬
ately to be followed by results should be postponed until
it is useless. The general election should impress this
very strongly on the whole country. Both parties have
lost in different localities by procrastination. Those who
hope to succeed in reforming the College of Surgeons
should lay this to heart, and not let their efforts be con¬
fined to a few weeks before next July. What is half a
year to organise and bring to bear any great reform.* Dark
as is the prospect, we believe that the Fellows really have
the power in their hands to effect a great good. Let
them unite and they may carry everything. There are
plenty of men who would like a seat on the Council, and
who are not afraid of the publicity that is essential for the
welfare of the profession and the public. Let the Fellows
unite to support only those who pledge themselves to vote
for the reforms desired. Some will say that this would
lead to too much canvassing. We have no wish to en¬
courage anything degrading, but some mode of publicity
must be attained. To elect a man to help to direct the
affairs of the College, ignorant of his views, solely because
he is a great operator or man of scientific attainments, is,
in oUr view, a great mistake. Those who have the deepest
interest in their College— an ambition to serve the profee*
sion, and the leisure to do so—would gladly .give the
pledges, without which we hope no one will support any
candidate.
The St. Panoras Medioal Officer of Health.
A contemporary states that—
“ The Vestry of St. Pancras, being about to appoint a
medical officer of health, in the place of the late Dr. Hillier,
has resolved to increase the salary from £250 to £300 a-
year. It was stated by several vestrymen that they were
astonished at the number of medical men of the highest
attainments and position by whom they were canvassed for
their support.”
We presume the scales by which the “ Fathers” took the
social and intellectual weights of the candidates in question
required super official “ overseeing” and adjustment. Me¬
dical gentlemen of the “ highest attainments and position,”
we do not for a moment suppose, canvassed the vestrymen
nor sought the appointment, for obvious reasons.
Disinfectants.
The large space devoted in our last two or three
volumes to disinfection shows that we have done our best
to keep our readers alive to this most urgent question, and
we trust that the claims of rival substances urged by
different authorities may eventually lead to something like
a general acquaintance with the merits of all. There are,
however, points to be studied whioh apply to all alike.
Professor Parkas has been making some experiments which
tend to throw light on the apparent failures that now and
again come under our notice. He found a larger quantity
of the disinfectant than is usually supposed necessary to
ensure its effect. Now, in our experience there has long
been a disposition with medical men to rest satisfied with
an inadequate system of disinfection and an insufficient
quantity of the agent employed. With patients this is to
be expected. Half of them seem to look upon a disinfec¬
tant as a sort of charm, and would be satisfied to see a
bottle on the shelf of the sick room though it were never
opened. Others have but little faith or knowledge, and
use the disinfectants in a sort of perfunctory manner.
Again, servants and nurses are often too lazy to take the
least trouble ; and finally, some people do not like the ex¬
pense.
It follows, then, that the medical attendant should per¬
sonally keep an eye on this matter, so as to see that it is
not neglected. We take the occasion of Dr. Parkes’ ex¬
periments to remark upon what has always appeared to us
the unfair tests to which daily practice puts disinfectants.
Were the amoant consumed in most households in times of
sickness doubled or trebled, we should bear of fewer cases
of the spread of diseases. There are other lessons also to
be learned on this topic.
Dry and Damp Soils.
It is not, according to some, always true that sandy and
gravel soils are to be preferred to lire upon. Pfeiffer and
Pettenkofer do not always agree with each other, or with
Buchanan, or Bowditch. The truth is, the facts are not so
simple as some seem to imagine, and statistics require great
care in handling. A clay soil has in many oases been the
only difference between buildings free from cholera and
others ravaged by the disease though situated on gravel.
True, in these cases, the day has frequently been of no great
depth. On the other hand, gravel or sand seem to be the
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NOTES ON CURRENT TOPICS.
December 14, IMS
best soils, and dryness is of the greatest importance in
reference to consumption. It has been suggested that a
layer of some impervious substance might advantageously
be placed over the whole surface occupied by our houses.
We have seen asphalte thus employed, and are of opinion
that the practice is a good one. In London we too often
see refuse and rubbish of most improper kinds thrown into
the foundations of houses. Who shall say how much dis¬
ease may not thus be caused ? Hot rooms will draw out
exhalations from such a soil as may bring disease and death
in their train. To remedy such iniquities on the part of
speculative builders the strong hand of the law is required.
The poor need protection from such evils engendered by
reckless covetousness. The rich may do well to take the
precaution, even with the finest concreted foundations, of
a thin layer of asphalte. Between this and the boards of
the floor the outer air ought to be allowed freely to
circulate.
Twice Lord Mayor of Dublin.
Thb unprecedented honour of being called for two suc¬
cessive years to the civic chair, has been conferred on Sir
William Carroll, M.D., Sir John Gray, M.D., M.P., having
declined the office for the ensuing year.
Prevalence of Scarlatina.
It appears from a report by Dr. Mapother to the Dublin
corporation, that fifty-five fatal cases of scarlatina occurred
in that city during the last four weeks. Another zymotic
would seem to be banished, for no death by small-pox has
been recorded for more than a year. The hot-air disinfect¬
ing chamber should be of immense service, but owing to
apathy on the part of the public very little use is made of
it. Unless arrangements are made for compelling the poor
to send infected articles, and unless hospital authorities oo-
operate, the erection of publie disinfecting houses will be
fbtile.
; , r
The Evils of Sewing Machines Prevented.
The objections to the general adoption of the sewing
machine in preference to the needle through the prevailing
impression—which experience has bat confirmed—that much
harm is done by these instruments, solely for the want of
some proper motive power by which the operator may be
relieved from the excessive labour of working the treadle,
are now likely to be removed. Our transatlantic neigh¬
bours, ever as ready to improve as to invent, have just hit
upon a contrivance which Mr. Abbot, in the Boston
Medical Journal, describes as an ingenious invention just
patented by Dr. Spencer, a dentist of Frovidence. This
contrivance he calls an “ improved mode of producing a
rotatory motion from the treadle and the effect of it is
that the motion is kept Up by the slightest movement of
the foot. In the case of ordinary treadles acting upon a
crank, the foot of necessity must move with each revolu¬
tion through the same distance up and down ; and the
effect of this monotonous repetition of the movement is
most wearisome and exhausting. By Dr. Spencer’s im¬
provement the machine is kept constantly in action
whether the foot moves through a longer or shorter dis¬
tance, giving the operator a chance of varying as often as
is desired the muscular effort necessary to run it.
Dublin Hospital Reports.
We have pleasure in announcing that Dr. W. Thoraley
Stokes, M.D. Queen’s University, and Demonstrator of
Anatomy in the Royal College of Surgeons, has undertaken
the recording, for the Medical Press and Circular, of
cases in the Hospital Practice of Dublin. We anticipate
that this arrangement will prove much more effective than
any we have yet been able to effect for this object, and
that we shall be able to offer our readers more valuable
clinical contributions than have yet been available.
The Under Secretaryship.
We give as a current, and in some quarters a credited,
rumour that Sir John Grey, the representative for Kil¬
kenny, and a member of our profession, will succeed to the
office of Under Secretary for Ireland, vacant by the resig¬
nation of Sir Thomas Larcom. If this intention should be
carried out, of which we are rather sceptical, Sir John
Gray will enjoy very great opportunities of advancing the
views of the profession in his intercourse with the Govern¬
ment, and we believe he would avail himself of them with
hearty good will.
Infirmary for the Sick Poor.
Mr. Wyatt, the Chairman of the St. Pancras Board of
Guardians, laid the foundation stone of this Infirmary on
Thursday last This is the first of those which are to be
built by the metropolitan workhouses under Mr. Gathorne
Hardy’s Act of 1867. Before laying the stone he explained
the circumstances which led to the passing of the Act, and
referred to the site chosen, and the accommodation which
would be provided. In replying to some objections which
had been made, he said : —
“ They had 350 cases of acute illness in St Pancras Work-
house, with only really good accommodation for 150, and
their outdoor medical officers reported another 150 cases
that ought to be sent to an infirmary, rather than be
treated at their own poor miserable homes! The principal
and interest, required to pay the cost of the new infirmary
would only amount to three farthings in the pound for 30
years, so that the parishiouer rated at £50 would pay some¬
thing less tliau 3s. per annum, with the knowledge that
While he did so he was conferring an inestimable benefit on
the suffering poor."
Health of Dublin.
The following official returns bear a somewhat unfavour¬
able comparison in the death-rate with some preceding
weeks :—The births registered during the week ending
Dec. 5tb, amounted to 141—69 boys and 72 girls. The
average number iu the corresponding week of the years
1S64 to ’67 inclusive, was 151. The deaths registered
during the week were 173—82 males and 91 females. The
average number in the corresponding week of the previous
four years was 160. Thirteen deaths from scarlatina, and
one from diphtheria, were registered during the week : the
deaths from the former disease during the preceding six
weeks were, respectively, 9, 12, 7, 21, 8, and 20. Fever
caused 9 deaths : the average number of deaths from this
disease registered in the corresponding week of the previous
four years was 10. Group proved fatal in 6 instances.
Twenty-three deaths resulted from phthisis or pulmonary
consumption. Twenty-seven deaths were caused by bron¬
chitis, and 2 by pneumonia or inflammation of the lungs.
Sixteen children were carried off by convulsions. Three
.deaths were referred to apoplexy, and 2 to paralysis. Chft-
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SCOTLAND.
December 16,1868. 513
cer was the cause of 7 deaths. Four deaths resulted from
heart disease, and a similar number from disease of the
liver. In as many as 16 instances death was attributed to
old age; of this number, 6 were of persons who had passed
their 80th year. This latter is a remarkably favourable
return, and speaks well for the climatic influences of this
city.
Turkey and Greece.
It seems more than possible that the breach existing
between the Governments of Turkey and Greece will,
after all the humane exertions of the Great Powers, end
in war. We trust these forebodings may not be realised,
but should hostilities unfortunately break out, there will
be a wide field thrown open for the junior members of
our profession, and an exodus similar to that which
happened in the Crimean War may take place from these
shores. It is well known that in neither country is the
science of surgery on a very exalted basis at the present
time, and we happen to know one or two young men
who have resolved to proffer their services to one or
other of the expectant combatants, should occasion
require.
The Registrar Chief of the King’s and Queen’s
College of Physicians of Ireland.
This office has again fallen vacant by the untimely
death of Dr. B. G. Guinness, who has only held it for
a couple of months since his succession to it on the
resignation of Dr. Athill. The title of Registrar is fixed by
the Act of Parliament, but the duties are rather equivalent
to those discharged by the Secretary of Council of other
kindred Colleges than to those fulfilled by the Registrars.
The salary attached to the office has hitherto been £100
a-year. We believe that Dr. Little, Physician to the
Adelaide Hospital, and Secretary to the Medical Society
of the College of Physicians, and Dr. Belcher may pro¬
bably offer themselves to the Fellows for the office, and
it [is believed that if Dr. Little offers himself for the
appointment, that he will meet with the most favourable
consideration of the Fellows.
Within the precincts of the queenly residence of the
Isle of Wight, we are told, the sanitary conditions of the
humbler class are all that can be desired. If the same in*
spection and care were exercised elsewhere, disease and
death might be diminished to an appreciable extent. But
then, who can penetrate the dismal and crowded abodes of
the metropolitan poor ?
A pew days ago, her Majesty the Queen, accompanied
by the Princesses, visited a sick woman in the neighbour¬
hood of Clewer, and, at the same time, took the opportu¬
nity to visit the Convalescent Hospital, and to inspect the
wards and other internal arrangements of the hospital,
which met with her Majesty’s approval.
At a meeting of the governors of the infirmary at
Teignmouth a few days ago, a suggestion from a lady re¬
siding in London as to the desirability of appropriating a
portion of the building for convalescent patient, was
brought forward for their consideration. The close proxi¬
mity of this institution to the sea was adduced as an argu¬
ment in favour of the suggestion.
The days on which the various examinations in the
University of London will be held, during the ensuing
year, have just been determined upon : full particulars
will be found iu our advertisement columns.
The name of Earl Spencer, the new Lord Lieutenant of
Ireland, is by no means strange to scientific ears. His
name appears more than once in the standard works on
physiology, in connexion with important experiments in
reference to the breading of cattle, and as a member of
the Cattle Plague Commission, Earl Spencer’s scientific
position and valuable judgment iu stock management
received a just official recognition.
The vacancy in the Midwifery Chair of Dr. Steveu’s
Hospital, Dublin, caused by the lamented death of Dr.
S. L Hardy, has been filled by the election of Dr. Isdell,
of Hardwicke Place, Ex.-Assistant ^Physican to the
Rotundo Hospital.
In consequence of his election, Dr. Isdell intends, we
learn, to vacate the office of examiner in midwifery in
the Royal College of Surgeons, for the succession to which
Dr. Kirkpatrick, Assistant Physician to the Rotundo
Hospital, will, we understand, present himself as a
claimant.
In the neighbourhood of the Houses of Parliament an
application of the signal system for the regulation of street
traffic is being practically tested. For a considerable time
past they have “ managed ” and regulated the street traffic
of Paris on the principle just illustrated at Westminster,
and, it is said, successfully.
-♦-
SCOTLAND.
EDINBURGH ROYAL INFIRMARY.
The site of the proposed new building appears to be a
subject of much discussion and considerable difference of
opinion. The views of the medical authorities ought cer¬
tainly to have some weight. In coming to a decision it is
to be hoped that all party feeling and inferior motive will
be laid aside, and that a building will be prepared every
way adapted to answer all the important purposes for
which it is designed, and worthy the great city to which it
will belong.
We understand that the fund in the Royal Bank is up¬
wards of £47,000 towards the accomplishment of this
object.
GLASGOW AND ABERDEEN UNIVERSmES.
Neither Mr. Moncrief nor Mr. Gordon were present
at the official declaration of the poll. The former gentle¬
man carried the election by a mtyority of 47, and is now
in the house, where he has been deputed, in the absence
of Mr. Gladstone, to offer the congratulations of the House
to the Speaker upon his re-appointment.
EDINBURGH UNIVERSITY.
The annual meeting of the Association for the better
endowment of this University was held on Monday week,
under the presidency of the Chancellor, the Lord J ustice-
GeneraL The statement of funds showed an annual
sum of about £250 at the disposal of the Association.
The report was adopted. The urgent necessity of en¬
deavouring to extend the resources of the University was
strongly urged by the various speakers, and a resolution
was passed setting forth the importance of a public sub¬
scription being immediately commenced for the purchase
of the sites in North College Street for the (erection of
additional University buildings.
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514 The Medled Preca and Circular.
MEDICO-SOCIAL PENCILLINGS.
December Id, 180.
EDINBURGH ROYAL SOCIETY.
On Monday, the 7th inst., the first ordinary meeting
of this Society for the session of 1868-9 was held. The
President, Professor Christison delivered the opening
address. He referred particularly to the aurora borealis.
It was, he said, usually considered to indicate bad and
stormy weather when it first appears in the autumn. He
had often mentioned to his mends the observation he
had made that, after a series of fine weather, the aurora
was sure to be followed by a storm of wind and rain the
second day afterwards. This was noted by'him so long
ago as 1884, and often since, as well as by several of his
friends. He was the means of saving the corn crop of a
friend on one occasion, who, but for the warning, would
never have thought of ordering his steward to # cover it in.
EDINBURGH MAGDALENE ASYLUM.
The annual meeting of this institution was held on
Monday week, in the Craigie Buildings. The chair was
taken by the Lord Provost. Among the charitable and
benevolent efforts of the present day, the object of this
society ought not to be overlooked. To rescue the fallen
and degraded of the sex, and afford them medical aid, is
a worthy effort. As well as the good effects produced upon
them as a class, it benefits the neighbourhood in which
they are found, by shutting up their houses, and so lessens
the opportunities of vice. Tne report shows that during
the past year, seventeen of these unfortunates were sent to
situations, two to the Lock Hospital, and 46 were still in
the asylum in November last.
THE WEST OF SCOTLAND.
A meeting was held in the Religious Institution Rooms,
Glasgow, to take steps for assisting in the movement,
inaugurated by Miss Beatrice Clugstou, to raise funds for
the purchase of two properties at Dunoon, at a cost of
£6,000, with the view of forming them into Sea-S ide
Homes for the sick among the wording classes.
HOMOEOPATHY IN THE ABERDEEN INFIR¬
MARY.
THIS subject, to which we called the attention of our
readers in a previous number, has been considered by the
Medico•Chirurgical Society at a late meeting. From
the accounts which we have seen of the proceedings we
find that some strong feeling was shown by the members
who introduced the different motions, as well as by all
who took part in the proceedings, and nothing was
settled when the meeting dosed. It is, however, to be
hoped that eventually by timely concession, where con¬
cession should be made, and by considerate and gentle¬
manly conduct on all sides, the affair may be amicably
settled.
QUARTERLY REPORT OF THE REGISTRAR-
GENERAL FOR SCOTLAND. *
In the third quarter of the year 1868, there were regis¬
tered 16,662 deaths, or 2*09 per cent. Both births and
deaths were high above the average. In the largest town,
Glasgow, the death-rate was as high as 3 01 per cent.
Heat, with intense drought, following Jane, with a scanty
fall of rain, characterized the first half of the quarter ; heavy
rains the latter half. Diarrhoea, dysentery, and cholera were
very prevalent and fatal, and largely increased the general
mortality : bat the numbers have not at present been
ascertained. Scarlet fever was also very prevalent and
fatal during the quarter, especially over the southern
half of Scotland ; but, unlike tne bowel complaints,
it seems to be subject to the usual law of diseases in
Scotland—viz., it increases in prevalence and fatality with
the fall of temperatuie. Thus, in the eight towns, scarlet
fever caused only 72 deaths daring July, the warmest month ;
bat 100 deaths in August, and 185 in September. It is still
the prevailing epidemic, and in many places was of a very
malignant type, catting off two, three, and even five members
of the same family. Much typhoid (enteric or gastric) fever
prevailed over Scotland during the quarter; while measles
would appear to have been the prevalent epidemic among
children over the northern half of Scotland. Inflammatory
affections of the respiratory organs were much less prevalent
thau during the previous quarter, bat diseases of the brain
were more numerous during the very warm weather.
-♦-
MEDICO-SOCIAL PENCILLINGS OF LONDON
LIFE AND PRACTICE.
No. 3.
The speech delivered by w Mister Chair” was of the
usual laudatory kind. He extolled the time-honoured
profession of which he had just become an “ unworthy, 11
yet a legally registered member—billions of miles above
the upper heavens. He radically ran over its history from
the earliest age of the pre-Christian period to the present
age of enlightenment and of Christian patience. He
eulogistically “ machined n my humble brow, and finally
wreathed it with a fanciful garland, culled from a good
knowledge of ancient and modern classics, aided and pro.
moted by “ gentle ” stimulation, and influenced by a very
fanciful temperament indeed. He was of opinion thxt I
should at no distant period of time become celebrated
as Harvey, Hunter, Abemethy, or Liston, honoured as
Brody, Ferguson, or Simpson, and successful as Graves,
Watson, Corrigan, or Paget. He spoke of the snows on
mountain peaks ; of verdant sunlit valleys ; of home,
colonial, and foreign climes; of time, space, and oppor¬
tunity ; of fellowship, universal brotherhood, peace and
goodwill; of poverty and the poor-laws ; of Church and
State ; of science and its advantages; and finally con¬
cluded his “ few remarks ”—which lasted over an hour
in delivery — by proposing my M health, happiness,
and successful professional career , 1 * parenthetically adding
that I possessed the “ elasticity of wrist, the firmness
of grasp, the courage of heart, the steadiness of eye,
the penetrability of observation, the bold decisiveness of
character, the intellectual acumen, the well-stored mind,
the humane sympathy with the afflicted, the force of will,
the strictness of discipline, and every other known or
likely to be discovered faculty that he considered essen¬
tially necessary, or likely to be advantageous in placing
me ‘ above the capital and on the pinnacle * of fame—the
head of a glorious profession of which I was already an
(china) ornament.”
The toast was duly honoured. It was honoured in the
usual w on your legs ” manner. It was honoured with the
usual flowing bumper and the time-revered fraternal clink
of glasses, accompanied by the celebrated yet scarcely
expressive old refrain to that Bacchanalian national anthem
—“For he’s a jolly gay fellow, which nobody can deny 5 *
—during the “ execution ” of which refrain the heads of
the entire company <c ducked” towards me over and over
again. Being at last apparently satisfied, silence was
restored, and the company “ resumed ” the sitting posture.
I rose to return thanks. It was the first time that I
attempted a display of the kind—I faltered and failed in
it, resumed my seat, got up again, said a few more words,
brought down the house with thunders of applause, during
which I finally “ knuckled under,” feeling as if I had
stratagetically eluded the agonies of strangulation,
caused by reason of a highly-rigid shirt-collar and a
neckcloth villanously inflexible ; and although the gay
little world present, I have reason to believe, expressed
and employed words to the effect that I retained my
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LITERATURE.
December 10, 1868. 515
former splendour as its superb sun and as it* attractive
centre, my own opinion on the point—confused as my
senses undoubtedly were at the time—was, and is even
as I write, that, if the gay little world was really serious
in considering me its sun and its centre, the gay little
world then laboured under the influence of a solar
eclipse, although it did not appear to be aware of the
phenomenon nor of a kindred one, namely, the fleeting
velocity with which, to my mind, it appeared both to
oscillate and to spin.
Digitalis followed. “ He begged to be pardoned for ob¬
truding himself thus prominently. He came to the
lodgings of his friend—not for the purpose of speech¬
making—uot for the purpose of making an exhibition of
himself before his friends and associates—not for the pur¬
pose of partaking of the sumptuous repast and the
44 flow of soul ” that met his view on all sides— not, in
a word, to make a d—n fool of himself. Did He find
himself amongst the cherished friends of ‘Auld Lang
Syne ? * No, he came there on principle ; he came there iu
vindication of one of the noblest attributes of mankind ;
in vindication of one of the grandest old dictates of ths
soul; in vindication of one of the most sublime prompt¬
ings of the mind. He came there to do honour to him
considered worthy of it! and he would traverse the earth
from pole to pole, and round them in a spiral manner,
from Bethlehem to Bethnal green, from Ringsend to
Gravesend, from earth to sky, to accomplish the task.’
44 We live, gentlemen,” continued Digitalis, 44 in no ordi¬
nary age of the world ; ours, gentlemen, is an extraordi¬
nary age, producing extraordinary men in religion, science,
law, and police. Our host is the production of this age
extraordinary to a degree, clever to a fault, talented to
within a single line of the Brim’s edge of perfection ; noble
as the forest king, without his viciousness, but possessing
his bravery ; gentle as the mythical dove, without its
passiveness, but possessing its sympathies; sincere in
friendship, truthful in love; trustful, hopeful, confiding*
and unchangeable in both; a friend in need, a man in¬
deed, such as heaven originally intended all of us should
be. Therefore, gentlemen, having said what I intended to
say, and having for so far faithfully discharged my duty
as * Steward and what not/1 sit down happy at heart, and
I sincerely hope there may he no more wine-glasses broken ,
as you know we're accountable to the kind landlady for
all damages/
Palmaris Brevis proceeded in the same strain. He
considered these dominions oversupplied with medical
men ; laughed at the very idea of a fellow becoming an
army assistant-surgeon; scornfully made a passing
allusion to the naval service; and finally, consigned
to Rapes Fergusii dispensary and workhouse appoint¬
ments, where “a fellow as old age comes on, you
know, has nothing to look forward at but beggary and
water-gruel.” Believed that South America was the
medical 44 hunting-ground " for those who wished to 44 go-a¬
head/ Produced and read portions of a letter from a
medical friend now located there, wherein that wiseacre
pithily said— 44 My dear Palm, get qualified and come here
at once ! This is the country for a fellow. An ounce of gold
for extracting a single tooth, and payment for all other
operations in proportion. But the natives here seldom lose
teeth, mutton being killed when young and tender, and
beef being first class ; and you know, fish and fowl may
be masticated with impunity when their bones have been
previously removed. The principal other operations here
are slitting fellow’s windpipes, performed by rather un¬
scientific and decidedly unqualified operators, who neither
use nor require saws, bone-forceps, clamps, nor silver wire,
and who leave the cure to be accomplished according to
the broad old rule of non-intervention, so I have taken
to stock-breeding. "For my part/’ continued Palmaris
Brevis, 44 London is to be my starting-point, where medi¬
cal men in carriages are thick as blackberries, or bees in
a rosary, during the Bummer months; where there is a
fe 3 in every chimney-pot if a fellow could only hit on a
ready method to smoke them out, and where guineas are
picked up as easily as pence in a pie-shop.” But Pal¬
maris Brevis was quite ignorant of the fact that carriages
may be hired iu Londou by the hour, by poor and puffy
doctors with great expectations ; and that some of those
who ride iu carriages receive guinea fees in fractional
argentine parts, appearing not only pleased, but highly
delighted to visit and to dose a fall dozen times any
unlucky patient desirous to receive fall value for 44 money
down,” at the stipulated sum of one shilling per visit,
and 44 a bottle in.”
Thus the evening sped, each member of the entire
company 44 toasting” his fellow. Absent friends and
44 the profession ” were not overlooked; politics and the
press were, for the gathering was a simple and a social one.
So after a vocal display of comic, heroic, and sentimental
songs, 44 The Ladies,” 44 The Cooks,” and 44 Mister Chair,”
(second time) were 44 gridironed,” and the evening’s cere¬
mony brought to a close, each guest happy with himself
and with his fellows, and vowiug never-dying fraternity
to all. Closed did I write ? Yes—the 44 business of the
evening” closed, but the caudate end, or rather the
bottle end, of the party 44 resumed,” and only retired under
the full influence of the jolly god, thence to seek repose,
if not rest, amidst the extremities of the room’s furniture ;
and with fender and irons amiably performing the hos¬
pitable yet scarcely soothing offices of pillows, and the
folds of a mahogany dining table aspiring to the grateful
and subtle duties of blankets and of coverlids.
Quid Nunc.
- » -
gyrate.
Water Analysis : a Practical Treatise on the Exami¬
nation op Potable Water. By J. Alfred Wanklyn,
M.R.C.S., Professor of Chemistry at the London Institu¬
tion, and Ernest Theophbon Chapman. London : Triibner
and Co. 18C8.
There has been no subject that of late has provoked more
discussion amongst chemists than questions concerning the
analysis of water, and consequently the practical treatise men¬
tioned above, 44 the first book published on water analysis,”
derives on importance which otherwise would not be attached
to it. The authors are very well known to the Fellows of the
Chemical Society, for their frequent reference to a new method
for estimating organic matter, and their very confident asser¬
tions of the unfailing action of that method.
It is uot called “ a complcte treatise/ and certainly it is
not so. The determination of the dissolved gases (a matter,
we conceive, of the highest importance ); the action of the
water on lead; are never as much as hinted at; and all the
preliminaries—preliminaries, we mean, of such vast import¬
ance as the appearance of the water, its odour, its colour, and
so on—ar6 all dismissed in one brief paragraph of five lines.
We have but little to say about the first chapter. The
authors recommend for the determination of the total solid re¬
sidue the evaporation of but a very small quantity of the
water. We confess that using, as they recommend, a pla-
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516 The Mediofcl Press and Circular.
GLEANINGS.
December 1«, ISM.
timim capsule capable of holding 100 c. c. f we think the
chances of error are Tory much greater than when ovaporating
down a larger quantity. A very fractional error in a weighing,
when multiplied over and over again, becomes very serious in
the long run.
Chapter II. is devoted to the determination of the hardness
of water, and is made up largely of extracts, but at the same
time of many original, good, and practical hints.
The subject of Chapter III. is the determination of the chlo¬
rine. And here we feel bound to ask, Did the authors ever
make one single satisfactory experiment with the quantities
such as are mentioned aud recommended. We are compelled,
much against our wish, to state our firm conviction that they
cannot nave done so. We have tried experiments over and
over again, and have come to the conclusion that it is posi¬
tively impossible to arrive at a single satisfactory result with
the potassic chromate of the strength they recommend.
“Add,” say they, “a drop of a solution containing half a
millegramme of neutral chromate of potash to the water, and
then the standard silver solution, until a permanent red colour
begins to form.” Did Professor Wauklyn ever see this per¬
manent red colour form in an ordinary water, upon adding the
silver solution after the addition of the amount of potassic
chromate he recommends ? At any rate, we never have. The
authors remark the determination of chlorine by this process
is very delicate. But at least it requires that the water under
examination should be somewhat deeply tinted with the chro¬
mate solution (say one or two septems of a saturated solution
of the salt), and then it is true the results are remarkably
accurate. We deeply regret that the authors should place
before the public such au unreliable and worthless moae of
conducting this beautiful experiment We regret much that
it is not the only illustration in Professor Wanklyn’s treatise
of a want of accuracy and patient investigation.
The first part of Chapter IV. is devoted to Schulz’s plan of
estimating the nitrogen existing in water as nitrates and ni¬
trites, by their conversion into ammonia, by acting on them
in a strongly alkaline solution with metallic aluminium ; and
further, the estimation of the quantity of ammonia thus gene¬
rated by the Nessler test. The latter half of the chapter is
taken up with Frankland aud Armstrong's modification of
Crum’s process for estimating the nitrates and nitrites (as
published in the Journal of the Chemical Society ), and re¬
marks thereon. That this method is a deal of trouble we at
once admit, but we feel convinced, that, for large quantities,
the results obtained from it are far more satisfactory tliau we
can possibly obtain from the method of Schulz, with the
proper working of which, it seems to us, so many things in¬
terfere. Again, we must say, that upon working in the way
pointed out by the authors, with solutions of knowu strength,
we are rarely able to obtain more than half the amount of ni¬
trogen that we had originally introduced. Perhaps our failures
may be due to an error in the strength of the solution recom¬
mended, or the omission in the description of some important
points in its working.
In Chapter V. is described at great length the estimation of
the ammonia and organic matter. They are, as the authors
remark, of vital importance. We agree with them in the
little dependence that can be placed on “loss by ignition.”
We agree with them further, in condemning Frankland and
Armstrong’s combustion process, which we have experimented
with largely, and which is certainly very troublesome and
very inaccurate. We agree, also, that there are many objec¬
tions to the employment of permanganate of potash for calcu¬
lating the organic matter, though, on the whole, we consider
the results obtained are fairly accurate, and tolerably constant.
And now follows a long account of the special, ana we must
add, most ingenious piocess introduced by the authors, de¬
pending on the curious reaction that occurs wheu a strongly
alkaline solution of potassic permanganate is brought into con¬
tact with nitrogenous organic matter. But, unfortunately,
the whole process is put forward, as we find, upon careful ex¬
periment, in such a crude aud undeveloped form, that the de¬
light we felt when we heard at the Chemical Society for the
first time of the marvellously accurate results obtained by a
process so simple and so easy, were doomed to almost utter
disappointment Perhaps we ought not to be surprised at
the delight of Messrs. Wauklyn and Chapman, running a
little wild in the first instance when they brought before che¬
mists the results of their labours ; bnt we do regret most
deeply that they had not striven to render their method more
trustworthy, and capable of giving more definite and certain
results. We have tried the process now a great many times,
and whilst it is fair to say the results we have obtained by
this process are more reliable than those we have obtained by
the method of Frankland and Armstrong, still it has many
drawbacks, which, however, we certainly venture to hope
may ultimately be overcome. There is one point we may ven¬
ture to mention where we have found some difficulty. We
have distilled, say from half a litre of water, to which we
have added the potassic permanganate, a certain quantity,
until all the ammonia has come over. The following day we
distil again some few ounces from what remains in the retort,
although we had obtained all the ammonia possible the day
before, when we again obtain a considerable quantity of am¬
monia. And again, we carry the distillation on until no more
ammonia is produced, aud yet, if distil again the following
day, we obtain more ammonia still. And where does it come
from? May we suggest the probability that the action of
this alkaline solution of potassic permanganate on nitrogenous
organic matter is very much slower than the discoverers of
theprocess seem to suppose.
Wo have read this book with very considerable care and
interest. Though we havo thought it right to review it, it
may be somewhat severely, still, with some alterations, it
may prove of considerable value.* We must add, however,
in conclusion, that it supplies us with one more illustration
of the unfortunate love that some people who live in glass¬
houses have of throwing stones.
* Certainly considerable credit it due to the authors for the care with
which they have collected together a mats of information, and for which
we feel much indebted to them.
-♦-
LENGTH OF THE COLON IN YOUNG CHILDREN.
At & stated meeting of the N. Y. Obstetrical Society, a
specimen of hemicephalus or anencephalns was presented by
Dr. Jacobi The child weighed nine pounds. The viscera
were well developed, and the colon was unusually long in this
case. Dr. Smith made the remark that he had measured the
colon in thirty cases of children under six months, and disco¬
vered that from one quarter to one third of the large intestine
lies below the brim of the pelvis. Dr. Jaoobi stated that the
descending portion of the colon in the young infant was nearly
twice the length of that of the adult. It crosses over diag¬
onally towards the right side, instead of lying parallel to the
long axis of the body. There is no proper sigmoid flexure as
in the adult, but on account of the great length of the oolon a
number of flexures are found.— Am. Journal of Obstetrics.
FRACTURES OF THE ELBOW-JOINT.
Dr. Henry J. Bigelow, of Boston, Mass. (Boston Med.
and Surg. Journal ), holds that in simple fractures of the
elbow, except of the olecranon, passive motion, as laid down
in woiks, is radically wrong and unnecessary; it occasions
excessive pain during the operation, and begets active inflam¬
mation, besides injuring severely the part under repair, which
nature iu her own good time will restore better without than
with it.
Case op Alleged Poisoning. — A strange case of alleged
poisoning has just oome to light in this locality. A young
woman, named Bridget Lynch, who was in the Berries of a
Mr. Baldrick, in the district of Bancrana, gave birth to a child
about three weeks ago. Shortly afterwards the woman died,
an inquest was held, and the body was buried in the new ceme¬
tery, near this city. From information given to the police by
a Roman Catholic clergyman, who alleged that she had been
poisoned, Mr. Baldrick was arrested, and the body of the
deceased was exhumed in presence of Mr. Hill, County In¬
spector, Dr. Hunter, Dr. Browne, Head-Constable Parkinson,
and two sisters and a brother of the woman. A postmortem
examination of the body was then held by the medical gentle¬
men, and a portion of it was given in (marge to a police con¬
stable, who was directed to proceed with it to Dr. Hodges,
of Belfast, in order that that gentleman might ascertain £
there were any traces of poison in the stomach. Mr. BaVbiik
is still detained in custody. We understand that the autho¬
rities have refused to release him upon substantial baS.—
Derry Sentinel.
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The Medical Ttm And Circular.
TRANSACTIONS OP SOCIETIES.
December 1(, 1848. 517
of $crciefirs.
THE JUNIOR SURGICAL SOCIETY OF
IRELAND.
The above Society held its opening meeting in the
Albert Hall of the Royal College of Surgeons on Wed¬
nesday last. The Chair was occupied by Mr. Porter,
President of the College, and Mr. Macnamara, Vice-
President, Mr. Adams, Dr. Benson, Dr. Jameson, Dr.
Mapotber, Dr. Jacob, and other members of the Council
of the College were present. The attendance of students
was very large.
After some introductory observations from the Presi¬
dent, Dr. Mapother read the following address :—
The Council of the Junior Surgical Society have usually
requested one of the professors of this College to offer
some remarks at its opening meetings, and my turn now
oomes at this its seventh session. I find, with great
satisfaction, that the President of the College fills the chair,
and that the Society has become an integral part of this great
institution, and meets in its hall. I will confine myself to two
topics ; firstly, the advantage which such an association con¬
fers on students of medicine ; and secondly, the better pros¬
pects of students now than ten years ago. The truths in Lord
Bacon’s aphorism are unquestionable—“ Reading maketh a
full man, writing an exact man, and speaking a ready man,”
if therefore a member of this Society notes carefully a case
in hospital, studies what authorities have recorded about
similar cases, reports it here, and defends, or more fully ex¬
plains, the views he has adopted, must he not have made him¬
self full, exact, and ready ? The training which he has thus
undergone fits him for the study of other subjects, while the
facts he has thus laboriously acquired remain indelibly impressed
on his memory. His literary education is likewise advanced,
and he thereby becomes more fitted for the competitive ex¬
aminations on which his success will depend. From the
peculiar relations of our schools and hospitals, a students’
society is more useful in Dublin than elsewhere, for pupils
from several hospitals will be found among its members, and
one important case in any of these institutions, if only the fact
of its admission be announced, can be rendered instructive to
the pupils of all the others. However, those heretofore
established have been short-lived, for the most active members
of one session complete their studentship before the next,
and zealous successors cannot always be found. I trust the
Junior Surgical Society may become as venerable as her eldest
sister of Edinburgh, which has continued uninterruptedly for
130 years, and has had hundreds of members who became
afterwards famous. In order to extend the benefits of the
association, it has been proposed to unite the students of all
the Dublin Schools in one Society. The proposal was made
too late to secure amalgamation this session, but it should not
be lost sight of. If the meetings were held in each of the six
schools each week alternately, as is the practice in the London
Students’ Society, the arrangement would be most advanta¬
geous. In this society emulation is excited by the prizes
which are offered for essays on special subjects. Last year
1 ceased to offer a medal for a physiological essay alone, but
strove to combine that mode of showing my pupils’ acquisitions
with vivd voce answering and practical demonstration, in con¬
testing for my prizes. If an essay of merit is presented this
year, I will gladly revert to my former practice. I have
always thought that prizes are a necessary institution in all
educational and licensing establishments, and that every
student should be afforded the opportunity of distinguishing
himself. It has often been said that prizemen confine their
efforts to one subject, and learn that theoretically and hastily,
and consequently do not become eminent in after life. If the
competition test be justly and rigorously applied, these ob¬
jections do not hold, and that the successful men of our pro¬
fession were the prize-takers among their fellow-students
appears from the records of many educational bodies. In that
most admirably-devised examining body, the London Univer¬
sity, such men as Quain, G. Johnson, Brinton, Gull, Professor
Parkes, Professor Savory, Professor Turner, Lister, Sir H.
Thompson, Garrod, Professor Huxley, Professor Humphrey,
and Graily-Hewitt were the first men of their respective years.
Again, have not the greatest statesmen of the day been
University prizemen ? and they are prouder of such distinc¬
tions than of all their hereditary acquisitions. Let me cite
a few examples of great though early successes : Desault,
while professor in the Academy of Medicine, had a habit of
calling on a student to read aloud an abstract of the previous
day’s lecture. On one occasion, his choice having fallen on
Bichat, the great Burgeon was so charmed with the student’s
judgment and learning, that he at once adopted him as his
assistant. You are aware that although Bichat lived to only
the age of 31, he founded, and greatly enriched, the science of
general Anatomy. Davy was Professor of Chemistry in the
Royal Institution when twenty-one years old, and Carmichael
was president of this College when thirty-four. Our senior
surgeon, Mr. Adams, w’hom I am proud to see here, was a great
and renowned teacher before his years had numbered one-fourth
of a century. When only twenty-three, Curling had won the
Jacksonian prize for his work on “ Tetanus,” and had been
appointed surgeon to the London Hospital. At twenty-four,
Bowman had read his great papers on the Structure of the
Kidneys and of Muscle, and had gained for them the fellowship
of the Royal Society, and the Royal Medal, and that great
work, the “ Principles of Human and Comparative Physiology,”
was published when its author, Carpenter, was but twenty-nve.
One instance more of student’s work. It was in the first year
of Abernethy’s apprenticeship, and when he was but sixteen
years of age, that he discovered and recorded that remarkable
fact that several drachms of opium remained undissolved in the
stomach of a patient who had died of tetanus, and thus that
student exposed a useless, if not fatal, mode of treating that
disease.
I will now remind you of a few of the improvements in
students' prospects which has taken place within the last ten
years. An army assistant-surgeoncy lias been made a position
of honour and just emolument, and to gain it, you need beg
no man’s aid, but proudly depend on your brains and industry
nlone. The naval service has been elevated in a like degree,
and for this the students have mainly to‘thank themselves.
They refused to enter the service until they would receive the
treatment suitable for educated gentlemen, and not one
accepted the subsidy which was temptingly offered to those
studying the profession, if they consented to enter the service
when they had obtaiued diplomas.
The difficulties which men of the greatest talent experienced
in getting assistant-surgeoncies in the navy a few years ago are
well illustrated by the biographer of Dr. James Johnson, the
famous editor of the Medico-Ckirurgical Review . Johnson
leaving Derry a poor and friendless young man, went to Lon¬
don to obtain a nomination for the service. After many dis¬
heartening failures he resolved to earn his bread asau anatomi¬
cal teacher, and in partnership with Mr. Bickersteth (who, by
the way, was afterwards Master of the Rolls), he had some
success. As he still yearned after a naval life, Wilson, the
great anatomist, furnished him with the following characteristic
letter to the chief physician of the navy :—“The bearer of
this, Mr. J. Johnstone, has actually lived in the dissecting-
room during the last six months. Examine him and see
whether ho has studied in vain.” This time his application
was successful. Other branches of public medical service,
which I feel sure will be opened to competition in a few years,
will be that of the Poor-law system, ana of the Public Health
Department. A month ago the lute Government issued a
most admirably chosen Royal Commission to investigate the
organization of the machinery for the preservation of the
public health in the United Kingdom, and we may shortly
expect to see a health officer in every county and town of
magnitude throughout the three kingdoms. Ireland will
especially benefit by this reform. Such appointments will
doubtless have to be gained by competitive examination.
Students are not to suppose that from such inducements to
learning, their profession is becoming a more difficult subject
of study, for although its boundaries are extending, and a
more thorough knowledge of each of its branches is now re¬
quired to pass the more searching and practical examination
recently established, the appliances for teaching have been
vastly improved.
I cannot refrain from noting how much in advance of
other educational bodies this college has been in improving the
examination test. Firstly, it has always refused to grant any
diploma except by examination ; secondly, teachers are pro¬
hibited from being the sole examiners ; thirdly, in 1845 admir¬
able rules were devised ior the examination of Fellowship
candidates by the bed-side of patients, but they did not
come into force, owing to the opposition, or at least, want of
co operation of rival licensing bodies; and, fourthly, opera-
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tions on the dead body are to be made for the future part of
tbo examination for the diploma—and so essential a part, that
candidates who wholly fail at operations are not to be al¬
lowed to proceed with the rest of the examination.
Further evidence of the brightened prospects for the
zealous student is afforded in the iact that among the hospital
physicians and surgeons of Dublin, there are at present
fifteen who have obtained their diploma within the last ten
years. They have achieved this early success by the distinc¬
tions which they won while students. However, to render,
the position of hospital surgeon the reward of fitness alone,
and to stimulate medical education as the opening of other
services has unquestionably done, I will never cease to advo¬
cate the competitive principle jp filling the office of hospital
surgeon, or rather that of assistant-surgeon, which should be
always introductory to the more responsible post
I am convinced that the extension of competition would
improve our national character, and if ever I should find in a
slight degree opportunity of influencing those who govern this
country, I will use that influence to prevent considerations of
birth, friendship, party, or creed, from outweighing what
should be the sole criterion—professional fitness as attested by
competitive trial.
The President then called upon Mr. Ray, who read a
paper on “ Some points in the Physiology of Respiration.”
He was followed by Mr. Barker, who read an interesting
communication on “ Stiffened Bandages,” and entered at
length upon the relative merits of starch, glue, egg, flour,
and other materials applied to a like purpose. Mr. Bur¬
nell then read two cases of Epithelioma about the lower
jaw ; and after several votes of thanks had been proposed
the Society adjourned.
THE DUBLIN OBSTETRICAL SOCIETY.
The above Society held its second meeting in the College of
Physicians on Saturday last, Dr. Ringland, President, in the
chair. A ballot having been taken, it was found that the fol¬
lowing members were duly elected .—F. Churchill, jun., F.K.
and Q.C.P. ; James Little, M.D., F.K., and Q.C.P. ; Wm.
Roe, M.D., F.R.C.S.I.
Dr. Atthill read a paper “ On Retroflexion of the Uterus,”
and having alluded to the frequency of the affection, and the
very distressing symptoms it often gives rise to, he proceeded
to state that, in his opinion, it was nearly always the result of
causes slowly producing these effects, which he classed as fol¬
lows :—
1 st. Chronic inflammation of the uterus and its result- -
hypertrophy of that organ.
2 nd. Subinvolution of the uterus after labour or abortion.
3rd. Tumour of the uterus.
The consideration of the latter class of cases he excluded for
the present.
Dr. Atthill stated that chronic inflammation, or perhaps to
uso a more correct term, “active congestion ” of the uterus,
terminating in retroflexion, was not unfrequentlv met with in
two opposite classes of females, namely, those of active habits,
and naturally robust constitutions, and the reverse of these,
females of weakly constitutions and who lead a sedentary life,
such as needlewomen, Ac. He. illustrated these views by
giving the details of a number of cases. In the first ease, the
patient was a healthy young unmarried woman, who had for
several yea n past beeu engaged in out-door occupations. Her
most prominent symptoms were, constant desire to micturate,
extreme difficulty in evacuating the contents of the rectum,
and great diminution of the catamenia. In the second, the
patient, also unmarried, was a schoolmistress. In her case,
too, the menstrual discharges had decreased greatly; for a
period of two years she had suffered from attacks of vomiting^
which, for some months previous to her coming under Dr.
Atthill’s care, had become incessant, every species of food be¬
ing rejected. In the third case, the patient, a married lady,
was a complete invalid, being unable to make the least exer¬
tion, as any attempt to walk caused great pain. She had suf¬
fered from several attacks of inflammation. In her case, too,
the catamenia, though not actually suppressed, were very
scanty. Four cases were subsequently detailed, in which the
retroflexion depended on subinvolution, in all of which the
menstrual discharge was profuse ; in two to an alarming ex¬
tent. In conclusion, Dr. Atthill drew the following infer¬
ences :—
1st That retroflexion of the uterus is a common affection,
and is met with in both married and unmarried females.
2nd. That it is a secondary, not a primary affection.
8 rd. That when it is the result of chronic inflammation, or
hypertrophy of the uterus, the catamenia are diminished.
4th. But that when retroflexion is the result of subinvolu-
tion of the uterus, following labour or abortion, the catamenial
discharge is increased in quantity; sometimes even to an
alarming degree.
5th. That in addition to the symptoms common to all forms
of uterine disease, namely, pain in the back, Ac., we have fre¬
quently, when the uterus is retroflected, reflex irritation of
the bladder, stomach, and breasts, occurring as to frequency
in the order given, and also difficulty in defication.
Dr. Atthill stated that since he had written his paper, the
subject had been discussed in the Obstetrical Society of
London, and that the views there propounded had in no way
modified his own, and that while he agreed with Dr. Meadows
“that inflammation or active congestion precedes and is a
common cause of this affection,” he did not agree with him
“ that our first care ought to be to remedy ” this condition, and
“ that, till this is accomplished, but not before, we may resort
to mechanical treatment.” On the other hand, he coincides
with Dr. Graily Hewitt, that “ the flexion is the prominent
feature of these cases, and that the restoration of the organ to
its proper position is the first indication. ” Dr. At thill also
confirmed Dr. Priestley’s statement, that “ retroflexion of the
unimpregnated uterus may give rise to uncontrollable vomit¬
ing,” and that of Dr. Barnes, “that in secondary puerperal
haemorrhage retroflexion is often fonnd to exist.** Dr. Atthill
dwelt very briefly on the treatment of this affection, as he
wished mainly to consider it with reference to its pathological
condition. Finally, he drew attention to the fact, that retro¬
flexion of the uterus was occasionally met with in patients to
whom it seems to cause no distress or inconvenience, tad
pointed out the necessity of avoiding all interference with such
cases.
Dr. G. H. Kidd exhibited some new forms of pessaries, and
while disclaiming any title to originality, considered that the
exhibition might, nevertheless, be interesting to the Society.
The first pessary was Hodge’s Lever Pessary ; of this there were
three forms, one of which, “the open lever pessary,” was un¬
known to any of the instrument makers. The second form
had been strongly recommended by Dr. Marion Sima, on the
ground it was not liable to turn round, but Dr. Kidd’s ex¬
perience did not confirm this view. He considered it better
to use a much longer form, and he believed that Dr. Churchills
cross-bar pessary would be found effective in this way. He
found that none of these forms were to be depended on to
remedy retroflection, and as a precaution he always introduced
a sound afterwards to make certain of the correct situation of
the uterus. The next form which Dr. Kidd produced was Dr
Greenhalgh’i elastic pessary, which he found was much easier of
introduction, and was borne with much greater comfort by a
tender or inflamed uterus. The next instrument was a modi¬
fication of Hodge’s pessary, always used by Sir James Stepson.
It had the advantage of being veiy easily made out of a
piece of gutta percha, and was considered by Sir J. Simpson
to be very easily introduced by the patient herself.
Dr. Kidd showed Dr. Graily Hewitt’s rings, which were
capable of being altered to any desirable shape, and converted
at the moment into a Hodge’s pessary, and he also showed Dr.
Protheroe Smith’s spring pessary, which is intended to be in¬
troduced, closed and opened after introduction. Dr. Kidd did
not consider the principle suitable for cases of retroflection.
The object of the Hodge pessary was rather to carry the os uteri
well backwards, and allow the weight of the uterus to adjust
itself. Dr. Kidd then showed the recently invented pessary of
Dr. Murray of Newcastle, which was a combination of Sir J.
Simpson’s and Dr. Protheroe Smith’s spring instruments. The
last form of Hodge’s pessary was one which Dr. Kidd had used m
a case of very distressing prolapse of the vaginal wall with
ovarian tumour and ascites. The poor woman had caused her
death in the attempt to relieve herself by tapping through the
vaginal wall with a knitting needle. This concluded the
catalogue of extra tUerine pessaries , and Dr. Kidd proceeded to
show the extra uterine forms which he introduced with Sir
James Simpson. The next was a silver ring pessary, with a
moveable stem. The third was the commonly known brooch
essary, which had been widely condemned, but which Dr.
Idd considered would be useful in suitable cases. The next
form was one in which the stem and body of the pessary were
separate, and were supposed to be introduced separately,
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The Medical Trm tad Circular.
TRANSACTIONS OF SOCIETIES.
December 16,1M8. 519
which, however, Dr. Kidd thought would prove to be a very
difficult manipulation. Dr. Aveling’s instrument was also a
combination of the stem and Hodge pessaries, in which the
stem was intended to adjust itself, but Dr. Kidd had had no
favourable experience of its use. The next form exhibited was
the galvanic pessary, of which the author expressed a very fa¬
vourable opinion, especially in cases of deficient development of
the uterus and amenorrheea. He was strongly of opinion that
the galvanic action was real and useful. These had the ob¬
jection of being liable to fall out of the vagina, and to obviate
this Dr. Beatty was in the habit of introducing a small
disc pessary after the stem, which plan Dr. Kidd had modi¬
fied by using Dr. Churchill's crossbar penary, to follow
stem, which he found more effective than the disc.
These were all the intra uterine pessaries, and Dr. Kidd
produced several intended for the prevention of prolapse, of
which the disc and globular pessaries were the most usual.
He considered the disc most effective, but the central aper¬
ture should be made smaller than is usual. Some of these
pessaries were made of tow, covered with some varnish, which
was liable to be dissolved by the secretions, and the pessary
then became wprse than useless. A modification of the
globular pessaiy was the air ball, which was introduced in the
collapsed condition and then inflated. It was objectionable on
account of the tube, which hung out of the vagina. The next
class were the stemmed vaginal pessaries, of which the first
was Sir James Simpson’s, which was apparently a modifica¬
tion of the Butterfly pessary. Dr. Matthew’s, Duncan’s and
Dr. Graham Weir’s pessaries were also produced, but Dr.
Kidd considered that those forms which were attached by
straps externally were necessarily uncomfortable.
At the conclusion of Dr. Kidd’s remarks.
Dr. Beatty said that retroflexion and retroversion were per¬
fectly distinct conditions. He had long since published a
paper advocating the relief of the chronic inflammation of the
uterus before resorting to mechanical means ; and occasion¬
ally the case might be cured by this treatment without under¬
taking the mechanical treatment at all. Dr. Beatty had used
the Hodge pessary largely, but did not find it very satisfactory,
being difficult to introduce and liable to turn round. In most
cases there was a diseased condition of the fibres of the uterus
at the beud, and thus mechanical means were indispensable
with the view of remedying the condition. Dr. Beatty objected
to Sir J. Simpson’s brooch pessary, because it fixed the uterus,
which was not its natural condition. He was in the habit of :
using the stem and disc for about two months, and then eni- :
ploying a ring for about two months longer, and he fouud the
treatment often very effective.
On the motion of Dr. Sawyer, the debate was adjourned to
a future evening.
- -
ARMY MEDICO-CHIRURGICAL SOCIETY OF
PORTSMOUTH.
December 2nd, 1868.
Deputy Inspector-General Dr. C. A Gordon, C.B., in
the Chair.
Suigeon Franklyn, R.A., exhibited in the microscope a
Guinea worm extracted from the ankle of a 9oldier recently
returned from Abyssinia, where he had probably beoome
affected with the parasite.
Staff-Surgeon Koch read a paper on
Heat Apoplexy.
He expressed the opinion that Insolation or Sunstroke, and
lleat Apoplexy were different diseases ; that not only were
their symptoms dissimilar, but so also were the post-mortem
appearances in fatal cases, and the treatment applicable during
life. Of seven cases of those affections treated by him on
board the Golden Fleece y in Annesley Bay, in May, 1868, six
occurred as secondary diseases in persons debilitated by
various causes, among which were dysentery, diarrhoea, fever,
and delirium tremens. He believed that the disease depended
more upon a stagnant state of the atmosphere than on actual
increased temperature. In one case the rise of the temperature
in the axilla reached 118° F. In five cases the treatment
consisted of tho cold douche, the application of ice to the head
and spine, mustard to the lower extremities, stimulating
enemata, Ac. All the men so treated died. Iu the sixth
case the patient was bled from the temporal artery ; he
recovered consciousness, but was uuable to articulate, had a
relapse six days afterwards, and died in six hours. The
seventh patient was also bled from both temporal arteries,
and for a time was restored to consciousness; he, however,
relapsed the following day, aud died.
Dr. Elliott, late R.N., read a paper on
The Communicability of Phthisis.
He alluded to the fact that about eighteen months ago
Dr. Budd, of Bristol, called attention to the idiosyncracy of
phthisis and zymotic diseases, and to its capability of being
transmitted from one person to another ; he noticed some of
the experiments that have been instituted in this country and
on the Continent in regard to the subject, mentioning in par¬
ticular those of Cheauveau, and expressed an opinion that up
to the present time the weight of evidence was in favour of the
disease being communicable. The great questions for consider¬
ation, he believed, were, whether it is not unjustifiable to allow
healthy persons to be in such frequent contact with the
diseased as to run the risk of becoming themselves affected ;
under what circumstances may such communication with the
affected take place without risk ; and what are the means of
prevention ? His own attention was first drawn to the sub¬
ject in 1854, when a very strong healthy young man, without
hereditary taiut of scrofula or tubercle, married a woman in
an advanced stage of phthisis. The wife died, and three
months afterwards the husband was found to be labouring
under the disease that had proved fatal in her. From that
time his attention has been directed to the possibility of tho
disease being thus communicable, and he has met with so
many confirmatory instances as now to have no doubt on the
subject. This view is further confirmed by the frequency of
phthisis amon.,' the nurses of Brompton hospital, and by the
fact that the danger is recognised among the class who usually
furnish the nurses for it and similar institutions. Ho did not
believe that phthisis ever is cured ; it may be for a time
ai rested, but never cured, and he questions if, in any case of
reported cure, tubercular deposit had really existed. Finally
ho alluded to the observations lately put forward by the
Registrar-General on the decrease of cases of pbthisis in districts
that have been recently drained; a circumstance which he
believed affords some hope that by this means much may yet
be done to mitigate the scourge in question.
Surgeon Lamprey, 67th Regiment, described a method of
making interrupted sutures by means of fine cambric needles.
These he inserted os close as possible to the margin ;
securing close apposition of tho lips of a wound by means of
a single noose of silk round the projecting extremities of each,
the points being then snipped off. He introduced some cases
in illustration of the readiness with which incised wounds
treated in this way united.
-
MEDICAL SOCIETY OF LONDON.
The meeting of this Society on Monday, December 7th,
was one devotea entirely to the consideration of
gall stones.
Some large and curious specimens of these concretions were
exhibited by Mr. Hainworth, Dr. Hutchinson, and others,
and Mr. Peter Marshall showed a patient from whom a
gall stone had passed by ulceration through the skin low
down on the abdomen, near the right groin.
The papers of the evening were by Dr. L&ared and Dr.
Thobowgood, and referred to several very interesting cases of
gall stone. %
In the discussion that followed, Dr. Thudichum, Dr. Day,
Dr. Routh, aud the President joined, and Dr. Kouth re¬
lated two cases where the agony of a gall stone was relieved,
and its passage facilitated, by the inhalation of chloroform
aud complete amesthesia.
The President stated that he had, on more than one occa¬
sion, in the same patient, given moat efficient relief by deep
freezing of the side during the paroxysm of pain.
Dr. Leaked and Dr. thorowgood having briefly replied,
the meeting separated soon after ten o'clock.
-♦-
ST. ANDREWS GRADUATES’ ASSOCIATION.
THE OPEN EXAMINATION SYSTEM.
At the recent meeting of the above-named association, an
unanimous opinion was given by several speakers, among whom
we may mention Dr. Richardson, Dr. Crisp, Dr. Drysdale, Dr.
Pike, and others, that the free system of examining all comers
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520 *Iht Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
far degrees in medicine ought to be resumed as soon as possible
by St. Andrews University. We Jbave always advocated the
necessity of, as soon as possible, obtaining an obligatory state
degree, granted by examiners chosen, it may be, from the
Medical Council, which should examine all candidates for the
title of M.D., indifferently at London, Edinburgh, St.
Andrews, Ac. The local degree system of past times is a
scandal and a disgrace to the intelligence of the day. We are
tempted to say, often, that universities seem to be hindrances
rather than assistants to the diffusion of learning. Let St.
Andrews University and London University always insist on
keeping aloof from the evil examples of more narrow-minded
corporations, and renew the noble precept of “ Good will to
all men,” by granting their degrees to all, totally independently
of all residential qualifications, and only on account of profi¬
ciency and experience.
—-♦-
©btarg.
DEATH OF SICHEL.
The regrets to which we gave expression a few weeks
since on the death of Mackenzie, the father of eye surgery
in Great Britain, might fittingly be repeated in our record
of the death of Sichel, the senior of the Parisian ophthalmic
specialists, which occurred late in the last month. Genuine
and real in every word of the experiences which he has left
to the instruction of his brethren, he separated himself by
the hardly-gained barrier of industrious observation and
a scientific judgment from the herd of flippant ophthalmo-
logical pretenders whose substitute for study and labour is
algebraic humbug and ineffable self-sufficiency. Sichel
the elder carried with him to the grave more actual intel¬
ligence on the subject to which he devoted himself than
would furnish the marrow to all the pretentious effusions
of the authors who affected a contempt for him. The
Bulletin de TMrapeutique in its obituary thus speaks of
him:—
“ Amongst the losses which our profession has recently
sustained we have specially to deplore that of Sichel the
elder, the learned and skilful oculist, and the celebrated
author of the Iconographie Ophthalmologique. The last
honours were paid him with the extremest simplicity,
according to his express wish, and therefore, unfortunately,
in the absence of fcliat assemblage of his brethren which
would not have failed, if they had been permitted, to pay
to his memoir the tribute of affection, respectful esteem,
and regret, wnich was his just due.
“ Sichel was not only at the summit of the speciality
which he had embraced. He attached himself to it with
a real passion, as we may say, and also with the greatest
success to different other brandies of knowledge, especially
to medical and ophthalmic archaeology and entomology.
He was president of the Entomological Society of France,
and left Dehind him a magnificent collection of hymen-
optera to the Museum of Natural History
DEATH OF DR. JEREMIAH DONOVAN.
We deeply regret to announce the death, at Plymouth,
of Dr. Jeremiah Donovan, R.N., the second son of Dr.
Daniel Donovan, of Skibbereen. Dr. Donovan, who was
educated at the Cork Queen’s College, entered the navy in
1861. Shortly after his appointment he joined the Medi¬
terranean squadron, and served there for nearly four
years. After a short stay on shore he joined the Coast
of Africa squadron, and returned invalided over twelve
months since. Dr. Donovan’s health apparently rallied
after a time, and he was appointed to the Naval Hospital
at Plymouth. But the seeds of fatal disease had been
sown in the pestilential climate of “ The Coast.” The im¬
provement in Dr. Donovan’s health soon ceased to exist,
and after a long and painful illness, borne with admirable
resignation and piety, and cheered by the consolations of
the church, Dr. Donovan passed away on Wednesday last.
The deceased was a valuable and trusted officer, a skilful
physician, and a young man of the very highest promise—
a most amiable, high-minded, and kindly gentleman. His
premature demise will cause the most heartfelt sorrow to
all who knew him, either in private or official circles. He
was one of those who never made an enemy, and who had
a host of friends. Had he been spared he would probably
have attained the very highest distinction in his profession.
As it is, he leaves behind him a blameless and an honoured
name. The fondest of sons, and the most affectionate of
brothers. All who know them must sympathise with the
sorrows of the dear ones he left to mourn his loss.
NOTICB8 TO CORRB8PONDBNT8.
Da Jacob's Lecture on the Eye i* unavoidably postponed to our next
number.
▲ Subscriber.—' The sulphur pastilles are made by Duncan and Flock-
hart, and may be had of Messrs Be wley and Hamilton, Dublin; tee
advertisement
Da. J. W. Lakh. —Enquiries are being instituted. We will endeavour
to enlighten you in out next The practice, which is strongly reprehensi¬
ble, has become rather common of late, and should be stopped ia its
iufaney.
Mm. W. R. B., London.— Thanks: your note shall receive immediate
attention. We were aware of the tacts mentioned, and shall not tail to
utilize them on the earliest opportunity.
H. H.—The articles in question were written by one of our 8ookh
editors, hence the point you notice. The Scotch edition Is published,
like the Medical Press and Circular, weekly.
A. M. Bennett.— The question has been referred to one of the ablest
physiologists, who will write an article upon it in a short time.
Dr. Bird.—T he journal in question states in the paragraph to whirh
von direct attention, what its editor has the best reason to know w abso¬
lutely without foundation.
♦
Lane.— At Bishop's Castle, Shropshire, on Nov. 36, the wife of J. W.
Lane, E*q., M.D., LR.C.8.1., of a daughter.
-♦-
APPOINTMENTS.
The following have just been Gasetted.
Ward, J., Esq.—Promoted to Staff-surgeon, with Seniority of Dse. *
1868.
Wilson, W. T., Esq.—Promoted to Staff-surgeon, with Seniority of Dea
3. 1868.
Pottixoer, R. Esq.—Promoted to Deputy-Inspector General of Hos¬
pitals and Fleets in Her Majesty's Fleet.
Rodokrs, M., Esq,, JH.D.—Promoted to Snrgeon in Her Majesty’*
Fleet.
Hadlow, H , Beq.—Promoted to 8nrgeon in Her Majesty's Fleet.
Birxie, T. K., burgeon from the lith Foot, to be 8taff-suigeon to the
same, vibe W. Sinclair, appointed to the 13th Foot.
Read, C. C., Assi> tent-surgeon, from the U re nailer Guards, to be Staff-
surgeon to the same.
Soott, j. A., Assistant-Surgeon, from the 91st Foot, to be 8taff As¬
sistant-surgeon to the same, vice T. P. Smith, M.B., pl ac ed up**
half-pay.
Climo, w. H.. M.D., Assistant-surgeon from the Rifle Brigade, to be
Staff Assistant-burgeon, vice A. A. Macrobin, M.B., who exchanges.
Bleneins, G. E, Burgeon-major, Grenadier Guards, who retires on half¬
pay, to have the honorary rank of Deputy-Inspector General of Hoe*
pitala.
-♦-
Mr. William Harris, M.R.C 8., having passed the examination en
the 2nd Insr., was admitted a Licentiate of the Royal College of Phy¬
sicians.
-♦-
BOOKS, PAMPHLETS, fro., RECEIVED.
Transactions of the Pathological Society of London. VoL XIX.
1868.
Nature and Art Poems by R. Ton son Evanson, M.D., F.B.C.&, Ac-
Loudon : W. Hunt and Co.
The Sanitary Aspect of the Sewage Question. By Jamas Adams, M.U
Glasgow: James Macletroee.
The Climatic Treatment of Consumption. By John C. Thorowfood,
M.D.. frc. London: H. K. Lewis, Gower street.
Four Letters on Homoeopathy. By Alexander Harvey, M.D. Aberdeen:
Wyllie and Sons.
The Nature and Treatment of Diabetes. By F. W. Pavsj, M.R,
F.R.S. Second Edition. London: John Church01 and Sons.
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©to* fgWial & Shatter.
“ SALUS POPULI SUPREMA LEX.”
WEDNESDAY, DECEMBER 23, 1 868.
CONTENTS*
PAOB
LECTURE.
Bye Dise*se§ and Injuries. A Course of
Lectures delivered in the City of Dublin
HosviUl. By Archibald H. Jacob.
M.D., Ac. No. I.—Introductory. 521
ORIGINAL COMMUNICATIONS.
On the Dismemberment of Pharmacy from
lfediuioe. By M. Donovan, M.B.I.A.. 523
Gleanings in Toxicology. No. II.—On
Poisonings by Colocynth. By Charles
Meymott Tidy, M.B., M.R, Ac.. 529
HOSPITAL REPORTS.
Dropsy and its Pathology. Under the care
of E. P. Sharkey, M.D., Dub., Ac. ....
524
TRANSACTIONS OP SOCIETIES.
Royal Medical and Chirurgical Society.. 525
Pathological Society of Dublin. 698
LITERATURE.
Hebra on |Diseases of the Skin. 527
PAOB
Summary of Science. By C. B. C. Tieh
borne, F.C.8., F.B.O.B.L, Ac. 527
GLEANINGS.
Babbits and Sparrows in Anstralia. 528
LEADING ARTICLES.
Educational Rbfobm.—No. IV. 531
Thb Cat. 582
Extra Professional Mxdical Publica¬
tion . 583
Thb Superannuation or Irish Poor-
law Mxdical OmciRs. 533
Army Mxdical Repost for the Ybar
1856. 584
SCOTLAND.
The Site of the New Edinburgh Infirmary. 535
Olasgow and Aberdeen Universities. 53g
I FRANCE.
I The Secret Poisonings at Marseilles...... 537
NOTES ON CURRENT TOPICS.
Mrs. Gladstone’s Convalescent Home .... 588
The Vestry of St. Pancras and the Medical
Officer of Health. 538
PAG I
The Indian Cholera Epidemic. 583
The Late Lunacy Case... 538
Smali-Pox at Sheffield. 539
Anglo-German Ophthalmic Hospital.... 589
French Hospital and Infirmary. 539
The Sanitary Condition of Falmouth.... 539
A Royal Commission on the Sanitary Laws 639
The Royal College of Science, Dublin .... 589
Ligature of the First Stage of the Right
8uhclavian Artery. 589
University of Cambridge—Natural Science
Scholarships. 539
CORRESPONDENCE.
Cognovi on Reform in Medical Education. 540
Medico-Social Fencillinffs of London Life
and Practice. No. IV. 641
OBITUARY.
Death of Dr. G. Edwards... 542
Opium and Belladonna . 542
Notices to Correspondents, Ac... 543
Stjctwrf.
EYE DISEASES AND INJURIES,
g. Conttt of £utnrts
DELIVERED IN THE
CITY OF DUBLIN HOSPITAL,
By Archibald Hamilton Jacob, M.D. Ed., F.R.C.SX,
Ophthalmic Surgeon to the Hospital.
No. 1.
Introductory.
The surgery of the eye and its appendages, Gentlemen,
has wi thin the last decade undergone a development so
rapid, and has at the present day become so deeply
involved in true and false theories—valuable and worth¬
less propositions—beneficial and pernicious practices—
that it is necessary for me before entering on my subject to
explain what I mean by ophthalmic surgery, and what
it is that I propose to offer to you in my course of lectures.
With the remembrance before me that I am here to afford
you information respecting the everyday treatment of
the injuries and diseases of the eye which you will be
called upon to take the responsibility of in your future prac¬
tice, I shall endeavour studiously to avoid wandering into the
transcendentalisms of the speciality which would require
my attentionif I were addressing an assembly of ophthalmic
surgeons. I must therefore omit notice of many valuable
suggestions which have not yet assumed the dignity of ac¬
cepted practices and procedures, and are therefore unsuited
to your position as general surgeons. The sti in ul us which eye
surgery, or, as it is grandiloquently called, ophthalmology,
has received has, as might be expected, produced an
immense flood of theories, the truth of which has yet to be
established, and of practices founded on them which have
yet to undeigo the test of experience. Furthermore,
many of those suggestions which have received the
Approval of surgeons who apply themselves to the exclu¬
sive study of ophthalmic surgery are quite unfitted for the
rough and ready purposes to which the ordinary run of
surgeons would require to apply them, and are much too
abstruse for you either to comprehend ifow or to make use
of hereafter. Few of you can expect to possess either the
special education to follow out the intricacies of ophthal¬
mology—the iactus erudites to effect its difficult manipula¬
tions—the confidence to deal with so delicate an organ as
the eye, or the inclination to devote to its study the time
and labour which is essential to proficiency. For all these
reasons I shall aim at supplying you with such informa¬
tion as will enable you to give an accurate diagnosis and
prognosis of eye disease, to render you independent of
the aid of the oculist iu your treatment of such cases as
you will usually meet with, to understand and perform
the most essential operations, and to add to your pro¬
fessional income by the practice of this amongst other
special branches of your profession.
Disease as it is modified in the Eye .—'The surgery of the
eye, while it differs in some important respects which l am
about to point out, resembles the auigery of other regions
in all its fundamental characters. This feet is a neces¬
sary consequence of the physiological identity’ of its con¬
stituent structures, (those entering into the construction
of the system generally), which, though they are ap¬
parently distinct, are in reality only varieties or modifi¬
cations of the same tissues which exist elsewhere. The
conjunctiva being simply a reflection of the epithelium of
the surrounding skin altered into the condition of a
mucous membrane, is subject to the some cuticular diseases,
as in pustular and phlyctenular ophthalmia. It partici¬
pates frequently in such eruptive diseases as small-pox
and measles, and in herpetic and aphthous affections
similar to those to which the mucous membranes of the
mouth and lips are subject. Its inflammations are in great
measure identical with those of mucous membranes else¬
where—catarrhal discharge, great swelling of the mem¬
brane, and the same purulent excretion as is eommon to
the mucous membranes of the nose and bronchi. The
scierotic or fibrous coat, partaking of the same characters
as in tendons, joints, and elsewhere, suffers fronvgouty and
rheumatic diseases. The retina or nervous fip aa si on/ia
Digitized by i^oooLe
522 Th* IfediCAlPrtts and Circyli*;
LECTUEES.
!**•»** **.!**
also liable to |he sauie sympathetic aqd functioned dis¬
turbances as occur in the other organs.
In the eye we have exactly the same conditions of
inflammation, exudation of lymph becoming organised
and forming adhesions, or suppurating and being elimi¬
nated from the system as foreign matter ; and all more or
l$ss amenable to the same course of treatment as when they
opcur in other organs. In point of fact, I repeat, the animal
structures are in the eye modified as regards their uses,
but still they am the same structures here as elsewhere,
subject to the same diseases, and to be combated with the
same remedial measures.
Every general principle which you will learn to apply
to the treatment of local diseases elsewhere, will, with
certain restrictions, be found proper to the eye, and must
be borne in mind as closely in their application to oph¬
thalmic surgery as in all other forms of disease.
But it is to be borne in mind that the eye possesses
characteristics which make lesions which would be of the
smallest import elsewhere of vital importance here, and
which cause an inflammatory process which might be
allowed to persist for weeks in other parts of the animal
economy, without much consideration, in a few hours to
inflict an irreparable injury.
These two qualities are transparency, and that peculiar
form of nervous sensibility to light, reposed in the organ,
and they are characteristics most vulnerable to all forms
of disease. A pustule or an ulcer of the cornea, an exuda¬
tion of lymph from the iris, or an inflammation of the
retina, demand special and peculiar treatment, for if they
were permitted to go on as they might do in another posi¬
tion, without any serious result, they would in the eye,
while resolution was proceeding, imperil or destroy the
transparency of the humours, or the sensibility of the
retina. For this reason your treatment of eye affections
must, speaking generally, be prompt while it is cautions,
and vigorous while it must be judicious ; and while
yon must be careful not to lose time by inefficient
measures, you must guard against the mistake too
frequently committed oi overdoing your treatment, and
thereby vitiating your results.
Injuries in the Neighbourhood of the Orbit —Injuries in
the neighbourhood of the orbit differ in their characteristics
in no essential respect from those to other regions of the
tmi, and I shall therefore leave your instruction in their
treatment to my surgical colleagues, except so for as the
result may be influenced by the neighbourhood of the
eyeball itself. You will see fractures of the bones and
concussion and injnry of the brain as elsewhere. Amau¬
rosis may be caused by blows outside the orbit. As the
spine or brain may suffer disorganizing injury by the
simple shook of violence without absolute rupture, so
the optic nerve may be permanently paralysed by indirect
concussion. Amongst the commonest causes of this
injnry are strokes on the temple or on the eyeball itself
from a racket ball, or blows inflicted on nurses by the
child in their arms unexpectedly raising its head. Thns
may result instantaneous amaurosis, Which was formerly
attributed to an injury of the frontal nerve, but is now
regarded as a molecular alteration in the nerve substance.
It is frequently attended with dilatation of the pupil—
cither of the whole or a part—send may or may not pre¬
sent under ophthalmoscopic examination appearances of
retinal injury. If the loss of vision be immediate and
complete, the paralysis of the nerve may be diagnosed;
and m such case, if the blindness persist for more than a
few hours, relief is almost hopeless, but if any interval,
however short, existed between the blow and the blind¬
ness, hope may be entertained that it is due to extravasa¬
tion of blood either on the optic tract or within the eye¬
ball, and that on the absorption of the clot vision may be
partially restored.
The recollection of the existence of this lesion should
make the surgeon careful of his prognosis when the retina
is obscured by extravasation into the eyeball, because
he may find if he succeed in removing the effused blood
that the patient is permanently blind.
I have lately had a patient under my care who was
struck partly amaurotic from a blow of a snowball on the
forehead, but, as I have said, his retinae present no lesion,
and his symptoms of general paralysis point to the cere¬
brum as the seat of the injury.
Injuries within the Orbit .—It is only in the case of
injuries within the orbit itself that the locality gives
a special character to the accident Proportionately
as the external defences of the orbit are strong, so
is its internal construction frail and liable to dan¬
gerous injury. The eyeball is so unyielding in itself,
so mobile, and so much smaller than the cavity in which
it is lodged, that a sharp instrument, such as the point of &
stick or umbrella, is almost certain to glance off it, leaving
it uninjured, and to pass deep into the orbit, where it
meets only with structures or great fragility protecting
the nervous centres and the oeular appendages. Inter¬
nally the lachrymal sac is divided from the orbit only by
the os unguis. Above, the anterior lobes of the brain, are
only protected by a thin expanse of the frontal bone, while
above and externally is tbe lachrymal gland. It is easy
to anticipate the result of violence from a penetrating
object. So well understood was the weakness of this
position, that in the day when the duel with small swords
was common, fencers who wished to kill their adversary
made the orbit their aim.
I need hardly recall to your minds a recent melancholy
illustration of this fact which occurred in the person of
one of your fellow students. This poor young man had
received a violent thrust of a stick or umbrella in the
orbit, and had suffered the following fatal lesions
On post-mortem examination, the wound on the head
was found simply to be one of the scalp, but that in front
under the eye showed the severe nature of the injury
which caused death. The instrument, which must have
been almost a blunt one, (and which afterwards was
shown to have been an umorellaj, penetrated under the
eyeball, entered the inner side of the orbit, broke through
tne ethnoid and sphenoid portions of tne cavity, and
entered the floor of the skull. Opening the side of the
cavernous sinus, and penetrating into the brain fully one
inch or more deep, the upper and inner part of the orbit
were completely broken up, and the unaer part of the left
anterior lobe oi the brain was ploughed up oy the instru¬
ment in its course ; there was a good deal, but not a very
excessive amount of dot about the wound internally.
The course and direction of the wound indicated what is
hoped and supposed to be its fortuitous infliction, by the
point of an umbrella used in tbe excitement of the
moment; tbe anatomical formation of tbe parts, and the
comparatively delicate structure of the bony walls, will
easily explain how a very moderate amount of force
would penetrate and cause the extensive and hopeless
injuries inflicted in this instance, cutting off in the fall
promise of manhood and vigour one of the finest young
men we have 6een f whose amiable character had attached
to him so many friends and fellow students.
Even if the brain be not injured we see the nsoal con¬
sequences of penetrating wounds elsewhere—extravasa¬
tion of blood, suppuration or necrosis, with the complies^
turns of coma, convulsions, and strabismus, conse qu ent
on the vicinity of the great nervous centre.
It should be specially observed that even a fotal
injury in this position may take place with very slight
external lesion, and the prognosis of such cases should
therefore be cautiously made. A careful search matt be
made for any missile or foreign body which might be
broken off and remain in the wound, for if such be
detected, it must be removed at once, before swelling sets
in, if possible without destroying the eyeball, but if
necessary even at the sacrifice of the eye. I sha ll show
presently that the eye may be displaced to a mat extent
from its normal position without permanent injury-to its
usualness, so that every (attempt should be made hy
Digitized by v^ooQle
ORIGINAL COMMUNICATIONS.
B«Maber$^lM8. ($3
pushing it on one aide to find the foreign body before
excising the eyeball. In the cases recorded of sticks and
other objects Breaking short in the orbit, they have been
found frequently so firmly fixed as to require great force
to dislodge them. If the foreign body be small, such as
grains of shot, the surgeon will, of course, not sacrifice
tne eye to the necessity for their extraction, as they may
become encysted, or may pass away after more or less
suppuration, taking often the openings of the spheno¬
maxillary fissure or maxillary sinus and being discWged
into the fauces.
A case is related by Horstius of a man who discharged
through the nostril an iron arrow-point which had been
retained in the orbit for thirty years.
A penetration of the fronial or ethnoidal cells is often
attended by emphysematous swelling of the lids, caused
by the patient in attempting to blow his nose forcing the
air into the neighboaring cellular tissues.
Treatment .—The treatment of penetrating wounds,
fractures, and such like injuries will at once suggest itself
and is comprised in perfect quietude, low diet, gentle
aperients, evaporating lotions, cataplasms whenever appli¬
cable, and washing out the cavity, if there be one, with
the syringe.
Caries and necrosis of the bones are frequently caused
by blows upon the edge of the orbit, especially in
syphilitic and strumous patients, and are attended with
similar symptoms and results as present themselves when
these affections arise spontaneously.
Fio. 1.
In the majority of cases if the eye itself be not injured
there is no loss of vision. If, however, a large body be
lodged behind it, or if extensive infiltration of senim or
deposition, of pus take place, it may be protruded or
even dislocated forwards. This displacement of the
entire eyeball, which is illustrated m Fig. 1» copied
from Mr. Haynes “Walton's valuable treatise, is very rare,
and arises when the eye is forced forwards until its
equator passes beyond the palpebral opening, and when
the orbicularis muscle ana elastic structures close in
behind it. Dr. Jameson communicated in 1853 such a
case to the Surgical Society of Ireland, and I have my--
aelf seen the accident occur in the attempt to examine the
posterior part of the eye when it was permanently ex¬
truded by a tumour. The tension of the optic nerve
usually renders the eye for the time totally blind, but
on its replacement vision is immediately restored. The
reduction is effected by insinuating the thumb nail of
one hand, or, if that be impossible, a curette, under the
upper lid, and pressing the eye back by the other thumb
placed against the cornea; but if this manoeuvre should
Uil the outer canthus must be divided.
ON THE DISMEMBERMENT OF PHARMACY
FROM MEDICINE.
By M. Donovan, M.R.I.A.,
And Member of the Philadelphia College of Pharmacy.
ORIGIN OF PHARMACEUTICAL CHEMISTS.
In many of the former numbers of the Medical Peers
I have given sketches of the lives and practices of the
chemists, or rather alchemists, of times long past, many of
whom were either impostors or dupes of designing empirics.
Yet their labours were productive of results which, in a
succeeding age, were rendered useful to the world by men
who, deriding the absurd pretensions of their predecessors,
turned their discoveries to good account Then appeared
the pharmaceutical chemists, of whose origin and progress
I have only been able to collect a few scattered notices, so
little of their history has been recorded, and so deficient is
that little of incident or interest; the important part is
within the memory of the present age.
The learned Dr. James, the inventor, or rather the im¬
prover, of the powder which bears his name, about the
middle of the eighteenth centuiy, gives the following ac¬
count of the origin of the pharmaceutical chemists, for¬
getful of the benefits conferred by them on society; but
says nothing to the disparagement of quacks, of which class
he himself was an egregious example. “ I cannot dismiss
this subject (says the doctor) without taking notice of the
chymist—a word produced within this last half-century in
the too rank soil of pharmacy, for want of due cultivation.
For if the apothecaries had, in pursuance of their duty,
taken care to prepare their own chymical remedies, this
trade would never have been established as a distinct
branch, nor would occasion have been given for the infinite
frauds which are now daily practised.”—f Dispensatory.}
Amongst the first who paid attention to pharmaceutical
chemistry was the illustnpns Conrad Gesner, an eminent
physician, philosopher, and philologist, born at Zurich in
1516. Amongst the surprising diversity of his pursuits,
he found opportunity to devise many new chemical pro¬
cesses, and amongst his numerous works we find a treatise
on distillation. Boerhaave considered him a prodigy of
learning ; and from the universality of his knowledge in
natural history he was styled the “ German Pliny.” He
died of the plague in 1645, in the forty-ninth year of his
useful life.
About this time many practical pharmaceutical chemists
were to be found in England, whose province it was to
make metallic medicinal preparations, and to distil quin¬
tessences and waters. George Baker, a London surgeon in
1576, says :—“ I do know some excellent chemists, as one
Mayster Kemmech, dwelling in Lothburie; another^
Mayater Geoffrey, in the Crouched Friers, men of singular
knowledge in that way ; another, named John Hester, the
which is a paynfull traveyler in those matters, as I by
proofs have seen, and used of their medicines to the fur¬
therance of my pacients’ healthes, and also one Thomas
Hill.”
1 John Rudolphus Glauber, a celebrated German philoeor
phical chemist, bom in the beginning of the seventeenth
century, travelled much, as he informs us, in search of
knowleoge, and during his intercourse with the world
seems to have acquired a hearty contempt for the generality
of men, as is evmced by the continual ebullition of his
misanthropic feelings throughout his works. He says :~7
“ Because I have never aspired after vain riches and honours
I might well be persuaded to leave my labours to others
not yet hating the world yet he wrote his book “ for the
benefit of those who by war are reduced to poverty;” ana
as a reason for publishing such vast secrets, as he conceived
his book to contain, he says that the burden of them is
too much for him alone to endure. He denies that the
philosophers’ stone has the power of converting the baser
OK&aU .into gold, But believes that it possesses the muph
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HOSPITAL REPORTS.
ttai.
524 Hu Ucdlttl tqm sad Offals*.
more T&taable property of curing “all distempers without
distinction.” He imagined that he had discovered an
antimonial preparation which may be deservedly called an
“ universal medicine,” so effectual is it in almost all dis¬
eases.
Glanber was an enterprising and indefatigable chemist;
he was the inventor of several furnaces and other kinds of
apparatus, as well as of many useful processes. That
which has made him more generally known is his method
of making muriatic acid, ana the salt which bears his name.
Up to his time muriatic acid was the most costly of all the
acids, being obtained by the tedious process of distilling a
mixture of common salt and potters' clay; to distil one
pound of the acid occupied twenty or thirty hours, and
consumed from 50 to 100 pounds of clay. He recommends
this acid for a variety of domestic purposes : mixed with
sugar it forms, in his opinion, an excellent sauce for roast
meat; it makes meats delightfully acid, such as chickens,
S igeons, and veal; beef macerated in it becomes in a few
ays tender, if previously tough; it preserves fruits for
years, and makes raisins swell out to their original bulk as
grapes. He recommends his sauce particularly to be used
with an old hen, which, he says, is thus rendered as tender
as a chicken. (See his book, translated in 1652.)
The chemists of London very soon began to open shops
like apothecaries, and to prepare those articles requiring
fire and peculiar apparatus, or which the apothecaries had
hitherto the sole manufacture. The chemists therefore
named themselves “ philosophers by fire and in several
attacks made on them defended themselves with spirit and
intelligence. William Salmon was one of these ; he speaks
of chemists’ shops in 1685, his own being “ at the blew bal¬
cony by the ditch near Holbom Bridge. His prices were
certainly such as to return tolerable profit: for stomach tinc¬
ture he chaiged 2s. 6d. per ounce ; for tincture of iron the
same ; for sweet spirit of nitre and spirit of hartshorn the
same; oil of turpentine, 6d. per ounce ; Glauber's salt, 6s.
per ounce; calomel, 2s. per ounce ; laudanum (some pe¬
culiar kind of his own), 16s. per ounce. These were the
halcyon days of chemists' profit
But the chemists did not confine themselves to encroach¬
ments on the apothecaries, but soon tried how far physi¬
cians would bear an experiment They defended them¬
selves by affecting to believe that, as chemistry was not
known in England when the Charter was granted to phy¬
sicians by King Henry VHL, it is impossible that its '
prohibitions could have been directed against chemists;
and they asked how should medicines be improved if the
inventors of improvements may not use them for the benefit
of the sick, and the doctors will not prescribe them because
they are out of the beaten track. Nathaniel Mery was
one of those chemists in 1683, and their apologist; he
says, in his published “ Plea for the Chemists,” that the
College had prosecuted him for curing diseases which they
could not They had already prosecuted others and failed.
A pamphlet “ On the Usefulness of Dispensaries,” pub¬
lished in 1702, says :—“ Chymists, distillers, astrologers,
midwives, fee., have each their share of the practice of
physic.” Nay, they even made an attempt about this time
to obtain an Incorporation Charter, and a privilege of ex-;
hibiting secret medicines of their own invention, but failed, i
The competition of the chemists soon afforded medicines !
to the public at a much more reasonable rate than the
apothecaries had been in the habit of charging. The
pamphlet called “ Calamities of the English in Sickness,
&c., 1707, says that the chymists charge out a shilling an
ounce for spirits and tinctures, which apothecaries would
mix and sell at five pounds.
“ A Complete Course of Chymistry, containing not only
the best Chymical Medicines, but a variety of useful Obser¬
vations,” was published in 1709 by George Wilson, Chy-
xnist, who, as he boasts, had been in business for half a
century. He kept a chemical laboratory in Watling street
in 1686, and published a folio sheet of advertisements con¬
taining the prices of all chemical medicines. He invented
what he called his 41 tincture antixbeumatica,” and defended
himself for concealing its preparation. He says that
modern physicians use chemical remedies, and their use is
increasing. He describes “ elixir cranii hnmani” and its
preparation thus : put six pounds of hnman skulls, grossly
powdered, into a retort ; lute it, and distil in an open
furnace ; a salt, spirit, and oil come over; dissolve them
after rectification in spirit of wine along with two ounces
of moss of human skulls. This invaluable remedy is good
against convulsions and hysterics ; the dose is from five to
one hundred drops.
From the same eminent authority we learn that hog-lice
are good in jaundice, stone, and other complaints ; and
that tincture of ants creates courage, and excites the
animal appetite.
This moss of hnman skulls, once in great repute, was
called usnea. The celebrated Robert Hoyle informs us
that being attacked with a violent bleeding of the nose,
which had resisted every remedy, he tried the true mom
of a dead man’s skull, which had been sent as a present
from Ireland ; by merely holding it in his hand the bleed¬
ing speedily stopped. Where ana how Mr. George Wilson
procured two ounces of this moss it is hard to conceive.
Other writers inform us that no usnea can be relied on hut
that obtained from the skull of a man executed for murder.
About the commencement of the eighteenth century the
apothecaries, in order to make good their losses by the en¬
croachments of the chemist, began to invade the trade of
the druggist, which was then merely the sale of simples.
The druggists, determined not to submit without retalia¬
tion, immediately commenced the selling of compound
medicines. The apothecaries were so busy in their own
encroachments on the provinces of the physician, surgeon,
and druggist, that they forgot their own proper businem;
and a pamphlet called “ Present State of the Practice of
Physic” (1702), informs us that, amongst the apothecaries
“ it is one in twenty that knows anything of chemistry.”
The pharmaceutical chemists of England, from small be¬
ginnings and humble pretensions, have attained to a high
position in the healing art. In their splendid establish¬
ments is to be found all that research has supplied, or
fancy imagined, for relief of suffering humanity, suffieieut
to satisfy the prurient desire of novelty, for which the
present age is so remarkable.
DROPSY AN® ITS PATHOLOGY.
Under the care of £. P. SHi&KXT, M.B. Dub.,
L.R.O.S. Edin., &c.
Continued from page 606.
December, 1865.
Bridget M., sot. sixty, has been for a considerable tuns
affected with ascites, which had been preceded by consti¬
pation and tympanitic distension. The constipation still
continues. There is no enlargement of the liver perceptible,
but an inward soreness is constantly complain*! of, refer¬
able principally to the epigastrium. The medicines triad
in this case were acet kali in mixture, in coz^junction wife
pills containing powdered squill., piL hyd. & gr:, and digi-
taUne granul. j. (gr. 1-50), together with the use of pOls of
comp, coloc. mass, and res. podphylL, as a purgative to re¬
lieve the constipation. On the 86ih, the accumulation of
fluid was so distressing that paracentesis was performed, fee
operation being followed by diarrhoea for two days. A
diuretic, containing tinct. scillae was substituted for feat
with acet kali on this account The fluid aorninnhferi
again, and between this date and 21st April, 1866, paza-
ceutesis was performed, at intervals of three or four weeks,
always at her own urgent request, in consequence of fee
distress experienced from the accumulated fluid, ebd ate
its evacuation the epigastric pain above referred to was felt
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The Medical Pro* and Circular.
TRANSACTIONS OF SOCIETIES.
December 23,1818. 525
more severely. After the last-mentioned date, the secretion
seemed to have been arrested, and the operation never was
necessary. The woman does the work of her house, carries
vessels of water on her head from a distance, comes to
market, a journey of three miles, and enjoys moderate
health. She was tapped above a dozen times. October,
27th, 1868. She enjoys average health. The question
naturally arising in connection with this case, but not easily
answered is, what was the pathological condition out of
which the ascites arose ? Ana to what was the arrest of the
fluid accumulation after the thirteenth tapping attributable ?
A man of very fine mould, and more than average mus¬
cular development and strength, aged thirty-five, had been
resembling ileus. ' He ascribes his present ailment to cold,
caught from exposure during violent perspiration. Symp¬
toms: Ascites, urine albuminous, sp. gr. *1025. As his
cabin presented few of the advantages desirable in the
treatment of any serious chronic disease, with the single
exception of healthy situation on elevated ground, I sent
him to the County Infirmary, where he remained for a few
weeks. While there he was attacked by apoplexy, as far
as could be made out from his description, having been, as
he alleged, “ insensible for many hours, and rescued from
death only by. blisters to the nape of his neck and other
active treatment whilst in the infirmary.” The fluid accu¬
mulated so as to require tapping, which was performed and
repeated there. He returned a few days ago. Present
state : Fluid evidently accumulating again. There is no
anasarca of face, limbs, or general cellular tissue. Urine
passed in normal quantity ; perspires freely sometimes,
u especially after tapping.” Sp. gr. of urine *1025. ft
calomel, pulv. scill., pulv. digitalis a gr. i. M. Fiat pilula
ter die suraenda.
To take pulv. jal. c. 3ij. occasionally for the relief of
constipation.
July 9th. —Fluid having again accumulated he was
tapped to-day, and 23 lbs. of fluid were drawn off.
The operation was repeated on the 17th, (22 lbs). The
urine has changed its character, no albumen being discover¬
able by heat or nitric acid, although it becomes distinctly
cloudy by corros. sublimate. Tapped again July 29th, to
amount of 23 lbs.
R Acet. kali, 3 iij.
Spt. junip. c., Jjss.
Spt. eth. nit., Jjs.
Aquae font. ad. $8. M.
Hujus misturae sumantur cochl. amp. ii. ter quotidie.
August 12 th. —Tapped (23 lbs.) On 20 th, a change of
the character of the urine is noted, viz., it had become red
and acid; specific gravity was *1030. Rep. M. Diuret.
September 2nd. —Tapped (18 lbs.) The same treatment
was continued, except that it was aided by the addition of
decoct, spartaci, and pot. bitart. He was tapped for the
last time, on the 12 tn, and died on 3rd January, 1868.
Here, I may observe, is a contrast to the preceding case,
and one which would not be anticipated—a Btrong young
man succumbing to disease seemingly not differing from
that from which, after the same number of operations, an
old woman had rallied and apparently recovered her health.
If asked to assign a reason, I must frankly confess my
ignorance. Most likely a post-mortem examination would
have revealed the cause.
J. B., male, set. thirty-six, habitually delicate in his
chest, three weeks ago. was attacked with bronchitic
symptoms, viz., oppression of breathing and cough, for
which he applied a blister, with the effect of promoting
expectoration and diminishing the oppression. He has
been always very susceptible of cold, which brings on
cough, but in these intervals between the attacks has enjoyed
moderate health. Has not at present any dyspnoea, palpi¬
tation, or distress, but his lower limbs have become ana-
sarcous, and his urine is highly albuminous. A mixture
containing ipecacuanha, antim. tart., and sp. eth. nitroai,
was prescribed, together with pills containing mass. pil.
hydrarg., p. scill. a gr. i. and digitaline, gr. 1-50.
June 2 8th .—Stomach much affected by mixture; swelling
is increasing. R Strychni® gr. L, mic. panis q. s., fiat
massa in pil. xx., sum. i. ter die ; sum. quoaue spt. eth.
nitros 3j., h. somni; imperial drink. On the 6 th, the
urine was tested, and found to be albuminous; specific
gravity, *1025.
U Acet. kali 3iij.,
Spt. junip. c. gjs 8 .
Eth. nit. Jjs.
Tinct. 6 cill. 3is#.
Aqu® 38 .
The distress caused by the accumulation of fluid was so
great that I scarified the legs and insteps, A great amount
of fluid was discharged with great relief, and diminution
in size of body and limbs ; the operation was repeated on
July 12 th, 17th, and 20 th, on account of the former cuts
closing and consequent recurrence of his distress. The
report on the 19th August was,—“serum has continued
to run from the scarifications, and he is free from ana¬
sarca ; is not taking any medicine except occasional
aperient 8 .’ , On Feb. 7 th, 1868, I noted as follows:
—“ The scarifications have all healed ; there is no ap-
earance of anasarca, except slight pitting on pressure of
is legs, but his urine is highly albuminous. He has a
comparatively healthy appearance.”
Presuming, however, too much on this improvement,
he exposed himself by working in his garden, and driving
a couple of miles into town in a common cart; he thus
brought on an acute attack, accompanied by sudden infil¬
tration of all the tissues. When I saw him he laboured
under orthopncea and subcoma, showing pressure on the
brain commencing. He died on 31st March, 1868.
This case is interesting, as showing how far a palliative
measure can go in amending health and rendering life
bearable. He presented a curious phenomenon for several
months ; like a leaky vessel, wherever he sat, stood, or
moved about his cabin, even when standing before his
glass, to Bhave, he had pools of fluid under him, and was
obliged to have tubs under his feet, otherwise, to use his
own expression, “ his floor would have been flooded; ”
and yet when this leakage gradually dried up he presented
a moderately healthy appearance, and comparatively en¬
joyed life, and would in all probability have done so for
a longer period had he been in a rank allowing of more
caution, care, and suitable diet.
fensarfaa xrf $arkties$.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
Tuesday, Nov. 24th, 1868.
Mb. Samuel Solly, F.R.S., President.
Dr. Althaus read a paper on
CERTAIN rOINTS IN THE PHYSIOLOGY AND PATHOLOGY OP
THE FIFTH PAIR OF CEREBRAL NERVES.
He said that the only two pairs of nerves the function of
which was not yet accurately determined were the pneumo-
gastric and the fifth, both of which were endowed with far
more complex functions than the rest of their fellows, and
were also less subject to disease, without simultaneous lesions
of important neighbouring organs. We had been obliged,
with respect to them, to trust to one of the two sources of
our knowledge as regards nervous function—namely, the re¬
sults of vivisections in animals ; while the corrective influence
of pathological observations had been wanting. He gave his
reasons for considering the evidence derived from pathological
cases, occurring in otherwise healthy adults, superior to that
merely deduced from vivisections, and related the details of a
very curious case of total loss of function of the whole fifth
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M6 The Hedies! Pre* snd Circular.
TRANSACTIONS OP SOCIETIES.
Daeeaiher It, 1M&,
pair, unaccompanied by any other affection of cerebral or
nerrcras matter, and which could be looked upon, in a certain
sense, as a complete physiological dissection of the fifth
nerve. The case occurred in an otherwise healthy Australian
sheep-farmer, and was due to exposure to cold. There were
at first symptoms of inflammation, and afterwards compres¬
sion and atrophy of the nerve. The case came under the
author’s care about two years after the commencement of the
affection. There was then total loss of muscular sensibility
about the face, and a peculiar expression of the features in
consequence of it. Vision was obstructed by leucoma of both
corner; yet the patient suffered much from photophobia,
although very little light could penetrate to the retina. An
ophthalmoscopic examination or the fundus oculi showed the
optic disk, as far as it could be seen, quite normal. The com¬
mon sensation of the face and scalp was entirely lost in both
sides. The sense of temperature was completely absent, and
the senses of touch and locality^were also lost. The conjunc¬
tiva was anaesthetic, the secretion of tears arrested, but there
was pathological hypersecretion of conjunctival mucus. The
mucous membrane of the noeo was quite insensible, and its
secretion much augmented. The sense of smell was in no way
impaired. The mucous membrane of the mouth, including
the tongue, was also anaesthetic. The secretion of saliva was
arrested, but the flow of buccal mucus increased. The tongue
had been severely bitten, as the patient was not at all aware
of biting it whenever he did so. The sense of taste was pre¬
served. The muscles of mastication were paralysed ; and the
patient complained of a rushing noise in the head, which was
probably due to paralysis of the tensor tympani muscle,
which is animated by the minor portion of the fifth nerve.
The sense of hearing was normal, and there were no other
morbid symptoms. The author, therefore, concluded that
the pathological lesion was confined to the course of the fifth
nerve between the pons Varolii and the Gasserian ganglion.
It could not be more peripheral, because not a single fibre of
the trifacial nerve had escaped the injury ; and it could not
be more centra], because there was no symptom of disease of
the pons. The treatment consisted in the systematic applica¬
tion of the continuous galvanic current. No medicine was
given. After three months’ treatment the patient was con¬
siderably improved in every respect, and his sight so much
better that he could again guide himself in the streets, and
follow a light occupation.
Dr. Alihans concluded by remarking, 1st As to tbe re¬
searches of Mageadie and Claude Bernard, who had endea¬
voured to prove that the olfactory was not the only nerve of
smell, but that the fifth had a great deal if not everything to
do with it the author considered his case to prove the con¬
trary. 2nd. Photophobia in this case had evidently little or
notning to do with the condition of the optic nerve or the
retina, but was a neurosis of the corneal branches of the fifth
nerve, and cured by galvanisation. 3rd. The question
whether the sense of taste was dependent upon the glosso¬
pharyngeal nerve, or upon the lingual branch of the fifth, was
one about which the greatest discrepancy existed amongst the
best observers. The author thought his case proved that,
although the special sensation of taste was due to the glosso¬
pharyngeal, yet the quickness of its perception was, in the
anterior part of the tongue, materially enhanced by a normal
condition of the fifth pair. 4th. The special kind of nervous
influence by which the secretion of the mucous membranes of
the eyes, nose, and month was ex cited, and by which it was
regulated, had hitherto not been investigated. Ludwig had
shown, with regard to salivary secretion, that branches of the
fifth were the exciting, and sympathetic fibres the inhibitory
nerves. The author thought his case proved that just the
reverse obtained as far as the secretion of conjunctival, nasal
and buooal muons was concerned ; and that for this latter
function the sympathetic was exciting, and the trifacial in¬
hibitory. 6th. The pathology of tinnitus annum was obscure.
The author believed it to be, if not always, at least frequently,
a symptom of neurosis of the fifth nerve. 6th. The present
case seemed to settle the question as to the precise way in
which the continuous galvanic current acted on the nervous
centres. Dr. Aithaus had always thought that the galvanic
impression was reflected from the peripheral branches of the
fifth to the base of the brain. This was now proved to be
correct; for it appeared that when the reflex function of the
fifth pair was in abeyance, no cerebral symptoms could be
produoed by the application of a powerful current to the head
or fase, although the physical relations of the skull, brain,
and blood-vessels had not been altered. The transmission of
the continuous galvanic current to the brain was therefore
effected, not physically, but physiologically, by nervous
influence.
A discussion followed, in which the following Fellows took
part:—Messrs. Carter, Soelberg Wells, Savory, Charles
Moore, and Drs. Anstie, Broadbent, Bussell Reynolds, and
William Ogle.
--♦-
PATHOLOGICAL SOCIETY OF DUBLIN.
Saturday, Dkc. 5th.
Dr. Churchill, in the Chair.
Dr. Robert McDohnell brought under the notice of the
society a remarkable tumour, which he had removed from the
breast of a lady in October last: he also exhibited a drawing
representing its appearance when removed. It was supposed
to be of a malignant nature, and to the eye it presented all
the appearance of a malignant growth ; its large size, its dusky
appearance, and the ramification of large veins over its surface^
would at first sight warrant this conclusion. He found, how¬
ever, that, notwithstanding its size, it was exceedingly move-
able, that the glands in the axilla were not engaged, and that
the upper portion, which was figured in the drawing as fuller
than the rest, was a fluctuating cyst. The nipple was not re¬
tracted, and there had never been any discharge from it. The
appearance of the lady was good, she was sixty-four years of
age, but looked considerably younger. Taking all these cir¬
cumstances into consideration, Dr. McDonnell arrived at the
conclusion that the tumour was not of a malignant type.
Some time subsequently he punctured the cyst and drew off
about two ounces or a clear but viscous fluid which came slowly
through the troca. This fluid gave no traoe of albumen
either on the application of heat or nitric acid, bat gave a
copious deposit of mucin with acetic acid: on examining fur¬
ther he found that it was the contents of a mucous cyst as
distinguished from a serous cyst. His colleague, Mr. Colics,
having agreed with him that the tumour was non-malignant,
it was accordingly removed on the 26th October.
The integument was so very thin and no where adherent, it
was removed with the greatest facility. When the tumour
was dislodged from behind, he considered it to be worthy of
note, that only two vessels required to be secured by tortion ;
it weighed between 9 and 10 lbs. The drawing which was
taken at the time very well delineated its bulk and charac¬
teristic colour : they could also see the large cyst laid open.
From this the internal structure of the tumour was broken
down, and the lower part only presented the original normal
structure as it existed two years ago. At tbe commencement of
its growth about a year ago, the patient received a blow upon
it, since when it underwent a rapid growth, and it is probable
that it is during this time that the internal structure nas thus
broken down.
The most interesting point in the pathology of this tumour
Dr. McDonnell remarked was, its microscopic appearance, the
original portion being composed of “ the spindle-shaped cells
of Virchow,” which so closely resemble the structure of con¬
nective tissue cells.
The tumour no doubt belonged to the class ot tumours
which had been called cystic sarcoma by Sir Astley Cooper
and sero-cystic sarcoma by Sir Benjamin Brodie, and
now-a-days known as myxoma. The mucus which filled
the cyst and the cells resembled that found in the vicinity of
the submammary structure, and it was probable that the
primary origin of the complaint was disease of the mucous
tubes of the mammary gland. In this case the mammary
gland was entirely gone. It was possible that this large cyst
was origiually one of the tubes of tbe mammary gland. It had
in it a fluid which was essentially different from that found in
serocysts, this being a mucocyst.
With regard to the diagnosis of this case, the points to be
considered were the mov&bility of the tumour, the non-retrsc-
tion of the nipple, the mobility of the integument, the health
of the patient, and the small amount of vascularity compared
to the bulk of the tumour. These proofs of its non-malignant
nature had been confirmed by the microscope, so as to leave no
doubt that this tumour, notwithstanding its malignant look,
really belonged to the class of benign tumours.
Dr. Bennett exhibited a specimen taken from the body of a
man admitted under his care to 8ir Patrick Dun’s hospital,
on the 9th September. This man had been oanght by the
handle of a broom working in a steam-engine, in the Dubliii
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LETERATUEE.
December SS, 1808. 527
gas-works; the handle was driven slowly, bnt forcibly, into bis
abdomen over the anterior superior spine of the ilium, making
a small oblique wound an inch and a half long, a simple linear
iucision without any ecehymosis or sign of bruising. The ab¬
dominal muscles were lacerated, and the resident pupil, who
saw the case before him (Dr. Bennett), was convinced he saw
the intestines protruding into the wound : the man suffered
intense agony. It was remarkable, however, that his pulse
was extremely good, which led him to conclude that there was
no injury of any of the great viscera of the abdomen. The
wound could be traced back along the transverse processes of
the lnmber vertebrae to the false ribs. There was at the time
of admission no paralysis, nor any indication of injury to the
spine, further than the fact that the wound could be traced to
the neighbourhood of the spine, and the intense pain which the
man suffered : this was relieved by opium ; greet reaction set
in. After a few days bad symptoms appeared; he had great
lever, furred tongue, rapid pulse, ana profuse suppuration
from the wound; within the next seven or eight days he be¬
came delirious and passed urine involuntarily ; still, if roused,
he could move in bed and had no signs of paralysis; he rallied
from this for a short time, but the case, nevertheless, ter¬
minated fatally on the 21st November.
During the first week of October he had repeated rigours,
and Dr. Bennett suspected from the profuseness of the dis¬
charge that some foreign body had been carried into the wound,
and a portion of his flannel vest, where the broom handle en¬
tered, was wanting. The man sank gradually from the profuse
discharge. On opening the cavity he found that the peri¬
toneum was not wounded; though the whole of the peritoneal
surface was discoloured from the quantity of purulent matter
outside it, there was no peritonitis. The ascending oolon,
where uncovered by peritoneal reflection, was adherent to the
abdominal walls, but there was no appearance of any injury
having happened to it. A great suppurating cavity existed
between the abdominal muscles back to the spine, communi¬
cating with the wound, and as soon as this was emptied he
fonna another flaaluating cavity in fiont of the transverse pro¬
cess of the lumbar vertebrae in the substance of the psoas
muscle ; between these cavities there was no communication.
There was a small abscess in the left psoas muscle communi¬
cating through the body of the third lumbar vertebra with
that on the nght side. On opening the abscess in the right
psoas muscle, he found a piece of dead bone ; his first impres¬
sion was that this was the result of caries following an iqjury
of the spine. On making a section, however, he Found that
the body of the third lumbar vertobra was broken into two pieces.
The anterior portion was detached and displaced slightly
upwards and forwards, while the posterior portion of the body
retained its relation to the arch of the vertebra. The two
abscesses communicated through this part, and the portion of
bone not dead was covered over with a lymph exudation.
Inside the theca vertebralis a small quantity of lymph was
fonnd amongst the nerves of the cauda equina. The absence of
any fracture of the vertebrae behind this line explained the
absence of paralytic symptoms. Dr. Bennett drew attention
to the mode of production of this injury, in which a direct
fractnre of the body of the vertebrae was produced without in¬
jury of the spinal canal, and without any wound of the abdo¬
minal cavity, by such an instrument os a broom handle which
went four and a half inches into the man’s body.
-■■ ■
^iterate.
Hebra on Diseases op the Skin, Vol. 2nd (Sydenham
Societies' Publications). London; H. K. Lewis, Gower
street
The name of an author, when well known and appreciated,
la a guarantee that his works deserve popularity, and if in addi¬
tion to a home circulation of his literary labours they should
fortunately attract the perusal of discriminating judge* in a
foreign land, and be considered worthy of translating and re¬
publishing, they must be assumed to possess unusual and
marked merit Professor Hebra has long been reoognised as
* diligent and successful observer in hiB special department.
Hia treatise is a text-book in Vienna, and its re-pubUcation by
the Sydenham Society commands for it admission into the
libraries of onr profession through the British empire. To
attempt reviewing such a work would be useless. Our readers’
time will be more profitably employed by directing their atten¬
tion to a few practical observations taken from its pages.
Professor Hebra, when describing the treatment of psoriasis,
properly objects to Mr. Hunt's “ summary method of pro¬
cedure ” in using arsenical preparations for skin diseases ; at
the same time he states—“ It is nevertheless quite true that
arsenic has a decided curative action in cases of psoriasis, and
can make this disease undergo involution for a time, if not per¬
manently.” And although the remedy may be taken for
months, or even years, without effecting a permanent cure, he
asserts he has “ never seen it give rise to any lasting injurious
effects, even when given in pretty large doses.” He prefers
employing Fowler’s or Pearson’s solutions, and recommends
the well-known Asiatic pill as a good formula to be tried for
long-continued use. Of Donovan’s solution he states :—“ I
have made trial of this preparation in various forms of
cutaneous disease, but I have never seen it produce any very
good results.”
Regarding attacks of psoriasis confined to the region of the
scalp, the following appears worth noting. Professor Hebra
asserts he has “ never failed to cure the complaint pretty,
quickly by having the part repeatedly washed with the spiritus
s&ponatus kalicus, without making use of any other remedy.”
Such gratifying results in the removal of a troublesome and
often tedious disease will no doubt lead to the adoption of this
1 practice. We hope it may prove as successful in Ireland as in
Vienna.
Our experience is altogether at variance with Hebra’s state¬
ments with reference to mercurial ecsema, and agrees with
that of Pearson and of Sir George Alley ; though fortunately
attacks of genuine mercurial eczema are now of rare occurrence,
still we have seen undoubted outbursts of eczema caused by
the internal administration of mercurials. We quote the pro¬
fessor’s opinion :—“ As far as my own experience goes I can
only admit the occurrence of hydrargyria from the local use of
mercury, and may assert with confidence that no affection of
the integument has ever been caused by the internal adminis¬
tration of any kind of mercurial drug.”
The employment of sulphur and sulphuretted baths for
attacks of eczema is still far too common. We fully coincide
with the following observations on this point :—
“ I am obliged to ascribe a very subordinate value to sul¬
phur in the treatment of even the most favourable cases of
this disease, while in many it is of no use at all, and in not a few
actually does harm.” “ This remedy is particularly mischie¬
vous in all acute forms of the disease, in E. rubrum or impetigi-
nosum with profuse secretion, and in all vesicular varieties.
It is no use st All in milder forms of E. squamosum or papu-
losum, some cases of which may get well undef sulphur, but
without any proof that it is by means of sulphur.” “ On the
whole, therefore, I would fain see sulphur expunged from the
list of medicines for eczema, without, at the same time, wish¬
ing to dispute its well-earned reputation in the treatment of
psoriasis, of prurigo, and of scabies.”
In all questions relating to the history of cutaneous disease,
the careful accuracy of the work deserves commendation. The
descriptions of the affections are given with laboured truth¬
fulness and minuteness. For his strong condemnation of the
absurd system of attributing different forms of eruption to sup¬
positious causes and fanciful diatheses, Professor Hebra
deserves the highest praise. The remarks on treatment are
always deserving of attention and respect, whilst we frankly
admit that in this, the great end of all practical medicine, we
cannot agree os fully with the statements of the learned pro¬
fessor as with the other portions of hit valuable publication.
- ♦-
#uiramtrg af Slim
[The Editor of this Summarv^wtshss it to be understood that he is
not responsible for the ideas, theories, or the correctness of statements
made in any of the papers quoted in the compilation.]
ON A NEW SERIES OF CHEMICAL REACTIONS
PRODUCED BY LIGHT.
(Specially Edited and Compiled for the Medical Press and Circular,)
By C. R. G. TICHBORNEj F.CJ9., F.R.Q.&I., etc.
Tyndall has been performing some experiments which
promise to be of great use in the hands of tne chemists.
He manipulates as follows A glass tube, 2.8 feet long
and 2.5 inches internal diameter, was supported horizon*
b 2
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528 The Medical Presl and Circular.
GLEANINGS.
December 34,18S*.
tally. At one end of it was placed an electric lamp. The
tube was closed by plates of rock salt, and subsequently by
plates of glass. This is called by him the experimental
tube. The experimental tube was connected with an air
pump, and also with a series of drying and other tubes, used
for the purification of the air.
A number of test tubes are then converted into Woxdfs
flasks by bent tubes, bo that when partially filled, the
liquid whose vapour was to be examined was introduced
into the path of the purified current of air. The experi¬
mental tube being exhausted, and the cock which cut off
the supply of punfied air cautiously turned on, the air en¬
tered the flask through the tube of the Woulfs bottles. It
then bubbled through the liquid and loaded itself with the
vapour, after which the mixed air and vapour, passing from
the flasks, entered the experimental tube, where they were
subjected to the action of the light. The power of the
electric beam to reveal the existence of anything within the
experimental tube, or the impurities of tne tube itself, is
extraordinary. When the experiment is made in a darkened
* room, a tube, which in ordinary daylight appears absolutely
dean, is often shown to be exceedingly filthy.
When the dectric light was passed through the vapour of
nitrite of amyle, curious clouds were observed to form near
the place of entry. For a moment the tube was optically
empty ; but before a second had elapsed, a shower of liquid
spherules was precipitated on the beam, thus generating a
cloud within tne tube. The doud became denser as the
light continued to act, showing at some places a vivid iri¬
descence. The doud, which shone with extraordinary
radiance under the dectric beam, was invisible in the ordi-
n ary light of the laboratory.
When dry oxygen or dry hydrogen was used as a vehicle,
the effect was always the same. This effect is not due,
therefore, to any interaction between the vapour of the
nitrite and its vehicle. Professor Tyndall says that the
molecule of nitrite of amyl is shaken asunder by certain
specific waves of the electric beam, forming nitric oxide and
other products, of which the nitrite of amyl is probably
one. The brown fumes of nitrous acid were seen to mingle
with the cloud within the experimental tube. The nitrate
of amyl being less volatile than the nitrite, could not main¬
tain itself in the condition of vapour, but was precipitated
in liouid spherules along the traoe of the beam.
A beam of solar light effects the decomposition of the
nitrite vapour in a similar manner.
When, previous to entering the experimental tube, the
beam was made to pass through red or yellow glasses, the
effect was greatly weakened, but not extinguished. A blue
glass augmented the precipitation. Hence the more refran¬
gible rays are the more chemically active in this case.
The odour of the liquid nitrite of amyl indicates that this
must be the case, it being distinctly yellow — in other
words, the yellow portion of the beam is most freely trans¬
mitted. It is not, however, the transmitted portion of a
beam which produces chemical action, but tne absorbed
portion. Blue, as the complementary colour to yellow, is
nere absorbed, and hence the more energetic action of the
blue ray. The special constituent of the beam, which pro¬
duces the decomposition, is shown to be arrested by the
liquid.
Iodide of Isopropyl was decomposed with the separation
of iodine.
Beautiful formed clouds were produood by operating on
moist Hydrochloric, Hydrobromic, and Hydroiodic acids,
which differed from the others. A family resemblance, how¬
ever, pervaded the nebuto of these three substances. It is
said that the phenomena of the electric discharge through
rarefied media oould not compete in point of beauty and
y mgtori ty with the appearances described in Professor
(To be continued.)
BABBITS AND SPARROWS IN AUSTRALIA
Ths shortsightedness of man on this side of the world has re¬
cently become unpleasantly very remarkable in connection
with one of his efforts at acclimatising English animals in this
country. The rabbit, which you are aware is not indigenous
to Australia, is now threatening to become a plague of almost
Egyptian magnitude in the distant and thinly populated
plains of the West. Only a year or two back not a rabbit was
to be seen here, save as a curiosity in a hutch ; but the wild
rabbit, most prolific of importations, has now so incr ea se d in
numbers in some parts of the country that they threaten to
starve the very sheep out of their runs. Hr. William
Robertson, a large landholder and squatter near Colac, has been
put to a cost of four or fivethousand pounds in the as yet abortive
effort to exterminate these now considered vermin, and he
estimates that it will cost him 10,0002. in wages to tri p pers
and killers before he will have achieved any marked suooem in
abating the nuisance. At the same time they are spreading
more or lees in all parts of the country, and I have seen them
scampering about even in gardens near Melbourne. As food
they greatly affect some of the most beautiful of our flowers,
—nothing, however, coming amiss to them, — and they are
therefore becoming the terror of horticulturists. Now that
the plague is on us in full force we can, of course, all very
easily account for what no one foresaw. Any equally prolific
animal, equally well circumstanced as to climate and feed, must
become equally numerous in any country as thinly populated
as ours. In England the wild rabbit meets with many des¬
troyers ; here there are very few. In England rabbit-kfliing
is sport; here it is generally work to be paid for. Dead rabbits
are daily hawked about the streets at fid. each, and the market
is always glutted.
The London sparrow is another importation against which
we should also take up arms—so abundant are these birds nowin
every direction — but for a common belief that he earns his
living by keeping down the caterpillars and noxious insects of
our fields ana gardens. Even he, however, has been M dis¬
puted on” in a paroxysm or two of a newspaper corre¬
spondence. One class of writers, led to the assault by a wrath¬
ful Presbyterian clergyman, sentences the sparrow without
benefit of clergy as a wholesale thief and glutton of every
kind of fruit, sad denies that he has any sufficently re¬
deeming merits as an insect destroyer. It must oer-
tainly be admitted by the London sparrow’s best friends —of
whom I profess myself one—that in his moral qualities of impu¬
dence and shrewdness he does not degenerate in this climate.
He is equally at home among the fowls in your farmyard—
astonishing some grave old hen by withdrawing a choice monel
from under her very beak—or in making a raid on your vine¬
yard or cherry trees just as the fruit is ripening, of which
f rocess he always keeps himself well informed by experiment.
have, notwithstanding, such a sneaking kindness for this
humorously audacious little vagabond—we have been so long
acquainted, and seem to have emigrated together—that I have
long since tacitly admitted him into partnership (not a sleeping
one) in all the fruit of my own garden, being quite unable,
even if I were willing, to shake off his attentions. Not by
the majority, however, is the sparrow equally respected ; and
it is not more oertain that the cherry season will come round
again in a month or two than that the Presbyterian clergyman
and his party will come round with it —Mdbourni Corrapomdtnt
of Time*,
Groundless Charge against a Mxdical Omen.— A
special meeting of the Roadford Dispensary Committee, in the
Ennistymon Union, was held to investigate a charge ef neglect
of duty brought against the Medical Officer, Dr. Willism
Ryan, by the Rev. Mr. Morris, Roman Catholic curate. CoL
M’Namara, Capt. Armstrong, Mr. Lucas, and several other
members were present After a long investigation, ths com¬
mittee came to the unanimous oonclusion that there was no
neglect of duty on the part of Dr. Ryan, who was at all times
a most attentive officer in the discharge of hie duties. His
public acknowledgment of the zeal and attention of Dr. Ryan
to the poor of the district is moat gratifying, while at the same
time it shows the utter groundlessness of such a charge, and
gives reason to suppose there was some other object for fcwapy
it than pure love for the poor.— Ncnagh Guardian.
By telegrams of yesterday’s date we learn that France, ss
one of the countries represented at the Conference of Geneva
on the subject of the care of the wounded in war, has mani¬
fested a desire that a further extension should be given to ths
proposed neutralisation of the ships set apart for the hospital
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December 26, 1868.
GLEANINGS IN TOXICOLOGY.
Th» IMictl Fmm tad Circular. 529
GLEANINGS IN TOXICOLOGY.
No. XL
ON POISONING BY COLOCYNTH.
By Charles Meyiiott Tidy, M.B., M.S.
Joint Lecturer on Chemistry at the London Hospital.
Mrs. P., a young married woman, had all her life en¬
joyed fair health. She had, however, suffered from a
slight cold, and had passed nearly a fortnight over her
usual monthly period. Talking with her landlady and
another friend, she asked them what was a good thing to
take, upon which her friend remarked she had heard
u bitter apple * recommended. This was on the afternoon
of the 5th of November. She took threepence out of her
pocket, and asked her friend to purchase some for her,
which she did]at a neighbouring chemist’s. She brought
it home and gave it deceased. When she took the drug
it is impossible to say, as there was no evidence on this
point She was seized, however, early the following day
with violent purging and vomiting, which never ceased
until her death, which took place on the 7th of November.
Dr. Godfrey made an examination of the body, and
reports that all the viscera were healthy. The uterus
with its appendages, and the stomach and its contents,
were forwarded to me for examination.
The uterus was unimpregnated, and seemed to me
slightly congested. The stomach was prefer naturally
pale, and contained about 16 oz. of a light, yellow fluid,
which smelt of digesting matter, and had a slightly acid
reaction. I allowed the sediment to collect, and then
examined it under the microscope, but was unable to
detect any substance having the structure of colocynth.
I then endeavoured to extract the bitter principle with
alcohol, but was again unsuccessful.
Colocynth is imported in the form of a dried fruit, but
is usually sold as a powder, having a yellowish white
colour. Three pennyworth is a somewhat vague quantity,
but 1 found that somewhere between two or three
drachms is usually sold for that sum. The chemist of
whom this sample was bought said at the inquest that he
never gave more than a drachm for threepence.
Upon experiment I found that one grain of colocynth
was the smallest possible quantity that could be de¬
tected in 10 oz. of a liquid made up of coffee, &c. Three
drachms and a-half was, I found further, the smallest
quantity that would prove fatal to a dog, in one case in
eighteen hours, in a second in twenty-two, in a third in
thirty-six hours; but its action is so uncertain, on account
of the excessive vomiting that occurs, that frequently
animals will recover after having taken a very much
larger dose. Orfila relates the case of a man who reco¬
vered after having token 3 oz. of the powdered colocynth
for a gonorrhoea—and Christison the case of a woman who
died in twenty-four hours after swallowring a teaspoonful
and a half. Clearly then the action of colocynth is very
uncertain, and so also is its detection after death ; 1
found it in eveiy case in the evacuations, but only in the
stomach provided death occurred within twenty-four
hours.
The symptoms in animals come on after a short time,
somewhere between one and three hours. Vomiting
generally occurs first, and diarrhoea follows rapidly upon
it, a considerable quantity of blood being invariably
evacuated. There is evidently, in most cases, severe pain,
and the pupils were in all cases contracted. I have
occasionally noticed giddiness and extreme languor, but in
no case convulsions.
The post-mortem appearances are variable in the extreme.
As a rule, the stomach and duodenum are highly con¬
gested, ana large ulcers are occasionally met with in the
stomach. But in other cases, the appearances are pre¬
cisely the reverse of this, the stomach and intestines
being paler than usual, with this exception, that the
rectum was in every instance considerably inflamed.
Occasionally traces of inflammatory action are to be found
in the bladder and kidneys. I have not noted anything
abnormal in the other viscera.
I do not regard, therefore, failing to find the poison in
this case as proof that death did not result from it,
inasmuch as forty hours must at least have elapsed
between the time she took the poison and death. Indeed,
on the contrary, the vomiting and violent purging, the
bloody stools, as noticed by Dr. Godfrey, the pale stomach
which I have referred to as not unusual; the previous
good health of the woman, the certain evidence the drug
had been bought, and she herself ascribing her illness to
having taken it, leave no question in my mind that the
cause of death was from the colocynth. And from all I
can gather, it is the smallest quantity on record that has
produced a fatal result.
On Poisoning by Opium .—In consequence of the facility
with which opium in one form or another can be obtained,
it is not surprising that more cases of poisoning occur with
this drug than with any other. It seldom happens, how¬
ever, that it is given in order to commit murder, as nearly
all the cases are suicidal^ except in some few instances
where it has been administered to induce stupor, in order
to facilitate the commission of other offences.
The two following cases that have occurred in my prac¬
tice within the last few months present several points of
very great interest to the medical jurist
A young man, J. E. H., aged twenty-eight, living in the
country, had led a somewhat irregular life, and suffered
from time to time with fits of melancholy. One night he
retired to rest somewhat earlier than usual, his relatives
remarking that he seemed brighter and better than he had
for some time past In the morning, not appearing at
breakfast at the usual hour he was accustomed, his friends
went up-stairs to call him, and were alarmed at finding him
in a perfectly comatose state. A medical man was sent for,
and, (quoting his words in a letter he addressed to me,)
“he seemed in a deep sleep, with a warm skin and frequent
pulse, with contracted pupils, the reflex functions being
active.” He succeeded in rousing him slightly, when he
said he had taken laudanum. Of this, however, there
was not a doubt, for there was a recently emptied bottle
on the table labelled “laudanum,” and by its side a
tumbler from which he had evidently drunk it. Every
means to recover him was of course .tried, but he died at
10 p.m. It is difficult to say precisely the interval of
time that had elapsed between death and the taking the
drug, but it must have been somewhere between fourteen
and twenty-four hours.
The following day, by the coroner’s orders, I had the
stomach and its contents sent me. I was unable to detect
any smell of opium : I examined the stomach and it
seemed healthy. I then made an analysis of one half of
the stomach for morphia and meconic acid, but could not
detect the slightest trace of either. I then retraced my
steps, and repeated the whole of the experiments on the
remaining half, but again was entirely unsuccessful. I
need scarcely add that I examined it systematically as I
always do, for both mineral and organic poisons, but with
negative results.
The second case I wish to refer to was one that excited
a great amount of public interest from the mystery that
seemed to surround it.
A policeman, whilst on his rounds early one morning
in the neighbourhood of Hackney Wick, discovered the
body of a man in the cupboard oi an unfinished house.
At the inquest it was proved to be a man who had escaped
some four months previously from a lunatic asylum at
no very great distance from the spot where he was found.
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030 The Medioal Press and Circular.
GLEANINGS IN TOXICOLOGY.
December tS, 19A
At the request of Mr. Humphreys, Mr. Gant, of the
Royal Free Hospital, made a post-mortem examination of
the body, and although it was in a somewhat advanced
state oi decomposition, he was unable to detect, in his
opinion, sufficient cause for death. The stomach was then
forwarded to me, by the coroner’s orders, for chemical
examination, as well as a bottle found by the side of the
deceased, labelled “ Laudanum, Poison.” The bottle
was perfectly dry, and merely had adhering to its side a
small quantity of a brown deposit, an appearance not un-
frequently seen on bottles in which laudanum has been
kept. This deposit I tested, and found to be opium. The
stomach was dried up, and it was impossible, owing to
its semi-decomposed state, to make out any peculiar post -
mortem appearances. It merely seemed covered inter¬
nally with a brownish red matter. One half I submitted
to analysis, and detected morphia in considerable quantity,
as well as a trace of meconic acid. These results 1 after¬
wards showed Dr. Letheby with the other half, and he
confirmed my analysis.
These two cases may be regarded as typical cases of
opium-poisoning. In the one, although it is a moral
certainty that death resulted from the action of opium,
the man confesses he has taken it^-by his side is the
empty bottle, and the glass from which he drank the
laudanum iB on the table—and yet chemical analysis
entirely fails to detect it. In the other, although a long
period has elapsed since death, there is no difficulty in its
detection.
And now the question naturally suggests itself, Why
in one case is its discovery so easy and so certain, and in
a second so difficult, indeed I may venture to add, im¬
possible ? There is but little doubt that the true expla¬
nation depends on the length of time that has elapsed
between death and the exhibition of the poison. The
action of the living stomach on opium, and as I shall
point out in future papers, on organic poisons generally,
m active and rapid. The poison may be taken, absorbed,
and circulated, and yet if a sufficiently long time has
passed, the medical jurist will probably fail to obtain any
evidence whatever of its existence.
I will not attempt here to speculate on the causes of
all this. It may be that the poison has been removed out
of the reach of analysis, passing off by the secretions and
excretions, if life be sufficiently prolonged—it may be
that the quantity taken when distributed throughout the
whole body is not in sufficient quantity in any one part,
such as i9 submitted to analysis, to be discoverable;
wheteas, if we could experiment on the whole body we
might find it; it may be that these poisons locate them¬
selves in special parts of special viscera—or it may be
(and such I deem most probable) that organic poisons
when present in the living blood and the living stomach
are really decomposed.
But on the other hand, I do not hesitate to state that
the dead stomach has no action on opium, or upon organic
poisons generally, which fact, as I believe it to be, I pur¬
pose dwelling upon at greater length afterwards. Here,
at anyrate, is an illustration that a man has been dead
four months, and yet opium is detected without difficulty.
I believe Dr. Letheby has had several other cases in which
he has found it after a still longer period. And thus we
were able to draw the following conclusion in this curious
case :—“ That the man died from the effects of opium
poisoning, and that he died very shortly afterhaving taken
the drug, or otherwise it would not nave been discover¬
able.”
I should wish here, briefly to allude to the detection of
opium, (or rather of morphia and meconic acid) in organic
mixtures. My own experience is that the morphia
is far more readily detected than meconic acid. The plan
occasionally recommended of decomposing the plumbic
meconate with diute sulphuric acid, seems to me a very
unsatisfactory and questionable mode of proceeding.
Certainly it is far preferable to suspend the precipitate in
a small quantity of water, and then decompose it by pass¬
ing a stream of sulphuretted hydrogen through it. The
length of time this method takes may be an oblection to
some. Meconic acid, I think, is broken up by the presence
of a trace of free sulphuric acid. And further, if this
mode of examination is adopted, the less water that is
employed for suspending the impure neconate of lead the
better, so that the application of heat to the neconk acid
solution may be in this way rendered necessary.
Perhaps the best plan is to throw the precipitate, filter
and all, into a mortar, and rub it up with either sulphate
of soda, or what I am disposed to think is even preferable,
namely, carbonate of soda, mixing it with a small quan¬
tity of water, uhtil a liquid is produced, having the con¬
sistency of a thick cream ; allow this to remain about four
or five hours, and then take up the neconic and set free
by shaking with alcohol. The filtered liquid may then
be tested.
I may venture, however, once again to repeat what I
have already stated, that I believe in opium poisoning;
it is quite possible to obtain very decided reactions of the
alkaloid and yet fail to detect neConie add.
-♦-
Wheaten Flour. —At a meeting of the Metropolitan As*
sociation of Medical Officers of Health on Saturday, objections
were strongly urged against the use of flour separated from the
husk, as is at present the custom for bread-making, especially
in the preparation of children’s food. The loss of the phos¬
phates and gluten thereby was much deplored, and the use of
entire wheaten floor- -that is, the bran being very finely ground
and dressed with the ordinary flour—advocated. We have
submitted to analysis the entire wheaten flour prepared by
Messrs. Chapman & Co., of Hatcham, and fully concur in the
remarks made at the meeting on-Saturday ; at the same time
we wonld suggest that the house mentioned should tempt the
public by offering their flour in bulk at as low a price as thev
consistently can, in preference to the pound packets, which
appears to be their present mode of sale.
The Siamese Twins arrived in Liverpool from New York
on Saturday last, and intend forthwith to again become the
objects of a public exhibition in some of our chief cities, prior
to the surgical separation, which is the primary cause of this
second visit to our shores.
Bequests to Medical Charities.— Mr. John Bairstow, a
manufacturer of Preston, who has just died at the age of
ninety, has made the following among numerous charitable
bequests :—Preston and County of Lancaster Royal Infirmary,
20,000/. ; Medical Benevolent College, London, 200/. ; and to
the Northern Counties Asylum for Idiots at Lancaster, he
leaves 6,000/.
Discovery in Regard to Blood-lettihg.—A “
Lecture on a case of Epilepsy and Vertigo, In which Blow¬
letting was employed With advantage,” is reported.The
lecturer is no less distinguished a personage thmi Dr. t.
Handfield Jones. A new light appears to be dawning on the
profession with reference to the therapeutic action of venesec¬
tion. The practice has now been discarded long enough to
render blood-letting a comparative novelty, and the know¬
ledge of its curative power, which was common-place with our
grandfathers, is to be recovered by fresh observation and pro¬
mulgated as original, to swell the current of progress which is
theboast of the present age.— Pacific Medical Journal
Thb Poison of Toads.— Some European savans have dis¬
covered what was known a thousand years ago, but has bean
almost lost in modern times, that the toad carries an active
poison in its parotid region, almost as deadly as the curare.
Wo opine that schoolboys in the Atlantic States ar e pram
against it, or, at least, that it is not Capable of any grew*
injury than Die production of warts, which a popular
attributes to the handling of the reptiles.^-«M/a JM. Jam.
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LEADING ARTICLES.
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every Wednesday morning . Price 5 d. Stamped 6d.
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“SALUS POPULI 8UPBEMA LEX.”
WEDNESDAY, DECEMBER 23, 1868.
EDUCATIONAL REFORM.—No. IY.
In our last two articles we pointed out that the institu¬
tion of a single and uniform set of examinations for the
bestowal of a minimum qualification to practise, and the
publication by the Medical Council of a single code of
regulations, were the essential and fundamental changes
which would introduce order and method into our educa¬
tional system. The difficulty of obtaining these changes
—the former especially—we fully recognised ; but as the
difficulty is not insurmountable, we proceeded to point
out the beneficial results which the changes would pro¬
duce. On three of these—the abolition of schedules, the
substitution for schedules of a general certificate vouching
for good conduct and satisfactory study and signed by the
Dean, and the reduction of lectures to their proper level—
we touched in the last article. The present article will be
occupied with the consideration of three other advantages
which would flow from the simple measures recommended
in the Report of the Medical Teachers’ Association.
These are, the definition of the work required from the
student, harmony between the curriculum established by
the Medical Council and the curricula of our Universities,
and the introduction of a single title in the place of a
number of separate titles of variable and uncertain
values.
In the present advanced state of scientific and medical
knowledge it is utterly impossible for the student, in the
limited time at his disposal, to master all the subjects
which are crowded into the curriculum. In less than four
years he has to obtain an acquaintance with chemistry,
botany, materia medica, anatomy, physiology, pathology,
medicine, surgery, hygiene, forensic medicine, midwifery,
diseases of the eye, diseases of the ear, diseases of the
skin, diseases of the throat, and diseases of the mind. In
point of fact, the curriculum is often got through in less
than three years, as the regulations of the English Licen¬
sing Bodies permit the student to pass one year or eighteen
months with a registered medical practitioner. The re¬
commendation of the Medical Council that there should
be four years’ professional study contemplated four yean’
study at really educational institutions ; but, owing to the
Medical Act conferring a merely permissive authority
over the licensing bodies, this important regulation is set
at nought. If the authority of the Medical Council were
made absolute over the corporations, four years’ medical
study would be insisted upon and divided into periods.
At the end of each period there would be an examination,
and no one would be able to count study in the second
period before he had passed the examination terminating
the first period ; or in the third period (if there were
three) before he had passed the examination terminating
the seoond period. This point is also recommended in the
Report of the Medical Teachers’ Association, and judging
from the remarks of the speakers at the last two meetings,
there appears to be a pretty general agreement that four
years’ bond fide study are not more than sufficient for
obtaining a theoretical and practical knowledge of the
profession. Add to the division of the four years into
periods the definition of the knowledge required from the
student, and a very satisfactory arrangement is obtained.
The latter desideratum is so well put in the Report to
which we have referred, that we extract the passage.
“We are of opinion that the controlling authority
ought to define with very much more precision than k
now used, within what area of knowledge candidates for
minimum qualification are to be examined—to what exact
extent in chemistry, to what exact extent in physiology,
to what exact extent in forensic medicine, and so forth.
We would insist that examinations should be thoroughly
searching and strict within the area to which they purport
to extend; and it is in order to this object that the
examiner’s requisition of knowledge should, in the first
instance, be well defined. The present programme, unless
it be understood with modifications which are not ex¬
pressed in it, is, we think, too pretentious for its object.
We cannot hope (much as we might wish) that everyone
entering upon practioe in the United Kingdom shall have
thoroughly mastered all the studies which are now
nominally comprised in his curriculum—all the botany,
physics, and chemistry, all the anatomy and physiology,
all the forensic medicine and pharmacology, Ac.; but if
the requisition of the examining authority in regard of
each such subject matter were defined in the manner we
suggest, a really thorough knowledge within that more
limited area might, we think, be made indispensable, and
very advantageously be substituted for smatterings of
larger pretension.”
The next advantage of an uniform code of regulations
issued by the Medical Council would be the harmony
which would thenceforth exist between the curriculum of
the Medical Council and the curricula of the Universities.
We cannot but think that the classification of subjects
and examinations adopted by the University of London is
essentially correct and logical To obtain the degree of
Bachelor of Medicine four examinations must be passed :
the first in general education, the second in scientific
knowledge, the third in knowledge of the anatomy, physio*
logy, and chemistry of the human body and in knowledge
of drugs, the fourth in diseases and the methods of cure.
The knowledge embraced under both the two first heads
can be acquired away from an hospital—at the universi¬
ties, at schools, at colleges, and by private reading and
tuition. It seems, therefore, an unsound principle to
require students to come to a medical school to learn what
they can learn as well elsewhere, and equally illogical to
mix up general science with science applied to the human
body. For these reasons we OOntend that botany, element
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532 Hie Medical Proas and Circular.
LEADING ARTICLES.
Deoember 29,1899.
tary chemistry, and physics should be removed from the
purely medical curriculum, and should be learnt, so far as
may be considered necessary, previously to anatomy and
physiology. If this view be sound, the only question to be
decided is—How much botany and how much chemistry and
physics should be required. Opinions on this head greatly
vary. Some are for the devotion of nearly a year to the
study of these subjects; some would add comparative
anatomy as the basis of human anatomy ; some would get
rid of botany altogether, as useless to the medical man and
derogatory to the profession of medicine, because it forms
a connecting link between medicine and herbalism. For
our own part, though differing from Dr. Parkes as to the
mode of arrangement of the subjects of study, (for he still
retains botany in the first summer session), we think, with
him, that “ it is futile to suppose we can ever insist on a
special scientific education for those who desire to enter
the medical profession.” We should be content to take
the amount of botany, elementary chemistry, and physic,
at his standard, merely providing that it should be ac¬
quired before the strictly medical studies. The amount
of knowledge of these subjects would be as clearly defined
as it is in the calendar of the University of London. On
comparative anatomy we would not insist. The botanical
knowledge should embrace morphology and vegetable
physiology, the natural orders being omitted altogether
and incorporated, as far as they are required at all, with
materia medica. The knowledge required in natural philo¬
sophy and chemistry would not greatly exceed the amount
demanded for the matriculation examination at the London
University. Putting all the preliminary scientific work
together, we believe it might all be learnt in a few months
—six at the outside—but most probably in only three or
four. The best men would easily pass in these subjects at
the same time as they passed in general education ; but
those who found the general and scientific knowledge to¬
gether too much for them could take up these subjects
separately.
The limits of our space prevent our entering more at
large into this subject in the present article, and therefore
we must reserve its further consideration, passing on now
to the last advantage which we specified as likely to result
from having an uniform minimum qualification and a
single code of regulations for it. This was the introduction
of a single title in the place of a number of separate titles
of variable and uncertain values. At the present time
there are a number of different titles evidencing complete
or partial qualification, representing different amounts of
knowledge and severity of examination, taking different
ranks in the estimation of the profession and the public,
and leading the minds of the uninitiated into a fixed con¬
tempt for alphabetical combinations.
There is a vast amount of jealousy introduced into our
ranks through the existence of so many titles, and intermin¬
able discussions go on about the right of licentiates of col¬
leges and bachelors of medicine to the title of doctor. If
there were one qualification which all were obliged to take,
one title could be given in respect of it, fixed by absolute
authority. The greater number of medical men would
content themselves with this one qualification ; others of
a more ambitious turn, and destined for the higher walks
of the profession, would plume themselves with college
fellowships and university degrees.
--
THE CAT.
We are amongst those who cannot restrain a feeling of
indignation when we remember how many a brave soldier
and sailor has been demoralised by the application of a
punishment only fit for the most depraved criminals. Only
those who have witnessed the tortures inflicted on the
triangles can form a just opinion on this subject. We
have no sympathy at all with the superfine omcers who
think “ the cat” the only means of maintaining the disci-
E line of the service, and we believe that such omcers must
ave irremediable deficiencies, winch ought to prevent
them holding commands. Discipline depends to a large
extent on the qualities of commanders, and those whose
authority depends on flogging could best serve their
country by selling their commissions.
A contemporary that has often given expression to
similar viewB, has recently produced a very flippant article
in which the sufferings produced by the punishment under
consideration are rather ridiculed than otherwise. How
the article in question came to appear we shall perhaps
never know, but it is scarcely worth noticing except inci¬
dentally.
Those who can best judge all agree with us. Those of
our brethren in the Army and Navy who have beeu re¬
quired to witness the degrading tortures, unequivocally
condemn it. This we could prove by abundant testimony,
and indeed it has been shown over and over again, never
more distinctly perhaps than in a little volume entitled
“ Medical Life in the Navy,” which has lately been pub¬
lished. The work is by Dr. W. Stables, and abounds in
much interesting and useful information, so that we can
heartily commend it to onr readers. It is neither large
nor pretentious, but will afford a very pleasant half day’s
reading. We propose to give the author’s views on the
“cat” as a sample of his style, and at the same time a
sufficient enforcement of the opinions we have expressed.
Dr. Stables thus writes :—
“ I do not believe I shall ever forget the first exhibition of
this sort I attended on board my own ship ; not that the
spectacle was iu any way more revolting than scores I have
since witnessed, but because the sight was new to me. 1 re¬
member it wanted fully twenty minutes of seven in the mor¬
ning, when my servant arousea me. ‘Why so early to-day?’
I inquired as I turned out. * A flaying match, yon know,
sir,’ said Jones. My heart gave an anxions ‘thud’ against
my ribs, as if I myself were to form the ‘ ram for the sacrifice.’
I hurried through with my bath, and dressing myself as if for
a holiday, in cocked hat, sword, and UDdress coat, I went on
deck. We were at anchor in Simon’s Bay. All the minuthe
of the scene I remember as though it were but yesterday. The
morning was cool and clear, the hills clad in lilac and green, sea¬
birds floating high in the air, and the waters of the bay reflect¬
ing the blue of the sky and the lofty mountain sides, forming
a picture almost dreamlike in its quietness and serenity. The
men were standing about in groups, dressed iu their whitest
of pantaloons, bluest of smocks, and neatest of black silk
neckerchiefs. By-and-bye the culprit was led aft by a file of
marines, and I went below with him to make the preliminary
examination, in order to report whether or not he might be fit
for the punishment. He was as good a specimen of the British
marine as one could wish to look upon—hardy, bold, and
wiry. His crime had been smuggling spirits on board.
‘Needn’t examine me, doctor,’ saicL he; ‘I ain’t afeard of
their four dozen ; they can’t hart me, sir—leastways my back
ou know—my breast though ; hum-m!’ and he shook his
ead, rather sadly 1 thought, as he bent down his eyes.
‘What,’ said I, ‘have you anything the matter with your
chest?' ‘Nay, doctor, nay; it’s my feelins they’ll hurt.
I’ve a little girl at home that loves me, and—bless you, sir, 1
won’t look her in the face again no-how.’ I felt his pulse.
No lack of strength there, no nervousness; the artery had
the firm beat of health, the tendons felt ‘like rods of iron be¬
neath the finger, and his biceps stood oat hard and round as
the mainstay of an old seventy-four. I pitied the brave
fellow, and—very wrong of me it was, but I could not help
it—filled out and offered him a large glass of rum. * Ah!
sir,’ he said, with a wistful eye ou the ruby liquid, * don’t
tempt me, sir. I can bear the hit o’ flaying athout that; I
Digitized by v^ooQle
The liediofi Pro* and Circular.
LEADING ARTICLES.
December 28, 1868. 533
wouldn’t hare my messmates smell Dutch courage on my
breath, sir; thankee all the same, doctor.’ And he walked
on deck and surrendered himself. All hands had already as¬
sembled, the men and boys on one side, and the officers, in
cocked hats and swords, on) the other. A grating had been
lashed against the bulwarks, and another placed on deck lie-
side it The culprit’s shoulders and back were bared, and
a strong beltj fastened around the lower part of the loins for
protection ; he was then firmly tied by the hands to the upper,
and by the feet to the lower grating; a little basin of cold
water was placed at his feet; and all was now prepared. The
sentence was read, and orders given to proceed with the
punishment. The cat is a terrible instrument of torture ; I
would not use it on a bull uuless in self-defence ; the shaft is
about a foot and a-half long, and covered with green or red
baize according to taste ; the thongs arc nine, about twenty*
eight inches in length, of the thickness of a goose-quill, and
with two knots tied on each. Men describe the first blow as
like a shower of molten lead. Combing out the thongs with
his five fingers before each blow, firmly and determinedly was
the first dozen delivered by the bo’swain's mate, and as un¬
flinchingly received. Then, * one dozen, sir, please,’ he re¬
ported, saluting the commander. ‘ Continue the punishment,’
was the calm reply. A new man and a new cat. Another
dozen reported; again the same reply. Three dozen. The
flesh, like burning steel, had changed from red to purple, and
blue and white; and between the third and fourth dozen the
suffering wretch, pale enough now. and in all probability
sick, begged a comrade to give him a mouthful of water.
There was a tear in the eye of the hardy sailor who
obeyed him, whispering as he did so, * keep up, Bill;
it’ll soon be over now. ‘Five, six,* the corporal slowly
counted—‘seven, eight.’ It is the last dozen, and how
acute roust be the torture ! ‘ Nine, ten.' The blood comes
now fast enough, and—yes, gentle reader, I will spare your
feelings. The man was,cast loose at last and put on the sick-
list ; he bad borne his punishment without a groan and with¬
out moving a muscle. A large pet monkey sat crunching
nuts in the rigging, and grinning all the time; I have no
doubt he enjoyed the spectacle immensely, for lie was only
an ape.
“Tommie O-was a pretty, fair-skinned, blue-eyed boy,
some sixteen summers old. He was one of a class only too
common in the service; having become enamoured of the
sea, he had run away from his Home and joined the service ;
and, poor little man! he found out when too late that the
stern realities of a sailor’s life did not at all accord with the
golden notions he had formed of it. Being fond of stowing
himself away in comers with a book, instead of keeping his
watch. Tommy very often got into disgrace, spent much of
his time at the mast-head, and had many unpleasant palmer
rencounters with the corporal’s cane.’ One day, his watch
being over, he had retired to a corner with his little ‘ditty-
box. Nobody ever knew one-half of the beloved kuicknacks
and valued nothings he kept in that wee box ; it was, in fact,
his private cabin, his sanctum sanctorum, to which he would
retreat when anything vexed him ; a sort of portable home,
in which he could forget the toils of his weary watch, the
giddy mast-head, or even the corporal’s canr. He had ex¬
tracted, and was dreamily gazing on, the portrait of a very
young lady, when the corporal came up and rudely seized it,
and made a very rough and inelegant remark concerning the
fair virgin. ‘ That is my sister,’ cried Tommy, with tears in
his eves. * Your sister/ sneered the corporal; ‘ she’s a-,'
and he added a word that cannot be named. There was the
spirit of yonng England, however, in Tommy’s breast; and
the word had scarcely crossed the corporal’s lips, when those
lips, and his nose too, were dyed in the blood the boy’s fist
had drawn. For that blow poor Tommy was condemned to
receive four dozen lashes. And the execution of the sentence
was carried out with all the pomp and show usual on such
occasions. Arrayed in cocked hats, epaulets, and swords, we
all assembled to witness that helpless child in his agony.
One would have thought that even the rough bo’s wain’s
mate would have hesitated to disfigure skin so white and
tender, or that the frightened and imploring glance Tommy
cast upward on the firet descending lash would have unnerved
his arm. Did it? No, reader; pity there doubtless was
among us, but mercy—none. Oh! we were a bravo band !
And the poor boy writhed in his agony; his screams and cries
were heartrending ; and, God forgive us! wo knew not till
then he was an orphan, till we heard him besoech his mother
in heaven to look down on her son, to pity and support him.
Ah! well, perhaps she did, for scarcely had the third dozen
commenced when Tommy’s cries were hushed, his head
drooped on his shoulder like a little dead bird’s, and for a
while his sufferings were at an end. I gladly took the oppor¬
tunity to report further proceedings as dangerous, and he was
taken away to his hammock. I will not shock the nerves and
feelings of the reader by any further relations of the horrors
of hogging, merely adding, that I consider corporal punish¬
ment, as applied to men, cowardly, cruel, aud debasing to
human nature ; and as applied to boys, brutal, and sometimes
even fiendish. There is only one question I wish to ask of
every true-hearted English lady who may read these lines—
be you sister, wife, or mother, could you in your heart have
respected the commander who, with folded arms and grim
smile, replied to poor Tommy’s frantic appeals for mercy,
‘continue the puuishment.’”
-»- -
EXTRA PROFESSIONAL MEDICAL PUBLICATION.
Dr. Haviland vice the Standardly or the Standard pro
Dr. Haviland, entered hist Saturday on a reply to the
extent of a column and a half to the flagellation adminis¬
tered to both by the Lancet a couple of weeks since, on
the occasion of the publication in its entirety of Dr. Havi-
land’s paper recently read before the Medical Society of
London.
The latter half of the defence is devoted altogether to
a refutation of certain alleged scientific errors which the
Lancet was supposed to have fallen into in its criticism,
and which had no relevancy whatever to the question of
the propriety of extra professional publication, with which
we are most interested. For the purposes of the Lancet's
condemnation it is immaterial whether Dr. Haviland’s
figures were right or wrong, and we cannot allow the ques¬
tion to be begged by the introduction of the scientific
matter at alL
We aver that the publication of medical communica<
tions in the public press is most injudicious on the paitof
the journal which admits them, and much worse than
injudicious on the part of any author who abets or permits
their publication.
The tacit consent of the public press generally to
abstain from the practice, while a legion of authors might
be had ready to furnish contributions, and while abun¬
dance of medical subjects might be selected such as would
interest their readers, is evidence of the feeling that such
publication is out of place and impolitic. For the same
reason that it would be inadvisable to introduce the art
of making gunpowder into a boy’s magazine, because the
readers are not educated so as to judge for themselves,
and most probably make a mistaken use of the instruction,
medical dissertations in public papers are objectionable.
Does not the reading of medical books on their own dis¬
eases always lead patients to delusions and panics in every
direction ? Surely then it is not well to place Dr. Havi¬
land’s fc or anyone else’s medical view3 before an indis¬
criminate herd of readers, many of whom have no doubt
felt all the imaginary symptoms of cancer ever since the
bug-a-boo lias been hung out by the Standard.
The defence would appear to exonerate Dr. Haviland
from active assistance in the publication.
In the good old times doctors wrote essays for the
instruction of their brethren, and the addition to medical
science of their views and experiences. Is that intention
subserved by contributions to the penny papers? We
think not, nor can we recognise any marked distinction
between the use of a doctors name (if with his consent)
in the news columns of a penny paper, and the same
doctor’s name amongst the advertisements in the adjoining
page.
-»■ ■
THE SUPERANNUATION OF IRISH POOR-LAW
MEDICAL OFFICERS.
The Draft Bill which we announced last week that the
Council of the Royal College of Surgeons of Ireland had
Digitized by kjOOQle
534 ThelMUoiirrMMUkCimUr.
LEADING ARTICLES.
ftSMmbtvtt, IMS,
instructed their solicitor to prepare, was laid before them
at their last meeting, and ordered to be printed. As a
measure of the greatest importance to a large section of the
profession in Ireland, we give it in extenso
“ A Bill to Provide for Superannuation Allowances to Medical
Ojjicers of Poor-law Unions in Ireland , ami of Dispensary
Districts of such Unions in Ireland.
“Whereas it is expedient that provision should]be made to
enable superannuation allowances to be granted to Medical
Officers of Poor-law Unions in Ireland, and of dispensary dis¬
tricts of sttch unions, who become disabled, either by infirmity
or age, to discharge the duties of their offices : Be it therefore
enacted by the Queen’s most excellent Majesty, by and with
the advice and Consent of the Lords Spiritual and Temporal
and Commons in this present Parliament assembled, and by
the authority of the same, as follows :—
“1. That the Board of Guardians of any union in Ireland
may, at their discretion, with the consent of the Commissioners
for administering the laws for relief of the poor in Ireland, grant
to any Medical Officer or Medical Officers of such union, or of
any dispensary district in such union, who shall have been ap¬
pointed as such officer or officers, and who shall, at any time
after his or their appointment, become incapable of discharging
the duties of his or their office with efficiency, by reason of infir¬
mity of mind or body or of old age, upon his or their resigning
or otherwise ceasing to hold his or their office or offices, such
annual allowance for his or their life or lives, not exceeding in
any case two-thirds of the income derived by such officer or
officers from his said office, as to the said Board of Guardians
shall seem fit j and shall charge such officer or officers’ allow¬
ance to the same account as tliat to which such salary or
salaries would have been charged if continued in his or tneir
office or offices.
“ 2. That in estimating such income it shall be lawful to
compute, not only the salary payable to any such Medical
Officer at the time of his resigning or otherwise ceasing to hold
his office, but also all snch fees derivable by such officer from
his said office under the authority of any Act of Parliament, or
which shall have been sanctioned by the said Commissioners;
the annual amount (of such fees to be ascertained by the
average amount thereof for the three years next preceding tbe
time of such resignation or ceasing to hold the said office :
Provided, that if any such Medical Officer shall not have held
his offioe for the period of three years, then the annual amount
of such fees shall be ascertained by the average of the fees
derived by such office^ and the next preceding officer or
officers for the period ot three years prior to the time of snch
resignation or ceasing to bold the aaia office.
“ 8. That such allowance shall be payable to, or in trust
for, such officer only, and shall not be assignable or chargeable
with his debts or other liabilities.
“4. No grant shall be made without one mouth’s previous
notice, to be specially given in writing to every guardian of
the union, of the proposal to make such graut and tbe time
when it shall be brought forward.
“A That nothing herein contained shall make it compul¬
sory upon the Board of Guardians of any union to grant any
suen allowance to any such Medical Officer.
“ 6. That no such grant made as aforesaid shall be effectual
or commence to be payable to such officer, unless and until
the same shall have been sanctioned by the said Commis¬
sioner^ and shall be effectual for such amount only as the
said Commissioners shall approve.
“7. Iu the construction of this Act the words Medical
Officer shall include Surgical Officer.
“ 8. Nothing herein contained shad affect the right of any
Medical Officer who may be entitled to any superannuation
allowance under any other Act or Acta.
“9. The words herein used shall be interpreted in the
manner prescribed by the Acta in force for the relief of the
destitute poor in Ireland.
“10. This Act shall be called ‘The Medical Officers’
Superannuation Act (Ireland 1 ), I860.’”
The details of this Bill will require full and earnest dis¬
cussion before it is laid on the table of the House, and in
order to provoke that expression of opinion, which must
afford the best guide to those who are charged with it as
to the feelings or tba Irish Poor-taw Medical Officers, we
proceed to point out some of the considerations which its
clauses involve.
The counsel commissioned by the College to prepare the
Bill has advised—
“ That the simplest course is to vest the power of granting
allowances in all cases in the Guardians of the Union only,
and not to confer the power upon the Dispensary Committee
in the case of Medical Officers of Districts.
“ It is always desirable to have as simple a machinery as
possible to work out in practice, and I see no reason why the
Guardians of the Union should not be the parties to decide
(subject of course to the Comnnsnonere' approval) in all eases.”
Now, there is not the least doubt that the more simple
the procedure under the Bill may be. and the fewer hand*
the superannuation claim may have to pass through on its
way to the Commissioners, the greater the probability of
the grant being undisputed. But it is to be remembered
that the persons who are most capable of judging of the
merits or demerits of the claimant, and the amount of zeal
with which he has managed his district, are the Dispensaiy
Committee, who are on the spot, and not the Guar di a ns ,
who are residents at some distance. Moreover, the mem¬
bers of the Dispensary Committee are usually of a rank
superior to the petty shopkeeper* who compose Boards of
Guardians, and therefore less accessible to the mean and
miserable promptings of parsimony, which have so fre¬
quently stood in the way of Medical Officers and their
claims. It would seem to us, therefore, that if the power
of granting superannuation be given to any single body, it
ought rather to pass directly from the Dispensary Com¬
mittee to the Commissioners for their approval.
Secondly. It would seem that a practical difficulty
► must necessarily arise in carrying out the clauses of the
Bill, if it be provided that the superannuation allowance
shall be charged in any part against the union funds. If
a Medical Officer has spent twenty years in tbe Poor-law
Service in three or four different Unions, can the last dis¬
trict to which he may be attached be asked to rote him
retiring compensation for his services in other places T We
i think not, and we should strongly urge, therefore, that the
i retiring allowances should be charged solely on the gftnt
! now made under Mr. MaoEvdy’s Act from the OoHsoli-
t dated Fund, for the payment of half tbo salaries of Irak
Medical Officers. We shall revert to this subject again,
and meanwhile shall be pleased by a free expression of
opinion on the part of our readers.
-—--
ARMY MEDICAL REPORT FOR TBS YEAR 1866 .
In our last notice of this valuable work we spoke of the
health of our troops in the West Indies, let us now set
how they thrive in China, Japan, and India.
The average strength of white troops in China in 180f
was 869, of whom 29 died, and 10 on their passage home
and at Netley. This gives a very high death-rate^ no less
than 43*72 per 1,000. Paroxysmal and continued fevers
were greatly above tbe average of the preceding seven
years. Dr. Heffernan, Inspector-General of Hospitals, re¬
ports great sanitary improvements, such as increased cubic
space to each man in barracks and hospital; in the format,
1,000 cubic feet in all the barracks save one ; in the hos¬
pital the space is 1,500 cubic feet per man. Surgeon*
Major Saunders reports from Hong Kong, that intermittent
fever prevailed to a considerable extent, as the result of
the last hot se&on, and the causes of sickness to which the
regiment had been exposed in 1865. In Japan there were*
at Yokohama, 887 men in 1866, and Iff of them died,
being a death-rate of 21*41 in 1,000. Enthetic diseases
during the year caused a large number of men to be sent
to hospital, no less than 566 in 1,000. Venereal diseases
are said to be extremely common among the native popUr
lation of Japan, and there are no measures in force to
diminish them. Upwards of half the cases were primary
venereal sores, and the progortien of secondary symptom*
ww one in 6*5 sons seem The climate is staled by hisin*
tant*8urgeen Pips* t» br id* Frost* mmmmmo* m
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TtolfadltfFiwuri Circuit*
SCOTLAND.
Dswab* st, me. 695
November. The country is very well cultivated. The
marshes are the rice grounds. Small-pox is very common
yet among the Japanese. There is much rainfall.
During 1866 the average strength of the European non¬
commissioned officers and men serving in Indian commands
was 58,901 ; the admissions into hospital 84,359, and the
deaths 1,278, of which 157 occurred among invalids on
their passage to England or at Netley. This gives 1,432
admissions and 21*70 deaths in 1,000 troops—a low death-
rate, in comparison with average years in India. There
were about 35,446 European troops in Bengal, of whom
822 died—i. 2319 in 1,000. Of these 2*71 in 1,000
died of consumption. The mortality from spasmodic
cholera was less than it had been for five years. The class
of enthetic diseases still causes one-seventh of the whole
admissions. Dysentery aud diarrhoea were much above
the average in the Presidency. In Allahabad, Saugor, and
Meerut Divisions diseases of the digestive system caused
107 in 1,000 admissions in Oude, and 4*59 in 1,000 in the
Presidency Division. Much of the most fatal diseases of
this class was inflammation of the liver. Delhi sore, a
kind of boil, is mentioned as being frequently met with.
One hundred and two cases of sunstroke or heat-apoplexy
occurred, of which 50 terminated fatally. Paroxysmal
fevers were very prevalent, as also continued fevers.
In 1865 there were no less than 121 deaths caused by
heat-apoplexy, and in 1866 there were only 61. The most
common disease of which soldiers suffer in Bengal is ague.
Venereal diseases have caused, says Surgeon-Major A. D.
Home, in 1866, slightly fewer admissions into hospital
than in 1865, being 206 admissions per 1,000 of the
strength, against 213 per 1,000 in 1865; but the after
consequences have been especially disastrous, 14 men
having died directly from venereal diseases. At nearly
all the stations it appears that police measures, sanctioned
by the Legislature, have been put in force for the purpose
of controlling this evil. " If the figures in the return of
diseases are to be taken as indicating the working of the
regulations, we find that they have produced a very slight
decrease in the number of cases, and a four-fold virulence
in the character of the malady.” No remarks are made
as to treatment. Our Indian brethren used to be much
addicted, we hope they are not so now, to the salivation
treatment of syphilis. It appears to be a hopeless task to
speak of draining the marshes, which cause the pernicious
fevers of Bengal. As to cubic space in barracks, it has
been ample, and sometimes sleeping tents have been
allowed. The smallest amount of cubic feet allowed was
at Dum-Dum, where the average space for the year was
1,300 feet for stations in the plains, and 600 cubic feet for
stations in the hills.
The average strength of European troops in the Madras
Command during 1866 was 11,378. Of these, 24*08 deaths
per 1,000 occurred. Spasmodic cholera does not seem to
We been prevalent. Miasmatic diseases had been more
prevalent there than in 1865, except on the plains. At
Secunderabad, dysentery was extremely prevalent, and 12
persons died of spasmodic cholera at that station. Dis¬
ease of the liver was a frequent cause of death, and 13
deaths from sunstroke are mentioned. “ The classes of
disease influencing invaliding were, in largest proportion,
diseases of the liver; next, affections of the circulation,
dysentery, and ailments derived from erotic sources, in
pretty equal proportion ; rheumatic affections, separated
as much as possible from chronic syphilitic affections, and
asthenia, furnished the subjects next most numerous, and.
included the cases chiefly of old debilitated soldiers, ap¬
proaching the completion of their service, and involving,
m most instances, men of prolonged residence in India.
The effects of attacks of periodic lever in young soldiers
chiefly, with affections of the chest, bring up the list.”
Residence in the Neilgherry Hills is found to be more
useful as a prophylactic than as a curative agent. Secun¬
derabad is considered the most unhealthy station in the
Madias Command.
The average strength Of European troops in Bombay in
1866 was 12,077, and the death-rate was 15 in 1,000 men.
Spasmodic cholera was not epidemic, except at Poona,
where six deaths occurred from it. Tubercular disease
gave a higher than ordinary rate of deaths. Nineteen
cases of sunstroke, or heat-apoplexy, occurred, and nine
proved fatal. One hundred ana fourteen admissions oc¬
curred from ophthalmia, attributed to a debilitated and
scorbutic condition of the system in such places os Aden
and Scinde. Deputy-Inspector-General Dr* Currie speaks
favourably as to the improved ventilation of the barracks
and hospitals. Water for drinking purposes is usually ob¬
tained from wells, and filtered through sand and charcoal—
a very indifferent mode of purifying it. The system of
drainage, again, of Indian Cantonments has not yet been
improved to the extent desirable. Drains are for the most
part surface and ineffective. Until water is supplied by
other means than by the present system of water carriers
and carts, the supply will always be more or less inade¬
quate. The dry earth conservancy system for latrines has
now become commonly adopted in the Bombay Presidency,
and is very successful. The carts are driven away beyond
the cantonment limits morning and evening.
The extent of invaliding from the three Presidencies
was as 47*23, 56*69, and 45*95 per 1,000 of mean strength
in 1866 ; 21*98 per 1,000 were discharged the service from
India in that year at Netley.
On looking back upon the results in the field we have
already surveyed, we find that the average deaths in 1,000
among our troops were in 1866—At home, 9*62 ; in British
America, 9*58 ; in the West Indies, 26*94; at the Cape,
10 46 ; at Mauritius, 14*01 ; at Ceylon, 21*44; in Aus¬
tralia, 12*53 ; in China and Japan, 32*46 ; in India, 21*70;
and on board ships, 10*54 ; in Gibraltar and Malta, 8*89.
The highest death-rate occurred among the black troops in
Western Africa, 38*09 per 1,000, and in China, 42*11 in
1,000. This report is perhaps one of the most favourable
which has hitherto been issued by the Army Board.
Hygiene is the great religion of our time. To preserves
the life and to assuage the sufferings of our own branch of
the human family, is to spread the knowledge of the true
religw medici among the various peoples under our sway.
“ Science,” [say the Chinese, “ is one; faiths are many.”
- ♦ -
SCOTLAND.
THE SITE OF THE NEW EDINBURGH
INFIRMARY.
Whbrk shall the new Infirmary stand? A fierce
controversy in regard to this matter, led by Mr. Syme,
is still being waged in our daily papers. Most of the
letters have been prompted by prejudice on one side
or the other, and have displayed little knowledge of either
the present or prospective necessities of a medical hospital
for so large and rapidly increasing a city as Edinburgh ;
and, besides, our hospital is cosmopolitan in its philan¬
thropy, and ought therefore to be at least proportionate in
its capacity for doing good, if not in actual capacity. This
it can never be under existing conditions, and it is not
easy to see how these conditions oan be improved on the
present site. To all this opposition the managers of the
Infirmary have hitherto made two replies—1st, they have
brought forward Mr. Syme's former evidence in favour of
the present site against his present views, and have thus
inferentially attempted to shew that his opinion is not
worth much either way; and, 2nd, they have stated that
the subscriptions towards rebuilding the hospital were ob¬
tained for a definite purpose, which must be carried out.
Mr. Syme, however, not more remarkable for his surgical
skill than for his straightforwardness of character, has
openly confessed that he has changed his opinion, but, as
he thinks, for very sufficient reasons; and we acknowledge
we agree with him that the present Surgical hospital is
behind the age. How oould it be otherwise when the best
and healthiest part of it Iras built for 4 school, and not fat
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536 The Medical Treat and Circular.
SCOTLAND.
December 23,1066.
an hospital? As to the other allegation, now that the
question has been raised, the contributors themselves are
taking a lively interest in it, and seem determined to shew
that it was to build a really good hospital for Edinburgh,
and not merely to perpetuate an anachronism, that their
money was so freely contributed.
By-and-bye we shall hope for some good result from all
this talk. Meanwhile the Medico-Ohirurgical Society
agitated the question at their last meeting, at which
a paper on the subject was read by Dr. Andrew Wood.
We hope, too, that the College of Physicians, as well
as the College of Surgeons, both of them large sub¬
scribers to the new hospital, will take the matter up and
see that their views are sufficiently enforced. By the way,
the plans for the new hospital are believed to have been
ready for some time, yet we have never heard of their sub¬
mission to either of these bodies, who have such a vital
interest in its proper construction, and to whose philan¬
thropy and fostering care the existence and continued
prosperity of the present Infirmary are due. Why is this ?
What can merchants, clergymen, and elderly medical men,
who probably know only of fever as fcbris continua (who
are the present managers), or any architect, however
talented, know of the wants of the community in regard
to hospital accommodation ? To know that fully, so as to
make the knowledge of practical benefit, something more
than architectural skill is required, as the past history of
our Infirmary could abundantly prove. A hint as to the
direction the proof would take may be found in the follow¬
ing letter, which we extract from the Scotsman of Decem¬
ber 9th :—
To the Editor of the Scotsman .
Sib,—T he controversy as to what ought to be the site of
the new Infirmary is being waged on very imperfect data, and
with very limited and incorrect views as to what is required,
and what can be obtained on the various proposed positions.
I am one of those who regard the present site as con¬
demned ; not because in itself bad—that is a mistake ; it is
easily drained, readily ventilated, and is very fairly penetrated
by the sun’s rays for a town site. It is infinitely superior in
every respect to the dwellings of those city denizens who seek
relief there ; and for those from the country, it is not air and
sunlight they seek—of that they have had enough in vain—
but skill; and that shall, I hope, be found in every position in
the future, as it has been in the past. But no one can deny
that the Surgical Hospital is a vast incongruous pile of stone
and lime—a series of corridors and staircases, with a compara¬
tively few ill-ventilated wards as appendages ; so, at least,
they present themselves to my eye ; and, as a body, the sur¬
geons are, I believe, dissatisfied with them and rightly so, I
think. But I leave the surgical wards to the surgeons, satis¬
fied that they can efficiently plead their own cause.
And for the Medical Hospital, what can I say ? Simply
that on the present site, inclusive of the South Bridge shops,
there is not room to build a Medical Hospital at all equal to
the present requirements of the country, far less one to provide
for the increasing necessities of the next hundred years. There
is no means at present, and without undue curtailment of the
general wards there never can be on the present site, any
proper means of separating the various fevers—typhus, enteric,
scarlatina, rubeola, and variola. Yet at least one ward for sus¬
pects, and adequate separate accommodation for each of these
varieties, is a positive necessity for any Medical Hospital
worthy of the name. As it now stands, the Medical Hospital
of Edinburgh is a disgrace alike to medicine and philanthropy,
specially in this respect What is wanted is space easily
drained. In the position of our city, ventilation is readily ob¬
tained, and sunlight such as we have can never be shut out
if we have sufficient space. Situation is a very secondary ob¬
ject—1st, Because, even under present conditions, the visit
hour may be changed, and made at any convenient hour—say
from six to nine in the morning, as it is on the Continent—so
as not to interfere with ordinary lectures ; but, 2nd, Because
the whole tendency of modern medical education is towards
the increase of the practical element to such a degree as will
ultimately necessitate its separation from the elementary
branches, as on the Continent; and in that case situation will
be a matter of secondary importance, and the hours of visit a
thing for private arrangement. Nearness to the University
is, therefore, a matter of not the slightest consequence, and
one to which we must be careful to attach no undue importance.
A large well-regulated hospital, with special cliniques, will
attract students from all parts of the world, with far greater
certainty than a whole series of systematic lecturers, however
eloquent and deservedly famous, besides being infinitely more
useful to the public at large.
Fancy a city like Edinburgh without special skin wards;
yet there is no town in the world where skin diseases are so
rife, or so infinitely various. We have no special chest
clinique ; yet where are chest diseases more frequent f And
what is the reason for all this ! Simply because, instituted
by private benevolence, actively and efficiently aided by the
Royal College of Physicians—and without their co-operation
the attempt would have boon abortive—the management of
the Infirmary has passed into the hands of a set of managers
who, however estimable in themselves, are not practically ac¬
quainted with the medical requirements of the community on
the one hand, or of the students of medicine on the other,
and who, from the absence of reporters at their meetings, are
for ever removed from that correction of their opinions and
direction of their views which would necessarily follow a pro¬
mulgation of the reasons for their dubious deeds.
I commenced this letter by saying that tins co n trov e r sy
was waged on very imperfect data; and what has most struck
me in this respect is the cool way in which George Watson's
Hospital site and grounds are set down for sale at a certain
moderate sum. It seems to me that the proposers of that
site are reckoning without their host, and that the Governers,
when the time comes, will know when to put on the screw.
That, however, is not the only, and far from being, in my
opinion, the best site, and I think it would be right for a
committee of contributors to be appointed to ascertain, in con¬
junction with a committee to be appointed jointly by the
Colleges of Physicians and Surgeons, what is the most suita¬
ble and least expensive site—the money value being put in
black and white before any arguments as to its suitabuity in
other respects are entered upon at all.—I am, Ac.,
A Physician.
P.S .—A grievous blot in our present Infirmary, which must
be remedied in the next, is the total absence of any wards to
which persons of moderate means can be admitted on pay¬
ment. How can we ever stamp out contagious diseases when
our very dairy-woman may be lying ill amongst her milk pails
for want of the accommodation just proposed T
GLASGOW AND ABERDEEN UNIVERSITIES.
It has been decided by a committee of Mr. Gordon’s
supporters to petition against the return of Mr. Monerieff
to Parliament on the ground of bribery. Associations of
the Presbyterian Church having paid the registration fee
of their members, it is intended to try whether this will
affect the validity of his election.
ABERDEEN ROYAL INFIRMARY AND LUNATIC
ASYLUM.
On the I4th a quarterly general meeting was held at
the hall of this institution. The special business was
the correspondence between Drs. Harvey, Smith, and
Keith on the subject of homoeopathy within the hospital,
as introduced by the latter gentleman.—The Provost
moved that, in regard to this correspondence, the
managers agree to the opinion given by the consulting
physicians, and refuse to give their countenance to its
continuance, which was almost unanimously agreed to.—
The medical staff were then re-elected, with the exception
of Dr. Keith.
EDINBURGH WATER SUPPLY.
The proposed scheme of supplying Edinburgh with
water from St. Mary’s Loch, Peeblesshire, was discussed
at a meeting of the town council. Fiually a special
committee on water supply was appointed.
GLASGOW.
The late Mr. J. Clark, jun., among other legacies, has
left £100 to the Eye Infirmary of this city, and an
estate (subject to the life rent of his widow), of the value,
it is thought, of £10,000, to the Royal Infirmary.
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Tht Medical Prm sad Circular.
FRANCE.
December S3,1838. 537
FRANCE.
(from our own correspondent.)
THE SECRET POISONINGS AT MARSEILLES.
Paris, December 13, 1868.
The public had scarcely recovered from the shock caused
by the trial of the Swiss nurse for poisoning her patients,
when the still more horrible affair of the secret poisonings
at Marseilles has caused every other topic of conversation
to take a secondary place. The idea of several women
being brought to the bar charged with disposing of their
husbands by means of arsenic and belladonna, of one of
them avowing the crime and accusing the others, and of the
whole being clearly proved in a court of justice, seems to
have taken a deep hold of the public mind ; and this trial
will for many reasons be long numbered amongst the
causes ckUbres. There are a great many points on which
I should like to comment, but which do not belong to the
province of a medical correspondent, and will probably be
noticed in some of your papers. No trial could possibly
throw more light on the manners and customs of some
strata of French society, though it is to be admitted those
strata should scarcely interest other nations, however much
they may cause the deepest anxiety to thoughtful French*
men.
The accused women seem to have possessed little con¬
science, for they exhibited no compunction for their enor¬
mous crimes, and seem to have provided each other with
white powder, &c., as a specific against inconvenient hus¬
bands with as much nonchalance as can possibly be con¬
ceived. Superstition, credulity, ignorance, and crime,
abound in the details, and account for the shudder with
which society has heard them. And yet what will society
do ? Very soon occupy itself with later news. The pages
of the Gazette des Tribunaux are filled with the trial. I
only give some of the medical evidence for the benefit of
your readers, without making any comments upon it.
The chemical expert (M. Pascal, of Marseilles) deposed
that the bottles and packets found in possession of the
accused contained arsenic. In one packet there was more
than a pound of this poison, not of a commercial kind, but
of the pure sort employed in medicine. Some belladonna
was also found in their possession. M. Broquier, an hos¬
pital surgeon at Marseilles, gave evidence as to the post¬
mortem examination of the exhumed bodies. One body
was in a state of complete putrefaction. Another was in a
fair state of preservation, having been buried only twenty-
five days. Dark spots, effusion of blood, &c., were detected.
One body gave no traces of arsenic on chemical investiga¬
tion, the second gave considerable quantities, and the third
traces. This witness further deposed that the body con¬
taining no traces of arsenic might nevertheless be that of
a man poisoned by this substance, and previous evidence
indicated that the deceased had taken none of the poison
for two months before he died. M. Broquier said that
after a certain time all poisons were removed from the
system, but that persons might die from the effects pro¬
duced, and so no trace be left in the body. The advocate
of the woman implicated interposed that all medical men
did not accept this doctrine. The witness replied that the
elimination of some poisons was slower than that of others,
but at the end of six weeks no trace of arsenic remained.
M. Rousset, Professor of Chemistry at the Marseilles
Medical School, gave similar evidence. He went fully into
all the chemical investigations made, and affirmed that a
considerable quantity of arsenic was present in one body,
appreciable traces in another, and none in the third. He
further deposed that the elimination of arsenic was com¬
pleted according to some authorities in a month, but
according to others in six weeks. In reply to the judge,
Professor Rousset said that if belladonna were given con¬
jointly with arsenic, the former poison would interfere with
and mask the effects of the latter.
Hereupon Madame Joye, one of the accused, was examined,
as her instructions in reference to giving the poisons were
to employ both the agents, either together or alternately.
This woman had also been shown to have practised medi¬
cine, and had been previously convicted of illegally prac¬
tising. Reminded of this, she was asked whether her
instructions were not founded on knowledge of the action
of the poisons. She answered she knew nothing about the
alleged interference of one poison with another ; had only
practised in trivial cases, and when ill herself had always
called in a doctor. On this the judge remarked that that
was easy to understand, as she would be anxious to be
cured herself, while as to her patients she would not be.
Passing by this interpellation, which sounded so curious
to English ears, I come to the next scientific witness and
his depositions.
Dr. Alex. Martin said he was the attendant of the
deceased M. Ville for about a year. In his last illness he
was called to him, and found him suffering from what
appeared at first to be typhoid fever, or gastritis. Nine
days later he found him vomiting. He called Dr. Rampal
into consultation, and they both noticed the dilatation of the
pupil, the pains in the stomach, and the persistent fever,
but the pulse had not the frequency it has in acute poison¬
ing. Still the witness said that the idea of poison had
haunted him, and one day when he met with Dr. Rampal
he named it to him. The vomitings became very frequent,
yet, the witness said, he could not get possession of the
vomited matters, as, although he frequently requested them
to be preserved, they were always thrown away. At length
one day the deceased vomited in his presence, and he put
some of the matter in a bottle and took it to M. Paret,
pharmacien, who was well qualified to make an analysis.
The patient at once became a good deal better, and the
witness abandoned the idea of poisoning, for Madame
Ville showed the greatest care of her husband, and had
summoned all his relations, so that there was no appear¬
ance of doing anything to conceal things. Three davs
after, the doctor called on M. Paret, who said he had sought
for phosphorus and then for copper, but found neither.
He was going to look for arsenic when the bottle was acci¬
dentally Droken. As the symptoms of poisoning did not
recur, Dr. Martin, although his patient died, did not dwell
further on the idea that had struck him, but when he heard
of a woman being arrested on such a charge he had recalled
his impression and mentioned it. The emotion of the wit¬
ness at this point completely overcame him.
M. Adolphe Paret confirmed the previous witness as to
his having requested him to analyse the vomited matters.
Turning from the scientific witnesses, one of the others
stated the instructions given for administering the poison
to be somewhat complete. He said the woman warned him
when she gave him tne substance not to be too fast, but to
go to work cautiously and slowly. She also told him that
when the vomiting which would follow the dose took place,
Ml the matters must be thrown away before the doctor was
sent for ; that he, not seeing it, would probably call the
attack a gastric fever, and would prescribe magnesia and
lemonade, into which a little pinen of the white powder
was to be put. On the next visit the doctor would call it
typhoid, and in four or five days the affair would be over.
Dr. Larche was examined at a later stage. He was called
to the deceased Salvago about January. Deceased's wife
told him she attributed his ailment to excessive drink,
lie took the case for delirium tremens. If it had not been
for the idea of ardent spirits having been communicated
to him, he might have suspected poison. Belladonna
would give rise to some of the symptoms of delirium
tremens. He had never known of any vomiting, without
which it would not be a case of poison.
Dr. Adout also visited Salvago in his last illness, but
had not examined the case very carefully, as it was under
the care of another medical man. He said deceased had
complained of pain in the stomach, and of having vomited
in the morning. When he saw him the case was quite
hopeless. He had attended him at times for ten years.
Digitized by v^ooQle
538 The Medical Pran snd Circular.
NOTES ON CURRENT TOPICS.
Deeente tt, 1868.
He had frequently had inflammatory attacks in the
stomach, and this was not surprising, as witness knew he
was addicted to spirit drinking.
Such is the principal part or the medical evidence against
these women, who have been found guilty of the most
atrocious crimes. I have no doubt it will be interesting to
many of our readers, and have therefore felt it better to
repeat it than to criticise it. The whole trial is full of
interesting points on which I would fain dwell, but space
forbids. Never have I seen such excitement as that of
which the court at Aix has been the scene.
- ♦ -
gfofcs term! Sfopra.
Mrs. Gladstone’s Convalescent Home;
The lease of the house, which Mrs. Gladstone obtained
for her beneficent purpose, has expired, and the landlord
yielding to the remonstrances of the inhabitants of Snares-
brook, who consider the “ Home ” a “ public nuisance,”
has refused to renew it The consequence is that at a
moment’s warning she has been obliged to remove her
convalescent patients to Clapton. This, of course, is only
a temporary expedient, and a permanent location must
be sought for elsewhere. No one can over-estimate the im¬
portance of Mrs. Gladstone’s efforts on behalf of the East-
end poor. The care and medical skill provided by our
Hospitals are not all that is necessary for perfect restora¬
tion after the effects of a debilitating disease. Pure air,
good food, and quietude, when a patient is dismissed
from the hospital, are equally needed before the wonted
strength is regained. These are the objects of Mrs. Glad¬
stone’s “ Home,” and we have no doubt of the sympathy
of the public. They will help her with their contributions,
and a place will eventually be found where her charitable
designs will be no more interrupted.
The Vestry of St. Pancras and the Medical
Officer of Health.
Nothing could show in a more glaring manner the
necessity for the admirable bill introduced into the House
of Commons last Session by Mr. John Stuart Mill, for
changing the present local government of London into a
series of federated municipalities, than the recent conduct
of the members of the St Pancras Vestry in appointing
the Medical Officer of Health for their district. It
appears that one of the candidates, according to the
Times, had but one qualification, and hence, and although
well qualified otherwise, he was rejected. Our own
opinion has long been that the whole system of appoint¬
ment of medical men to public responsible posts, such as
hospitals, &c., in this country, is one beneath contempt.
We boast of being a practical people, in order to save our¬
selves the trouble of thinking how many follies we are
guilty of in public affairs. The only just method of
appointing educated and skilled persons to public posts of
responsibility is that followed in France, i.e. these appoint¬
ments should all be made by open competition among
the candidates, the examiners being appointed by the
municipality. Every other system leads, as in this case,
to egregious folly and nepotism. We have ourselves been
so constantly witnesses of like absurdities, that we are
quite indifferent to all little changes that might be sug¬
gested. The only change we desire to hear of is that of
introducing the concours system, which has gifted French
hospitals and Paris with such a galaxy of gifted men as
they at present are advised by, and compared with whom
our staffs are, we fear, but second-rate.
The Indian Cholera Epidemic.
The report of the Sanitary Commissioner with the
Government of India, for 1867, adds one more to the
able investigations which support the water theory, and
will therefore at once be quoted by those who have com¬
mitted themselves to that theory, while it will no doubt
be subjected to searching criticism by those who hold
opposite views. It is of great importance that labours of
this kind should be widely known, and that those who
cannot accept the conclusions which such reports adopt
should be willing to publicly express their dissent. We
are not amongst those who believe that truth has any¬
thing to fear from the most animated debate, nor have
we so much reverence for any hypothesis as to lead us to
ignore the difficulties by which it may be surrounded.
Even in this present case we are by no means satisfied
with the manner in which the upholders of the water
hypothesis have met the criticisms of their opponents.
Those criticisms have been based on facts which cannot
be ignored, and a fair consideration of them would be
more convincing than repeated quotations from those
who maintain the truth of the hypothesis. The advocates
of the water theory seem to have entered into a tacit
agreement to quote each other’s conclusions, instead of
supplying their readers with new arguments. However
this may serve as an interchange of compliments it by no
means increases the confidence of those who have doubts.
The Late Lunaoy Casa
The case of Johnstone v. Gotham, tried before die
Lord Chief Justice and special jury, is interesting to the
profession, more on account of the surrounding circum¬
stances than the principles involved. A chaplain to a
large London Hospital, who gives himself up to the most
violent language and actions, asserts a Fenian conspiracy
is formed against him, has to be removed from a house
by policemen, is found disturbing the peace of his neigh¬
bours at two o’clock in the morning, declares his lodgings
to be full of thieves and Fenians, threatens to shoot his
successor in a curacy, makes use of very excited gestures
with a large stick, and otherwise acts violently and fool¬
ishly, has small reason to complain that people consider
him mad and secure his restraint. It was clearly shown
that those who placed him in an asylum acted in a most
generous manner towards him, and the jury were per¬
fectly satisfied that it was a case for restraint and gave
their verdict for the defendant. It appears, however,
that the jury were not quite satisfied as to the mode of
removal adopted. They did not approve, apparently, of
any deception being used. Yet it is a difficult question
bow most easily to remove any one so violent to an
asylum. A great display of force and constraint would
only irritate men half frantic already, and labouring
under the effects of morphine and spirits* We should
like to ask the twelve sensible jurymen who thought it
necessary to confine this person as a lunatic how they
would set to work to place him in a licensed asylum.
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The Medleal Pres and Circular.
NOTES ON CURRENT TOPICS.
December 23, 1868, 599
Small Pox ftt Sheffield.
The medical department of the Privy Council have
instructed Dr. Beaton to visit Sheffield with the view, to
inquire into the action taken by its poor-law guardians
for the suppression of the epidemic.
Anglo-German Ophthalmic Hospital.
A ball in aid of the funds of this institution was given
on Thursday evening last, at St. James’s Hall, Regent-
street. The company was numerous and fashionable,
and included several persons of distinction. The tem¬
porary offices of this charity are at 15, Old Cavendish
street, Cavendish square.
French Hospital and Infirmary.
Alderman Sir Benjamin Phillips presided at a
dinner held in the Queen’s Concert Rooms, Hanover
square, on Tuesday, the 15th inst, iu aid of the funds of
this institution. It is situated in Leicester square, and
was established for the relief of foreigners, chiefly French,
who are distressed and in need of medical advice, though
a proportion of Belgians, Swiss, and Italians have been
admitted to a share of its benefits. The principal French
medical men of the metropolis form the staff, and it is
visited by Sisters of Charity. It contains four wards—
two for men and two for women—a consulting room, and
a dispensary. Since it was opened, about a year ago, 160
in-patients and 3,716 out-patients have been relieved.
The Sanitary Condition of Falmouth.
An inquiry respecting the sanitary condition of Fal¬
mouth has l>een held during the last few days. After
hearing much evidence Mr. Taylor, the Inspector, pro¬
posed that the town and parish Boards should amalgamate
for the purpose of sewerage. He advised tbe local
authorities to drain, and to avoid draining into the har¬
bour if possible, adopting in preference a system of irri¬
gation by pumping up the sewage for that purpose.
A Royal Commission on the Sanitary Laws.
Dr. Rumsey and other leading sanitarians are to be
congratulated on the issue of their labours. They have
desired a Royal Commission to investigate the sanitary
laws of the country, and such an one has been appointed.
Our opinions on the matters to be investigated are pretty
well known, as well os our idea of the benefits, imme¬
diate and remote, that may be expected from the labours of
the commission. On the face of it, we are glad to observe
that the medical authorities of the three kingdoms will
be fairly represented, although there are some names that
we miss from the list in the Gazette the ^presence of
which would have been extremely satisfactory. The
public health has become a question interesting to many
outside our profession, and we may fairly anticipate that
one result of such a commission having been appointed
will be to vastly increase the number of sanitarians. By
medical men a certain weariness has been felt on account
of the apathy shown by the public ; but the appointment
of the Commission will revive their courage, with the
assurance that their labours have not been altogether in
vain. They have educated the public to the present
point, and they may fairly expect that so much having
"been gained, the future progress of sanitation will be
more rapid.
The Royal College of Science, Dublin.
Important changes are rumoured in connection with
the new College of Science in Dublin, and, consequent on
thorn, in the Queen’s College, Belfast. We believe that
Professor Wyville Thompson, of Belfast, will be ap¬
pointed to the Chair of Botany and Zoology in the College
of Science, and will, therefore, necessarily vacate the
analogous Professorship which he holds in the Queen’s
College, Belfast. There will probably be a very hot
competition for the latter Professorship, and already the
names of Dr. Alexander MacAlister, of Dublin, Dr.
Traquair, of Dublin, Dr. Spencer Cobbold, of London,
and Dr. Burden, of Belfast, are mentioned as those of
probable competitors. Dr. MacAlister is Secretary of the
Geological Society of Ireland, and well known os a very
earnest observer in comparative and human anatomy.
Dr. Traquair is already connected with the College of
Science in connection with the chair which Professor
Wyville Thompson is expected to occupy. Dr. Spencer
Cobbold has acquired considerable rank as a helmin¬
thologist and microscopic observer in London. It is
likely that Professor Thompson will not vacate the
Belfast Professorship until next April, as his duties in
connection with the College of Science will not com¬
mence till May. It is thought probable that he will
be a candidate for the Professorship of Botany in the
University, vacated some months ago by Dr. Dickson.
Ligature of the First Stage of the Right
Subclavian Artery.
We had an opportunity of witnessing this operation on
Thursday morning last, performed by Mr. Morgan, on a
man aged thirty-four, at Mercer’s Hospital. The disease
was au extensive aneurism of the right subclavian.
The patient being chloroformed, a triangular flap was
raised over the right sternomastoid muscle at its origin,
the parts carefully dissected and pushed aside till the
division of the arteria innominate, was exposed, as it was
intended to ligature it, if the subclavian was much
diseased or dilated. As the first stage of the subclavian
appeared healthy, it was decided to put on a permanent
hemp ligature ; this was done as close to the origin of the
artery as possible. We were much struck by seeing the
depth of the artery, the intricacy of the steps required to
expose it, and the precision of anatomical knowledge
necessary to the operation. There were not two ounces of
blood lost, the veins being for the most part pushed aside,
and the steps of the operation carefully conducted. So
far the patient progresses without unfavourable symptoms
as to artery, and the issue of the operation is anxiously
watched for.
University ^of Cambridge.—Natural Science
Scholarships.
Trinity College offers a foundation scholarship (value
^80 to ,£100 a-year) for natural science. The examination
will be held in Easter week, and will be open to all under¬
graduates, members of colleges or halls in Cambridge or
Oxford. To qualify himself therefore, a gentleman need
only place his name on the boards of a college or hall.
Further information may be obtained from the Rev. E.
Blore, Trinity College, Cambridge.
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540 Tho Medloal Press and Circular.
CORRESPONDENCE,
December 23, 1868.
Lord Robert Montagu intends, during the session
of Parliament, to introduce a bill to amend the 1868
Pharmacy Act.
The office of Gas Examiner for the City of London,
salary £600 per annum, is vacant.
Bv a narrow majority Dr. Stevenson has been elected
Officer of Health to St. Pancras parish.
In the Army Medical Department, on the 8th
February, 1869, the next competitive examination for
Army Medical Surgeons will be held at Chelsea.
In a late number of his periodical Mr. Charles Dickens
eloquently advocates the claims of the East London
Children’s Hospital for public support and patronage.
Dr. Stirling, arbitrarily dismissed by the Commodore
at the Cape of Good Hope, has been appointed Medical
Store-keeper at Plymouth Hospital, rendered vacant by
the promotion of Dr. Pottinger.
A marble bust of the late Dr. Trousseau has just been
erected in the Amphitheatre of the Paris School of Medi¬
cine. It is placed on a porphyry pedestal, in the front of
which is a gilded wreath, and below the words : “ Sub¬
scription—1867.”
The surgeoncy of the Dublin Militia, which was occu¬
pied by Dr. Benjamin Grattan Guinness, thelate esteemed
Registrar of the King’s and Queen’s College of Physicians,
has been conferred by the Earl of Howth, Lord Lieutenant
of the county, on Dr. William Stokes, surgeon to the
Richmond Hospital.
M. Joseph Perier, Regent of the Bank of France, and
lost surviving brother of M. Casiuiir Perier, although
eighty-two years of age, has just undergone an amputa¬
tion of the leg from an incurable tumour. The operation
was performed by M. Huguier, in presence of MM.
Nelaton, Jules Cloquet, Ricord, Tardieu, and other dis¬
tinguished medical men, who had previously held a con¬
sultation on the case. There are now great hopes of the
patient’s recovery.
A most extraordinary case was communicated to the
Surgical Society of Ireland by Dr. Kirkead, of Tuam, at
their last meeting, the details of which we shall lay fully
before our readers in the reports of the Society next week.
A patient had been subject to epileptic fits, and had been
treated without benefit for them. Being taken suddenly
in one of the attacks, the patient fell with the head against
the bars of the grate, and sustained very severe bums over
the parietal bone6. After a protracted illness the parietal
bone became detached and exfoliated almost in its entirety,
and the patient recovered, cured of the epilepsy but minus
the parietal bone, and with no protection for the brain bat
the cicatrised integument
-♦-
The notorious Madame Rachel was yesterday liberated on
bail, pending a new trial, so that if she answers to her bail
when the ease comes on again for hearing, we shall probably
have a repetition of some of those disgusting disclosures which
ti? alike an offence to decency and a disgrace to the boasted
morality of the age.
Mttrxtsginibtnct.
REFORM IN MEDICAL EDUCATION.
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.
Sin,—Though the question of Medical Education has of
late occupied much attention, a partial solution of the diffi¬
culties which surround this important subject has (as far as I
know) been overlooked. Many plans have been devised to
compel the idle student to retain something of the studies he
is supposed to be engaged in. Now, with this object I would
propose this simple plan, viz.:—That no student should be
entitled to a certificate of attending a course of lectures, or s
session at an hospital, until he had passed a strict public
examination for such certificate. All the change necessary
for the carryiug out of this plan would be to make compulsory
tho examinations which are customary in all hospitals and
schools of medicine at the close of every session. If students
felt that they could not obtain a certificate until they gave
satisfactory evidence that they had acquired a fair knowledge
of the subjects they were supposed to study, we would not see
so many instance's of total idleness as medical students,
during their first two or three years, so often afford, nor
would the dissecting room fire have so many “chronic men "
round it.
I have known many students of three years' standing who
knew as little of their profession as they did after the first
three months. I remember one in particular, who used to
boast that he had never opened a book on any one of the sub¬
jects in the course. The fact is that students of this class,
and unfortunately they are a large class, flatter themselves
that, with the assistance of a grinder, they can make up
enough of “ tips” in the last year to pass ; and though there
are some few who, though they may have put off to the
eleventh hour, yet by reacting ten hours a day for the last
year, pass, and pass with credit too, yet the vast majority
manage to squeeze themselves through one of those “back¬
doors of the profession” which for the present shall be nameless;
but with what knowledge we must leave to the imagination.
Why should a student in medicine be exempt from regula¬
tions to which a student in arts must submit ? It might not
be fair, indeed, to compel him to take out lectures in one
particular routine, bnt let each course be independent of the
other, and no certificate granted for that course without a
strict examination —no farce. If all the Schools of Medicine
and Hospitals, even in Ireland, adopted some plan of this
kind, fewer medical students would be found in the haunts of
idleness and vice than at present.
With regard to preliminary education, although (as has
often been pointed out) we can hope for no good result till
the rivalry of licensing bodies is abolished, yet the sad
defects of medical students (as a class) in this respect, cannot
but be deplored. The grand aim of Medical Reformers should
be that the test of preliminary education should be nothing
less than the degree of A.B. However, as this view has met
with much opposition, a compromise might be effected ; for
instance, a student might reasonably, in the first instance, be
obliged to pass an examination similar in all respects to that
for tne first half of the degree of B.A. of the Queen’s Uni¬
versity ; then for the first year {twelve months) let him study
Chemistry, Botany, a second course of Physics*, and a second
course of Mathematics ; at the end of these twelve months
let him pass an examination in these subjects before he can be
registered as a medical student.
Some such regulation as this is required to pwge the profes¬
sion of a class who manage to make up a book or two of
Virgil and a few chapters of Greek Testament, and who, if
they even scrape through at last, are not able to read their
diploma, if it should happen to be in Latin, no more than if
it were in Chinese. I am. Sir,
Your obedient servant,
COGXOVL
♦
Medical Rkmtkebatioe. —Dr. Reynett, Medical Officer of
Rathgormuck district, applied to the board for £2 2s far assist¬
ing Dr. Martin, Portlaw, in amputating the arm of John
Boland. It appeared that Boland wan drawing home some
water to his employer's house when the hone took a start and
ran away; he was thrown off the car, and the wheal pswnrl
over his leg and arm. The doctors found it necessary to am¬
putate the arm at the shoulder, since which time Mr. Pirn
stated that Dr. Martin Tinted him three tunes a day.
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Tfce Meffiwd Prsss and Chenier.
MEDiC^CrAL PltfCItLlffOS.
Dsesmbsr 53, INI TS4&’ c
MEDICO-SOCIAL PENCILLINGS OF LONDON
LIFE AND PRACTICE.
No. 4.
Student days have the reputation of being the happiest
in a medical careeiyeven when that career is successful,
brilliant, and famous ad /rum. My little experience on
the point confirms me in an opinion quite the reverse of
this: so I am compelled to declare that I never yet had the
felicity to discover a really happy medical student
Plumule the freshman, just arrived from his mother's
apron-strings, will tell you he’s a “ blighted being” with
all his troubles before him. Perianth, who seeks immediate
entrance through the ASiculapian portal, we all know is
but a sorry specimen of the representative man of the
type happy, his airs and his jauntiness notwithstanding.
Too soon for these, oh P. ! They are assumed, my dear
boy. Spongiolis, the idle chronic, always short of funds,
displays the needle nose of care at other times than when
the postman fails to carry him a letter with enclosure
from a loving mother, a deluded uncle, a philanthropic
aunt, a gossip, or a sweatheart, the victim of misplaced
confidence. " Is it possible for a fellow to be in high
feather, and the danger of being ‘ plucked ’ visibly before
his eyes every day?” said Stylo-Glossus on a certain
occasion to his class-fellows,and his class-fellows answered
to a man, “ It isn’t” Was Crista Galli, who had three
hundred per annum and extras, happy the night he
“ punched my ribs,” and asked an opinion on the tension
of Madame Grisi’s vocal chords as she stood before us,
rendering in the wild, impassioned, and inimitable
" tootles ” of her sub-heavenly canticle a passage from
Norma ? Was Scalenus happy when he awoke me from a
blissful slumber on a certain night “ long after the witching
hour,” in order to recapitulate, from before backwards,
the names of the parts exposed on the base of the brain,
and the boundaries of the circle of Willis ? These and
many far better reasons might be adduced in order to show
that the medical-student age is not the happy one. The
happy age is in prospective, however:—let us look to it.
The curtain rises. Our second act commences. The
scene is an extremely pretty one. A brilliant sun-lit,
eloudlese, peaceful, and happy-looking horizon ; a back¬
ground of bud and blossom, and of rippleless waters, in
which is mirrored the etherial grandeur which encom¬
passes it. A proscenium displaying the ages pastoral,
agricultural, and medical, in the poetic voluptuousness of
old classic art and imagery. Fields of golden grain, each
stalk of which ends in a chubby head, apparently in the
diphtheric throbs of suffocation, so anxious is it to throw off
its quantum, to assist the never-ending wants of the ever
"bolting” universal "inside.” Flocks tended by heavy¬
eyed reclining shepherds, fed and watered by Faun or by
Fredrika, as the case may be—Shepherdesses with
crooks, Students vrithout books, yet displaying their
wonted gallantry and anxiety to render the modem Egerim
any assistance that their studies require. Groves heavily
weighted with foliage of emerald freshness, with fruits of
every shape, of every hue, of every flavour, with perfumes in-
toxicatingly exquisite and delicious. Through these groves
stretch in long and zig-zag distance, paths of coral,
shingled with perfumed spangles of pearl, of ruby, of onyx,
and of opal. Naiads in semi-habits, wreathed in flowers of
newly-born freshness, reclining on rose-buds, imbibing
sherry-cobblers, and withsuch pretty attendants ! 3iy eye!
In a word, an Eden without an Eve ; an universe with¬
out a single unit of discontent; where the right royal de¬
lights, peace, plenty, contentment, harmony, and jubilation
reign the crown monarchs ; their rule, the good old golden
one. A lovely scene no doubt; a scene which to behold
was well worth the study of years; a scene never painted
on canvas, yet always present on the enravished retinae of
the " newly fledged,” during the octave when he flaunts
about, a " thing of life and beauty,** honoured if not
admired, respected if not beloved, fawned on if not
fondled.
That is the only truly happy time in a medical career.
That is a time when the heart is buoyant and elastic,
joyous and gushing; big as it were with brotherly love,
and overflowing with Christian feeling; a time when you
charitably consider, with all the seriousness of an inebriated
stoic, that the examination, though " stiff,” was as it should
be, and the vivd voce sectionof it" such as any fellow should
know; * although old Maledicus did not deign to take
much notice of some of the answers given him, but ap¬
peared to watch with nervous anxiety the evolutions of
a tiny quadruped engaged in putting his fellows through
their facings on the ceiling of the examination hall, (one
of whose foster kin, visible to the naked eye, was perched
on his barnacles); and although Merturius put his
questions to you with the "curled lips and disdain¬
ful snuffle-pouts” for which he is characterised, and
with the " T want to know from you, sir,” expressed so
bitterly as to cause you to suggest—if your head had not
" gone” prior to this time—the propriety of shying at him
with merciless precision the proverbial boot-jack a time
when you forgive your washerwoman for her inattention
to your buttons, your landlady for her noise about that
latch key, the cat for tripping up your milk-jug so often,
and your “ legitimate enemies”—the “ Bobbies.”
Such a time is during the first days following your
examination, and before the gilding is brushed off your
gingerbread ; ere some considerate friend— if you lack the
moral courage—pointedly asks, " What do you intend to do
with yourself now, old fellow ? ”
Quid Nunc.
- -♦
•
How to dial with ouu Criminals.— The Daily Newt
objects to sny system of treating crime which would make the
criminal far ever belong to a caste with the police as his slave
drivers. To admit the police as sole witnesses of so vague a
thing as suspicion would be too tremendous an engine of inti¬
midation against the innocent to be ever permitted as a weapon
against the guilty. Nor would the suggestion that police sus¬
picions 'must be corroborated by positive evidence of previous
convictions much mend the matter. The Neva approves
Mr. E. Hill’s proposal to attack not merely the thieves, but
the thieves’ houses, the pawnbrokers who take their plunder,
the tool-makers who supply them with implements. It is
almost necessary for their avocation that thieves should live
together. Their haunts are well known to the police, and
evidence of one or two residents having been convicted would
sufficiently corroborate in this matter police suspicions.
There would be no new principle involved in making owners
of such houses indictable. The law already does so in regard
to brothels ; and a public house that harbours disorderly
persons loses its licence on conviction. The old adage which
John Knox applied to the monasteries will here prove true,
“ Pull down their steeples, and the daws will fly away.” The
thieves’ landlord is their abettor, if not their patron, teacher,
and master. We must make him responsible for their oondUdt,
for it is oertain that he cannot bug give them shelter without
knowing their character and avoca t ions.
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84* jteiMMMuttiCtootar. NOTICES TO COBBB8PONDBNT8. December 23, 1863.
DEATH OF DR. G. N. EDWARDS, M.D. CANTAB.,
ST. BARTHOLOMEW’S HOSPITAL.
Swan, B. J., LM-—Assistant to the Maternity D e partment, Dr.
Sieerena'e Hospital, Dublin.
Tanvahill, Dr. R. D.—Elected Physician-Accoucheur to the Glasgow
Lying-in Hospital
Vaghub, F.—House-Surgeon te the Birkenhead Borough Hosp ital, Tice
G. W. Harrison, resigned.
Wiuaov, Dr. J. G. ( Professor of Midwifery in Anderson's University has
been elected Phyrtsisn-Aooouobeur to ths Glasgow Lying-in Hospital
With very great regret we hare to announce the
demise of the above highly-esteemed physician, after a
long and painful illness. In 1860 Dr. .Edwards was
elected Assistant Physician to St. Bartholomew’s Hos¬
pital, and in 1867 attained the distinctive 4 post of fall
Physician. Dr. Edwards was Lecturer on Forensic Medi¬
cine to the school, and also Physician to the Consumptive
Hospital, Victoria Park.
OPIUM AND BELLADONNA
It was thought here, not long ago, that belladonna as an
antidote for opium poisoning was something new. That this
is not the case may be seen by the following: “ In the year
1670, this question already engaged the attention of the pro¬
fession. Prosper, Alpin and Label were the first who pointed
out the antagonism of these two remedies, as their observations
had proved that they weakened each other's action. In the
year 1677 the profession was so far enlightened on this snb-
ject, that Horsthu and Faber proposed to use opium and
belladonna aslantidotee for each other. In the year 1766 the
same proposition was renewed by Boucher, of Lille. In the
present century the opinions pro et contra have appeared more
numerous. For the antagonism Lippi, Graves and Carignan
have especially declared themselves, who based their opinions
on many cases of poisoning successfully cured by the use of
these remedies against each other.’*— Erlenmeyer'i Subcutaneous
Injections.—Cincinnati Lancet and Observer .
NOTICES TO CORRESPONDENTS.
Da. Peawt.—W e much regret that through an error in the address
y ottr conies should here been delivered late. The alteration has been
attended to, and we hope with that the annoyance will cease.
Monsiiur V. Pburevs, Paris.—' We have forwarded your letter to Dr.
Richardson as desired. Allow us to disabuse your mind of the impres¬
sion you appear to entertain with regard to Mr. Barnard Holt. We are
satisfied that no animus was intended to be displayed by this gen¬
tleman in the discussion with Dr. Richardson in our columns, as to
the relative merits of the two dilators. In etch case the writers had but
one object in view, via, to establish upon a basis for future guidance the
origin of the invention of the “ Dove-tailed Stricture Dilator," the im-
provamsats made thereon, and by whom.
Dr. L.—The advertisement has Jong been condemned by the entire profes¬
sion, but unfbrtunatelythe Roy si College of Surgeons in Ireland has no power
to intervene in the matter, unless the culprit be a Fellow. The Charter
declares that if a person duly qualified shall answer satisfactorily in his
examination, the Council shall admit him to the Licence. The person in
question expressed his wish to present himself for the Fellowship some
time since, and offered to cease advertising, but he got no encouragement
and thought the experiment unsafe.
• Da. Frasrr.— lhsnks. Proofs shall be sent you in due course.
Dr. Kirrubad.— We shall be happy to receive and publish the eases
when most convenient to yourself.
Thb Riort Rbv. Dr. Alsxarorr Gosa— No contradiction of the
Report of the proceedings of the Dialectical Society, printed in this
journal on July 22nd. has reached us. Had Lfrd Amberley " contra¬
dicted the sentiments attributed to him," we should have been happy
to publish the communication. We beg to thank you for the stamps re-
coiyed for numbers soul
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APPOINTMENTS.
ijmisflov, Dr. A.—Elected Consulting-Physician to the Glasgow Lying-
in Hospital.
Brostbr, j., M.D.—Assistant-Physician to the Royal South Hants Infir¬
mary, Southampton, vice G. Soott, MD., resigned.
Bvcbarar, Dr. G.—Elected Consulting-Surgeon to the Glasgow Lying-
In Hospital.
Bullar, j., MD.—A Consulting-Physician to the Royal South Hants
Infirmary, on Tselgulug as Physician.
Bullar, W., MD.—A Consulting-Physician to ths Royal South Hants
Infirmary, oa resigning as Physician.
Dowbon, C. H., L. R.Q.P.Ed.—Medical Offlcar for th« new Medical Dis¬
trict No. 2, of the City of Bristol.
Maul, K H., M.D.—Physician to the Royal South Hants Infirmary,
vice J. Bullar- M.D., resigned.
Qrtov, Mr. F. —House-Surgeon to the Coventry and Warwickshire Hos-
’ pital, vice R. Ploughman, LR.C.P.L., resigned.
Pnc, F., L.K.Q.O.P.1.—Medical Offloer to ths Asylum for Idiotic and
Imlw^i|a T jinrn
Ravt, G., M.D.—WaUonisn Lecturer on the Eye in the University of
Glasgow, vice W. Mackenzie, MD., deceased.
Soorr, G., MD.—Physician to the Royal South Hants Infirmary, vice
W. Bullar, MD., resigned. *
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A System of Physical Education. By Archibald Maclaren. London:
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Report of the Sanitary Inspection oi Shipping within the District of
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Pacific Medical and Surgical Journal.
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distinguished from the original bv the closest observer; they will wwvwr
oh a vo a colour oa dbcat, and wul be found veiy eoperior to any teeth
ever before need. This method does not require the extraction of root*
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WEDNESDAY, DECEMBER 30, 1 868.
CO NTEN TS.
PAGE
ORIGINAL COMMUNICATIONS.
Therapeutic Application of Heat and Cold.
By David Basil Hewitt, A.B., T.C.D..
Lie. Coll. PhyB., Physician to City of
Dublin Hospital . 548
Notes on Urticaria. By Henry Samuel
Pardon, M.D., L.R.C.P.B., Physician to
the Belfast Dispensary for Diseases of
the Skin. 546
HOSPITAL REPORTS.
Sr. Gaoaoz’s Hospital
Dr. Ogle's Cases of Abdominal Tumours. 547
Hbbcsbs* Hospital—
Locomotor Ataxy Supervening upon By*
philitio Taint — Successful Results
from Anti-Syphilitic Treatment By
Benjamin F. McDowell, A.B., MB.
Univ. Dub-. Ac. One of the Burgeons
to the Hospital, Ac.. 648
LITERATURE.
The Mercurial Vapour Bath, being an Ac¬
count of its Successful Mode of Bmploy-
ment. By Langston Parker, F.R.C.S.
Ueber die Behandlund der Syphilis, Ac.,
PACE
ohne Quecksilber. Von Carl Drysdale,
M.D., aus dem Englischen. Mit einem
Vorwortsvon Dr. Joseph Hermann, K.K; 549
TRANSACTIONS OF SOCIETIES.
Medical Society of London. 516
National Association for the Promotion of
Social Science . 550
Summary or Science . 551
LEADING ARTICLES.
Educational Reform — No. V. 552
Fevsrs in Schools . 553
Trainino Ships and the Navy. 654
The Indian 8anitary Commissions. 555
Detention or Lunatics . 555
SCOTLAND.
The Universities of Edinburgh and Aber¬
deen... 550
The Royal Infirmary, Edinburgh, Ac., Ac. 556
NOTES ON CURRENT TOPICS.
Charity . 557
Public Health . 567
The Treatment- of Consumption by Ether 557
Army Medical Promotion. 558
Rumoured Reduction in the Army Mcdio&l
Department . 558
The Vacancy In Vincent’s Hospital, Dublin 558
Professor Skoda . 558
Propagation of Nuisances by the London
Corporation. 558
The Recent Candidature of Sir D. J. Corri¬
gan . 558
Death of Sir Richard Mayne, K.C.B. 559
Medical Society of Dublin. 569
Qhiloren’s Hospital iu Brighton. 659
Medico-Social Pencilling* of London Life
and Practice. No. V. . 659
The Projected Appointnnntsat the Dublin
College of Science .. 661
CORRESPONDENCE.
Letter from Dr. Carey . 561
OBITUARY.
Dr. O’Ferrall, of Dublin . 662
Dr. Ryan . 56$
Notice® to Correspondents, Ac. 548
THERAPEUTIC APPLICATION OF HEAT AND
COLD.*
By David Basil Hewitt, A.B., T.C.D., Lie* Ooll. Phys.
Physician to City of Dublin Hospital.
Thermal therapeutics are no mere modern innovation.
The fathers of medicine were intimately acquainted with
the effects of heat and cold when applied to the cure of
disease. Hippocrates speaks of the value of cold in check¬
ing external haemorrhage, and he strongly advocates the
use of cold affusion in idiopathic tetanus. It is a curious
coincidence that he, in common with Dr. Chapman, held
that the use of snpw or ice to the external surfaoe of the
chest was liable to give rise to pulmonary haemorrhage,
and that ice was contra-indicated in hematuria. Celsus
and Galen also speak of the use of cold in the cure of con¬
stipation, disorders of the bowels, and fevers. In fact,
the modern quackery of hydropathy had its brief periods
of favour among the ancients, for we find that in the
time of Pliny a certain native of Marseilles, Charmis by
name, amassed a large fortune by the cold water cure.
As this paper is intended rather to ventilate the truth
of certain modem views regarding the use of heat and cold
than os a historical notice of the opinions of the ancients,
I shall merely remind you that during the latter half of the
eighteenth century the use of heat and cold appears to have
been almost forgotten, until revived by Currie and Jack-
son, who advocated the use of cold water in various dis¬
orders.
Dr. Arnott, of Brighton, published some interesting
cases in the Medical Gazette for 1849, in which he used ice
or some freezing mixture as the remedial agent. He
regarded the use of congelation as a certain and safe
remedy for external inflammation, and as a prophylactic
against erysipelas and secondary inflammation arising from
wounds. He detailed some cases of erysipelas in which
intense cold had seemed to assist the disease, and he found
that many cases of severe cephalalgia which resisted all
other remedies were signally benefited by this treatment.
In cholera, Dr. Araott advocated the use of large doses of
• Read before the Medical Society, Oollige ef Phj aleUiw, Dublin.
solutions reduced five or six degrees below the tempera¬
ture of freezing water.
I do not think that Dr. Arnott supported his views by
the citation of a sufficient number of cases, and I do not
find that his plan of treatment was looked upon with much
favour by the profession.
In the Lumleian Lectures for 1849, the late eminent Dr.
Richard Bently Todd unfolded his views with respect to
the pathology and treatment of tetanus. Regarding the
phenomena of this disease os due to an exalted polarity
of the spinal cord, he proposed to diminish this condition
of tho»nervous centres by the application of ice in ox
gullets to the spine ; and he especially insists on the
Frequent renewal of the ice, as by this means alone could
the cold reach the spinal cord. Thus it will be seen that
this eminent physician maintained the possibility of
influencing the spinal cord by the direct transmission of
cold externally applied. But Dr. Todd has left us no
record of the effects of this treatment on the temperature
of the body, on secretion, or on the pulse. He con¬
tended, however, that the local application of ice to the
spine was depressing in its effects, but whether on the
nervous system or the vascular system does not clearly
appear.
On the 18th July, 1863, there appeared in the Medical
Times and Gazette a paper by Dr. John Chapman, on “ A
new method of treating disease by controlling the circu¬
lation of the blood in (Efferent parts of the body/’ It con¬
sisted in the application of ice, iced water, or hot water to
the spine, and its discoverer rightly regarded it as a new
and potent addition to therapeutics.
Having regard to the discoveries of Bernard and Brown-
Sequard respecting the function of the sympathetic nerve
in controlling the diameter of the arterial capillaries, Dr.
Chapman believes that he has discovered agents which,
by increasing or diminishing the functional activity of
the sympathetic ganglia, can diminish or increase the
diameter of the capillaries. These agents are heat or cold
applied along the spine or some segment of it.
For the sake of clearness I may be allowed to enumerate
the supposed effects of each agent, and we shall then be
in a better position to compare the hypothetical results
with observed facts.
Heat is supposed to cause hyper® mia of the spinal
cord, and in the sympathetic ganglia ; it therefore stimu¬
lates and increases the vital properties of these nerve
centres.
Digitized by v^ooQle
544 The Medical Press and Circular.
ORIGINAL COMMUNICATIONS.
December S0 t 1801
The excito-motor power of the spinal cord is increased, .
thus riving rise to cramp of voluntary and involuntary
muscles.
The nerves derived from the cerebro-spinal system,
which, on the authority of Bernard, Ludwig, and PflUger,
are supposed to supply some glands, and hypothetically
by Chapman all glands and glandular cells, have their
vital activity increased, and consequently secretion is
increased ; and this notwithstanding that the amount of
blood sent to the gland at that penod is less than when
it is inactive.
I state this second effect thus fully, because a writer in
the Medical Press ard Circular of November 18th
has fallen into an error respecting glandular inaction.
He makes Chapman to attribute glandular inaction to a
preponderance of sympathetic nerve force, whereas Dr.
Chapman himself states in his work on Diarrhoea and
Cholera, at page 4
“ When heat is applied along the spine, and when the
glands are stimulatea most vigorously, the vaso-motor
nerves are emitting their maximum of energy, and are
thus shutting off a large proportion of the blood.”
Glandular inaction, therefore, is due to a paralysed state
of the cerebro-spinal glandular nerve fibres, and is almost
always attended by hyperaemia of the gland, due to a like
paralysis of the vaso-motor nerves supplying the vessels
of the gland.
He allows that any secretion—sweating, for example-
way occur when the vessels of the skin are dilated ; but
this arises from the application of heat to the general
surface, and not merely along the spine. It is well known
that cold to the general surface checks sweating, but this,
Dr. Chapman contends, is due to a local spasm of the
capillaries^ which is unaccompanied by the excessive
activity of the cerebro-spinal glandular nerves found in
certain diseases, like delirium tremens, where with a cold
anaemic skin we have profuse perspiration.
In the second place, heat applied along the spine
induces through the vaso-motor system :—
1. Contraction of the capillaries of the body. •
2. A fall in temperature of those portions in which
the capillaries contract
On the other hand, cold diminishes the vital activity of^
and amount of blood in, the cerebro-spinal and sympa¬
thetic nerve centres, and consequently—
Muscular spasm is relaxed.
Glandular activity is diminished.
The arterial capillaries are dilated.
The temperature of the part is raised.
Let us now see how far these hypotheses and supposed
results accord with observed facts.
As to the existence of the so-called positive motor
nerves, which I have named cerebro-spinal gland nerves,
their existence is partly hypothetical but partly real, as
is proved by Bernard, Ludwig, and Pfluger.
As to the power of ice to induce anaemia of the spinal
coTd and sympathetic ganglia, this is purely hypothetical,
but the resulting effects which have been observed are
quite in accordance with the supposed condition of the
spinal centres.
It is similar with regard to the effect of heat
It must be remembered that although the circulation
through a part may be modified directly through the
sympathetic ganglia, it may also be modified, though !
less effectually, by the direct application to the part
affected, or even by means of reflex action.
In this way may be explained the fact referred to by
Dr.. Robert McDonnell at a meeting of the Surgical
Society last year, namely, that if one thermometer be
placed in the left hand, another under the tongue, and the
right arm be plunged into a vessel containing ice, the
thermometer under the tongue was not affected, while
that in the left hand sank.
This does not invakdate any statement of Chapman's ;
it rather proves what he asserts, that symmetrical parts of
the body are affected in like manner ; and I have found
that when ice is applied to the head, for example, the
temperature falls, and the pulse is diminished in fre¬
quency, while in the very same case the ice when applied
to the spine produced an elevation in temperature, and
increase in tne frequency of the pulse.
The effects I have found to result from the application
of ice to the Bpine are quite in accordance with those
enumerated above as given by Dr. Chapman, but I find
with this, as with all other remedies, that its effects vary
in degree in different persons and in the same disease. I
shall proceed to enumerate my experience and to refer to
that of others in Dublin who have tried this mode of
treatment.
Dr. J. H. Benson read a paper before the Surgical
Society lost year in which he detailed the success of the
ice bag in a case of amenorrhoea accompanied by remark¬
able coldness of the feet. The amenorrhoea was sup¬
pression due to exposure to cold.
I have tried the ice bag in a similar case, of which the
following is a note :—M. K., twenty-five years of age, five
months irregular, complains of intense headache, which
gives her a stupid expression of countenance, and is ex¬
tremely persistent She has also a most distressing pain
in the lumbar region, and eats almost nothing. She
was treated with tonics, iron, ‘and Kudus’ pill without
effect, but on the application of the ice bag to the spine
for two hours daily the headache and spinal pain were
greatly relieved, and when the ice was placed on the head
as well as on the spine the pain was quite cured. The
patient being in hospital for rather more than a month
without menstruating, I placed a small blister on the
sacrum, and in two days the discharge came on, lasting
for six days, and being extremely abundant. This case
proves the value of ice in headache, and while I am
inclined to think the great abundance of the discharge
was due to the application of the ice to the spine, yet the
use of the blister diminishes very much the value of this
case as evidence.
I am convinced of the value of ice in many forms
of headache, but more especially when occurring in
hysterical patients or those suffering from anaemia and
amenorrhoea.
In some cases it is painful and disagreeable when
applied to the forehead, but most comfortable and bene¬
ficial when applied to the cervical spine. I tried it about
three weeks ago in a young lady complaining of violent
pain limited to the right temple, and when applied to the
forehead it increased the pain; but when an ice bag was
procured, and I fixed it on the spine from the base of the
skull to about the sixth dorsal vertebra, she experienced
immediate relief and soon fell asleep. This laay is sub¬
ject to the most curious congestions of the face, accom¬
panied by a sensation of burning heat. One cheek will
De pale and cold, the other with a pink flush and of a
burning heat. Her hands and feet are constantly pain¬
fully cold. On the occasion referred to, the ice had the
effect of equalising and raising the temperature, but 1
did not use the thermometer as I had not it with me at
the time. She now gets the ice and uses it herself when
the headache comes on, and she always finds it relieve the
pain.
My experience in other cases is the reverse of this. In
two cases lately under my care in the Cifcv of Dublin Hos¬
pital, the ice when applied to the spine had no effect on
the headache, but when applied to the forehead it entirely
removed the pain as long as it was left on, but it returned,
although with much less severity, when the ice was re¬
moved. One of these, a girl named Cowley, suffered from
pain which was confined to the right side of her head, and
she had been leeched, blistered, and salivated .before ahe
came under my care. Whenever the ice was not applied
for a day she always complained of an increase of the
pain. I have, however, discontinued the use of the ieein
this case, as no permanent benefit seemed to follow from
Digitized by v^ooQle
December SO, I860.
ORIGINAL COMMUNICATIONS.
The Medical Pren and Circular* 545
ita use, and am now giving her large doses of bromide ot
ammonium with good effect.
I tried the ice m a case of chorea, but although the
patient expressed herself better from it, I did not find her
prepress as well as I had seen others under the use of
sulphate of zinc, and I therefore substituted the latter
drug with perfect success.
Dr. J. H. Benson reported a case of chorea treated by
ice in the Medical Press and Circular on the 19th
of August. In this case little benefit was produced until
purgatives had first removed the eccentric cause of irrita¬
tion, but subsequently the effect was rapid and complete.
In a paper read by me before this society last session,
I gave the results of some thermometrical observations
which I made on the action of ice to the spine in a case of
hemiplegia, in which this agent diminished the rigidity in
the flexor tendons of the fore arm, removed tremors from
the muscles of the sound arm, and restored much power
to the paralyzed muscles. The result was a rise of from
one-filtn to three-fifths of a degree in the temperature of
the axilla.
I have since tried the remedy in a case of partial hemi¬
plegia of two years’ standing, in which there was great
rigidity in some of the flexor tendons of the fore arm, but
especially in the flexor carpi radialis. The result, how¬
ever, was negative, but all other modes of treatment like¬
wise failed.
In the paper referred to above, I gave the result of the
use of ice in a case of delirium tremens, in which capsi¬
cum, tartar emetic and opium, and cold affusion had all
failed. In this case the use of the remedv was followed
by the happiest results, and since that time Mr. Hamilton,
surgeon to Steeven’s Hospital, has treated three cases of
delirium tremens by ice. His cases were published in
the Medical Press and Circular on the 30th Septem¬
ber, and his results were similar to mine. I may here
enumerate them:—
1st—The induction of sleep.
2nd—The diminution, and finally the disappearance of
tremors.
3rd—The regulation of vascular action.
4th—The cessation of sweating.
5th—The production of a rise in temperature, with a
return of the natural colour to the face.
. that paper I stated tl that the most suitable cases for
its use would be those in which there is profuse sweating,
pallor of countenance, much tremor, and continued wake¬
fulness and I can confirm this statement by further ex¬
perience.
. the 12th November, 1868, James Coon was a dmi tted
into the City oi Dublin Hospital, under my care, suffering
from a fourth attack of delirium tremens. He is thiitv-
eight years of age. In the third attack he was also
under my care, and after the failure of ice to the spine
I treated him successfully with capsicum in large doses,
without any other stimulant. On tnis occasion lie begged
he might be treated by stimulants, as he said he had been
“ living very low ” for some time. When admitted his
face was flushed, the conjunctiva) were congested, and the
skin was dry and hot. He bore an excited aspect, but
there was very little tremor, and little or no delirium.
He had slept but little for some nights, for when he dozed
he was soon awakened by some hideous spectre. Tongue
was tremulous, and covered with yellowish-white fur.
Pulse was sixty and feeble. Ordered twenty grains of
freshly-powdered capsicum in a bolus with honey. In the
evening he was not any better. The capsicum was
repeated. He passed a restless night, being delirious and
starting from his sleep. He was less excited next morn-
mg, but not much improved. Capsicum to be repeated
every eight.hours.
On the 14th he was much worse, sweating profusely ;
but the skin was so hot that when the bedclothes were
drawn down he steamed as one in acute rheumatism. The
muscular tremors were so much increased that he could
hardly hold anything in his hand. Slept none. Imagined
that insects were crawling over him. Pulse could not be
counted at the wrist owing to the tremors, but counted
by the first sound of heart it was 68. Hie heart’s action
regular but feeble.
At one o’clock p.m. the ice bag was applied to the spine
from the occiput to the lower part of the dorsal region.
Before application, pulse 60, temp. 99.7°
After „ „ 64, muen stronger, temp. 100*.
Feels much better. Slept a little. Perspiration checked.
After an interval it was again applied, but this time to
his head.
Pulse before application, 76 ; temp., 99.3°.
ft after „ 70 j ,, 99.3*
Here the effect was to lower the pulse ; the tempera¬
ture was not affected. He experienced great relief in his
head and felt more inclined to slumber, but the sleep was
still milch disturbed by hallucinations.
On the 15th.—Ice to the head for two hours.
Temp., before, 99.3 C .
„ after, 99.2.
16th.—Passed a restless night, but appears much better
to-day. There is no perspiration and less tremor.
Application to head for an hour and a-half.
Before application—
Pulse, 80 ; temp. 99.7°.
After application—
Pulse, 74 ; temp. 99.2®.
Again in the evening for an hour and a-half—
Pulse, 84 ; temp. 98.9°.
Afterwards—
Pulse, 80 ; temp. 98.7°.
He passed a very good night, sleeping at intervals, and
on the 17th ate a chop for h is dinner.
On the 18th he told me he had slept soundly for six
hours last night, and was greatly refreshed. The tremors
were quite gone, and the appetite was quite restored.
After a few days he was discharged cured.
This case is interesting as showing the difference in the
effect of cold when applied to the spine and to the head.
In the first case the pulse was increased in frequency, and
the temperature increased three-tenths of a degree ; while
on the four occasions of its application to the head there
was a diminution in the frequency of the pulse, and the
temperature of the body was decreased in three instances.
In a case of spinal meningitis and myelitis which I
hope to have the honour of bringing under the notice of
this society on a future occasion, the ice bag was applied
several times, and almost always there was an increased
rapidity of pulse and a rise in the temperature ; at the
same time a rigid condition of the flexor muscles, which
was present in a marked degree, was lessened by the use
of the ice, and a hypersesthetic condition of the upper ex¬
tremities was cured. The expense, however, of tne ice,
led me to use extract of belladonna instead, and this has
produced even more marked benefit than the ice. If our
notions as to the effect of belladonna on the capillaries of
the spinal cord be correct, I think this rather confirms
the view that ice produces anaemia of cord ; but this
action of belladonna is now denied by many eminent
authorities.
In a case of obstinate vomiting to which I was sum¬
moned early in July last, the effect of the ice was most
remarkable.
The lady was in the seventh month of pregnancy, and
after giving dilute hydrocyanic acid, small quantities of
soda water, with liquor bismuthi and small bits of ice,
putting mustard to the epigastrium, &c., without effect, I
thought of Chapman’s method, and as I had no bag I pro¬
cured a large lump of Wenham Lake ice, and held it by
means of a piece of flannel against the lower dorsal and
upper lumbar spines. In less than five minutes all
retching ceased, and the patient felt so relieved that she
preferred bearing the wetting of the clothes produced by
the melting of the ice rather than allow it to be removed.
In an hour she had fallen asleep, chiefly, I think, from
b
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December 80.1861
the fatigue produced by constant vomiting. She had no
return of the vomiting.
I never saw au instance in which any other remedy
produced 60 sudden and complete relief of vomiting, and
even of nausea, as in this case, and it is difficult to ac¬
count for the effect produced on any hitherto accepted
hypothesis.
Thus it will he seen that in many cases there can be no
doubt that the effects produced by the application of ice
to the spine are those detailed by Dr. Chapman. My
wish is to stimulate further investigation on this subject
in an impartial spirit, and to avoid rushing into any dog¬
matic statements until much more numerous observations
shall warrant our making some induction from which we
shall not soon have to recede. I accept Dr. Chapman's
hypothesis as at least convenient, and even probably near
the truth ; but I # do so merely provisionally, and because
I conceive that by it the facts observed are more readily
accounted for than by any other hypothesis.
I cannot, however, agree with Chapman that we must
revolutionize medicine, and regard all disease as due
primarily to either anaemia or hyperaemia of the spinal and
sympathetic nerve centres. The history of medicine fur¬
nishes us with many similar attempts to refer all disease to
a single source, but such theories have never been adopted
by truly philosophic minds, and have always led their pro¬
mulgators into what is closely allied to empiricism. The
truth seems to be that we may have in ice and hot water,
when applied to the spine, agents which may modify some
of the known effects of disease.
I have hitherto chiefly referred to the use of ice, I shall
now give you the result of my limited experience respect¬
ing the use of heat to the spine.
I first used it in two cases of bronchitis occurring in the
course of typhoid fever. In one of these cases the vesicular
murmur was everywhere replaced by rhoncus and sibilus.
The respirations were forty-five in the minute, temperature
105°, and pulse 128. Turpentine stupes, and mustard and
linseed-meal poultices, had been previously applied, without
apparent effect. I then ordered the spinal water bag to
be filled with water at a temperature of 140°, and applied
to the upper dorsal spine ; the water to be changed every
twenty minutes. Unfortunately this produced extensive
vesication where the surface had been previously reddened
by the turpentine, so that the marked improvement that
followed might be said to be due to the vesication. The
respirations fell to thirty-four within a few hours, and
abundant mucous rales indicated that secretion had taken
place.
In the second case there was much less inflammation,
but the patient expressed a great sense of relief from the
application of the not water, and in two days all rales had
disappeared, although the fever had by no means abated.
Some ten days ago a patient named Martin was admitted
under my care into the City of Dublin Hospital, suffering
from chronic bronchitis with emphysema. He complained
much of the constant cough, which kept him awake all
night ; great difficulty of breathing ; a distressing feeling
of tightness, referred to the diaphragm ; and great difficulty
of expectoration. All over the chest the vesicular murmur
was replaced by rhoncus sibilus and mucous rales ; the
resonance on percussion at the base of both lungs partook
of the tympanitic character in a marked degree. The
spinal water bag, temperature 140°, was ordered to be
kept constantly applied to the dorsal spines during the
day ; and Mr. Donaldson recorded the effect on the tem¬
perature of the axilla by means of Casella's thermo¬
meter :—
First day.
11 o’clock, when the bag was applied ; temp. 99.6°
12 „ „ ,, 99.7
J n n >» 99.0
2 , 9 # „ 99.0
4 ,, ,, „ 99.1
T 6 „ „ „ 99.2
It will be seen that after an hour there was a rise of
1-lOth, whereas at the end of two hours the temperature
had fallen 7-10ths deg. After five hours the temperature
again began to rise.
Second day.
1 o’clock, when the bag was applied ; temp
2 ,, 11 11
11 11 n
4
5
8
it
ii
ii
ii »
ii ii
ii ii
98.68
98.2
98.9
98.7
98.7
98.8
Here it will be noted that the temperature of the axilla
had fallen one degree since the previous trial, three days
before, during which time the use of the spinal water bag
was persisted in, but that on this occasion the diminution
of temperature which took place at first was followed by a
rise of 3-10ths after two hours.
I presume this may be due to reaction, but I do not
profess to be satisfied with such an explanation. And now
as to the effect on the bronchitis. Although no other
treatment was adopted, there was a marked improvement
both in the symptoms and physical signs. There was a
considerable increase in the amount of expectoration, which
was frothy and not viscid. Dyspnoea was greatly relieved.
The sense of constriction and distress about the diaphragm
disappeared, and there was much less rhoncus and sibilus
audible. In fact, the effect was quite as good, if not
better, than that produced by expectorants, &c. The man
is still under treatment.
This, gentlemen, is the result of my experience on this
subject. I am not so sanguine as to expect that a more
extended induction will exhibit the same results, but I
trust you will give me credit for a wish to arrive at truth ;
and I shall be delighted to avail myself of the experience
of other members of this society who may have used these
agents.
NOTES ON URTICARIA.
By Henry Samuel Purdon, M.D., L.R.C.P.E.,
Physician to the Belfast Dispensary for Diseases of the Skin. Ac.
Urticaria is in many cases nosologically identical with
erythema, as is proved by their occasional occurrence in
the same person from the same cause. To herpes it like¬
wise bears some resemblance ; one^ of the principal differ¬
ences observed is, that herpes is generally preceded by
neuralgic pains, frequently of some days’ duration, which
is not the case in urticuria, that affection occurring sud¬
denly— as, after eating various kinds of indigestible
food, &c., or from irritation of the lining membrane of the
uterus, as noticed by Scanzoni (1) ; but they resemble each
other in the fact, that in herpes the oedema ends in serous
exudation, which elevates the cuticle in the form of vesi¬
cles ; whilst in the latter, the effused fluid is not so super¬
ficial, and gives rise to the appearance of wheds,
accompanied by spasm of the muscular tissue of the skin.
Hebra has seen cases of urticaria in which bullae developed
themselves upon some of the wheals; this is accounted for
by the extension of the serous exudation beyond its usual
limits. In the affection under notice, three symptoms are
apparent, viz., increased sensibility, vaso-motor spasm, and
vaso-motor paresis. It is well known that the cerebro¬
spinal nerves cause dilatation, the sympathetic constriction
of the capillaries ; and Virchow (2) informs us that the
exudation we meet with is essentially composed of that
material which is due to both the altered condition of the
part, and to the transuded fluid which escapes from the
vessels, urticaria being a reflex irritation affecting the sen¬
sibility and nutrition of the skin. Many other cutaneous
diseases, owing to the irritation they oocasion, cause the
appearance of wheals—as, for instance, scabies. The red*
ness surrounding a wheal is due to hyperaemia, and which
state was considered by the late Dr. Buchanan to arise
1. “Edinbirgh Medical Journal,” October, 1859.
2. “ Cellular Pathology.”
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HOSPITAL REPORTS.
December 30,1818. 547
from a circumscribed oedema of a cluster of capillary loops
springing from a common stem, and under the influence of
a common nervous twig.
Before the cutaneous eruption becomes manifested a
feeling of fulness at the stomach, nausea, headache, &c., are
complained of; the pulse is also quickened. Scratching
makes the pruritus worse, also warmth, as when in bed, the
heat probably relaxing the capillaries. In chronic cases
furfuraceous desquamation of the cuticle takes place.
Urticaria is occasionally connected with the presence of a
rheumatic or gouty diathesis, and I have observed the
eruption alternating with chronic bronchitis. A short time
sinoe I had under treatment a female, aged fifty-four, who
had lately returned to this country from California, where
she had endured great hardships, and also suffered from
rheumatic fever. During the time this patient was under
observation, the eruption of wheals alternated with lum¬
bago, and were evidently connected with rheumatism, this
latter disease being well known to involve both the motor
and sensory nerves. In some cases the capillary vessels
may be ruptured, allowing extravasation of blood, followed
by the formation of wheals, hence the purpura urticant of
Wiliam Dr. Tilbury Fox (1) states “ that the solar plexus
is oftentimes involved, 71 and those individuals subject to
this distressing complaint are occasionally troubled with
functional palpitation of the heart, which may be accounted
for by means of its nervous connexions, that organ becom¬
ing symptomatically affected through the means of the
semi-lunar ganglia of the sympathetic ; the splanchnic
nerves which from the ganglia communicating in the
thorax with the cardiac, the greater splanchnic receiving
also a small twig from the pneumogastric and phrenic;
this accounts likewise for the difficulty of breathing ex¬
perienced during the attack in some cases. The treatment
of an acute attack of urticaria is to remove the cause, and
an emetic to unload the stomach is generally prescribed,
followed by an aperient. During the attack the skin may
be sponged with a weak alkaline lotion, which tends to re¬
lieve the tingling. In chronic urticaria the cause, if pos¬
sible, must be ascertained. If it arises from a rheumatic
or gouty tendency, we may prescribe in the former bi-car¬
bonate of potash, or tincture of actea racemosa ; this latter
drug, besides being useful in rheumatic affections, is an
excellent anodyne; if gout be suspected, colchicum or
carbonate of lithia are indicated. Sometimes the stomach
seems morbidly sensitive to nearly all kinds of food, being
in a state of what is called “ gastric irritability.” In such
cases I have derived benefit from the administration of the
hypo-phosphites of lime, soda, and potash. In many cases
the bowels are costive, and the patient troubled with
flatulence. The former condition must be remedied by
appropriate aperients, the latter by carminatives. I may
mention that when copaiba occasions urticaria—as when
administered for the cure of gonorrhoea—an excellent sub¬
stitute is found in the yellow oil of sandal wood, which I
have used largely in several cases. (2).
Urticaria is occasionally complicated with lichen, ( lichen
urticatus ), and also occasionally occurs in the course of
many acute febrile diseases.
-
ST. GEORGE’S HOSPITAL.
Dr. Ogle’s Cases or Abdominal Tcjmours.
( Continued.)
Cask XXXII.— Tumour formed bp a soft carcinomatous
growth of the kidney, simulating ascites bp its apparent
fluctuation during life .
Tn patient, a child, set. three yean, was an out-patient
at the hospital, and was thought to be labouring under
1. “ MkhuaI of Skin Diseases,” page 85.
2. “ Medical Mirur,’' September, 1W5.
ascites. She was taken ill at her own house, and died.
The early history of the case is unknown.
Post-mortem Examination . — Thorax. — Carcinomatous
disease of the lungs was found.
Abdomen.—The liver and other abdominal viscera were
healthy, excepting one kidney, which was occupied by car¬
cinoma. This growth consisted of large masses, which had
evidently originated in the concave portion of the kidney,
and had grown inwards, the convex end of the organ pro¬
jecting separately from the outer side of the mass, whilst
its upper and lower parts were continued a little distance
into the upper and lower parts of the tumour, the remain¬
ing portion of the surface of the tumour being covered by
the fibrous capsule of the organ. The apparent fluctuation
noticed during life was altogether dependent on the carci¬
nomatous tumour of the kidney. All parts, examined
microscopically , were found to consist exclusively of cir¬
cular granular nuclei, exactly similar to the nuclei of th
ductless glands.
Case XXXIII. — Tumour in the left iliac (?) 'region;
excessive distension of the urinary bladder , which became
ulcerated and perforated ; peritonitis; unsuspected preg¬
nancy after an interval of nine years from, the birth of the
previous child.
Martha M., set. 45, was admitted March 19th, 1854
Last child had been bom nine years previously; had not
suspected herself to be pregnant; had been ailing since
Christmas, and had latterly had a tumour in the left iliac
region, which was thought to be the cause of her illness.
On the 25th of February she was suddenly seized with
pain in the abdomen, and for the three following days is
said to have passed no urine. It then began to dribble
away; and from that time she had never been able to re¬
tain the urine, and had not been free from pain. It ap¬
peared that no catheter had been passed until the day
before admission, when her medical man had been changed.
For some time before admission, the legs and abdomen had
swelled. The bowels had been constipated, and she had
great thirst.
Post-mortem Examination. —Thorax : Firm adhesions
existed in both pleural sacs. Lungs emphysematous and
congested and friable in their lower parts; and in the sub¬
stance of the right one some blood was extravasated. The
lining of the bronchial tubes was very vascular and covered
with bloody mucus. The heart was natural.
Abdomen : There was much fat in the integuments and
beneath the muscles. The peritoneal sac contained dark-
coloured fluid and shreds of recent fibrin. The great
omentum was thickened and adherent, along with one or
two folds of small intestine, to the left part of the upper
surface of the bladder, which reached as high as the um¬
bilicus, and was distended. On removing the adherent
omentum and intestine, a small aperture in the walls of
the bladder became apparent, as also some recent pus
among the adhesions ; and through this aperture came a
quantity of dark-coloured urinous fluid. The bladder was
round to be enormously distended with fetid dark fluid.
Its walls were thickened, and its lining surface presented
in many parts rounded ulcerations, by one of which pene¬
tration of its walls was only obviated (as before said) by
adhesions externally. The neck of the bladder was very
vascular, and presented one or two abrasions or ulcerations.
The entire pelvis was filled with a fluctuating tumour,
which proved to be a pregnant uterus ; the foetus being
about four months old, ana apparently healthy. The dis¬
tended membranes projected through the os uteri.
Cranium : The arachnoid cavity contained a quantity of
recent yellow fibrin ; but otherwise all the contents were
natural.
Case XXXIV .—Abscess in the walls of the abdomen *'*
connection with a piece of bone which had been swallo
and which perforated the intestine. itfid,
A. B., admitted May 19, 1855. She was a charwoman,
who had been living badly, but who did not appear un-
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HOSPITAL REPORTS.
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healthy; the tongue was irritable and the appetite bad ;
and she applied to the hospital owing to an abscess in the
abdominal walls about one inch below the umbilicus in the
median line. Of its history she could give no account,
except that she had observed a lump at the affected part
for three weeks, which had been increasing and getting
painful for two weeks ; had two fits of shivering, one six
days and the other two days, before admission. On ad¬
mission the skin covering the tumour was red, but no
fluctuation was apparent. There was no impulse at the
part on coughing, and it was not resonant. Leeches were
applied ; and in a few days an abscess formed, which was
opened and much foul pus let out. The fetid discharge con¬
tinued until the 30th, when, after sleep, at night she was
suddenly seized with faintness and a sensation of cold. In
spite of stimulants she became pulseless and cold, but was
still sensible enough to indicate that she had no pain in
the abdomen. She very quickly sank and died.
Post-mortem Examination. —Lungs and heart healthy;
the right cavities of the latter being distended with fluid
blood.
The abscess described above was of about the size of the
palm of the hand, and found to exist between the struc¬
tures of the abdominal walls. Shreds of sloughing areolar
tissue were found along with the fetid pus of the abscess
which had opened through the abdominal wall behind
by an irregularly-shaped sloughy orifice of about the
size of the end of the index finger; but this orifice did
not communicate with the abdominal cavity as far as could
be observed, for the great omentum was adherent to its
margins and the surrounding part to some extent. The
central part of the transverse colon was also adherent to
the abdominal wall at the same part; the bands of ad¬
hesion connecting the colon to the abdomen were, however,
firmer in texture and evidently of older date than those
connecting the great omentum to the same part. In the
cavity of the abscess was found an acicular piece of bone,
smooth on its surface, pointed at both extremities, and of
a yellowish-white colour. (I took it to Mr. Quekett, who
determined that it was part of the rib of a rabbit.) The
colon was found to be quite healthy. The general peri¬
tonaeum was somewhat vascular; but the abdominal organs
were natural.
-»■ ■
MERCERS’ HOSPITAL.
LOCOMOTOR ATAXY SUPERVENING UPON SYPHILITIC
TAINT.—SUCCESSFUL RESULTS FROM ANTI-SYPHILITIC
TREATMENT.
By Benjamin F. McDowell, A.B., M.B. Univ. Dub., &e.
O-je of the Surgeons to the Hospital, Ac.
As the highly interesting and important subject of
nervous disorders arising from constitutional syphilis is
daily engaging more attention, I have no doubt the
history of tne following case will be considered worthy of
notice.
Richard Brophy, a well-built and strong man, set. 24,
by trade a plasterer, was admitted to Mercers’ Hospital
under my care on the 13th March, 1868. He had to be
carried to his bed. On admission it was found there was
no muscular atrophy of the lou er limbs, but there was
the fear to walk lest he might fall. Loss of co-ordinating
power in the lower limbs, and partial loss of sensation.
Frequent desire to pass water, which is highly acid—sp.
gr. 10*21, ex-albuminous. Pulse 94 ; soft, regular. Has
no stricture or calculus, and has not suffered from worms
or haemorrhoids. There is no ptosis, strabismus, or iritic
adhesions, or visual impairment of any kind. Defcecates
involuntarily, and sometimes unconsciously. He gave
the following history of his case :—Contracted a venereal
sore about twenty months back, up to which time he
enjoyed excellent health. The sore he did not mind. In
about two months it was followed by an eruption, which
was accompanied by a very sore throat He now obtained
medical advice, but did not pursue his treatment regu¬
larly. The eruptions gradually faded, but after an inter¬
val of several months he had a second evolution of the
disease in the form of severe sore throat, unaccompanied
by any eruption that he could observe. About five
months ago he was ordered mercury, and continued it for
some time after being salivated. All this time he
suffered from severe rheumatic jxiins , wliich rtcurred chiefly
at night. During his illness he led an irregular life.
About seven weeks ago the present attack commenced.
The first symptoms he remembers were constant head¬
ache and severe pains, chiefly in the loins; soreness and
tightness about the stomach, which affected him most at
night; afterwards a sensation, as he explains it himself,
as if u pins and needles ” were darting mto his feet and
lower part of his legs. There was also numbness in his
lower extremities. His gait now became tottering, and
he feared to walk lest he might fall forward on his face.
Ultimately, for some weeks back, he has been quite help
less. He gave the following family history :—Father and
mother both alive, and u have never l»een a day sick/
Two brothers and two sisters alive and healthy. Two
brothers died young ; one from severe injury. He was
ordered to be kept iu a hot bath for twenty minutes, and to
have a brisk purgative afterwards. The next day a mix¬
ture containing in each dose ten grains of iodide of potas¬
sium and one-sixteenth of a grain of strychnia was pre¬
scribed, the dose to be repeated every sixth hour. The
linimentum iodidi potassii c. sapone of the British Phar¬
macopoeia, to be ruDbed over the lower part of the spine
night and morning. It was directed that the limbs should
be hand-rubbed for half-an-hour twice a day, and this to
be followed by electricity down the spine.
In a fortnight his condition was improved in every
way. The numbness had almost disappeared. He did
not suffer much from pains. Could retain his water
several hours at a time, and had complete control over the
sphincter ani. He continued rapidly to mend until the
date of his discharge on the 1st of May, when he was
able to walk with perfect ease, and no totter in liis gait
could be observed. I saw him in the country about
three weeks ago looking perfectly well, and with entire
control over the movements of his limbs, and able to
follow his usual business.
The number of recorded cases of locomotor ataxy
resulting from syphilitic lesion are few, and I believe
this is the first in which the supervention of the disorder
took place after so short an interval from the first constitu¬
tional manifestation of syphilis. Mr. J onathan Hutchinson,
in the excellent essay he ha9 written upon constitutional
syphilis, remarks that u syphilitic affections of the ner¬
vous system are usually among the late tertiary pheno¬
mena. I have rarely seen them at an earlier period than
about five years after the primary disease, and in most
instances the interval is much longer.” In the present
case it will be remembered that a period of only eighteen
months at furthest elapsed from the occurrence of the con¬
stitutional symptoms of syphilis to the development of
the nervous disorder. In another case, however, in which
I attribute the origin of the lesion to syphilitic taint, an
interval of seven years elapsed. I aiu sorry I cannot
give the full history of this case, as the patient was not
under my care for the nervous lesion ; but, as I treated
him a short time previously for another disease, I will
mention what I do know, because it appears to me to fix
beyond a doubt the origin of the subsequent ataxy from
wliich he suffered upon syphilitic taint
In November, 1867, Mr.-consulted me for disease
of his testicles, which I at once pronounced to be syphi¬
litic. He states that he contracted a venereal sore some seven
'/ears previously , which was followed by an eruption. The
[eft oigan was very much enlarged, heavy, bard, and was
adherent to the scrotum anteriorly, in which there were
two ulcerated points, oue about the size of a foorpenny-
piece, superior and external to the other, which was
much smaller. The point of a probe could be pasted
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LITERATURE.
December SO, 1808. 549
about half an inch under the integument of the larger
ulceration inferiorly. Two vascular protrusions appeared
in the centre of the ulcerated surfaces. The right testicle
was slightly enlarged. He complained most of the
stinging pain and sensation of great weight in the testicles.
He got a mixture consisting of one-sixteenth of red iodide
of mercury, and ten grains of iodide of potassium,
and fifteen minims of tincture of opium, in each dose,
three times a day. Peroxide of mercury was applied to
the ulcerated points over the testicles, and a suspensory
bandage ordered to be worn constantly. The symptoms
yielded rapidly to this treatment, and he left me in three
weeks apparently cured. But he was not well, for in
about four months afterwards he was attacked by severe
rheumatic jxiins , for which he was attended by Dr.
Watson, of this city. Subsequently he became paralytic,
and was placed under the care of Dr. Walshe, of the
Adelaide Hospital, under whose treatment he recovered
entirely the use of his limbs, and is now able to walk a
distance of three miles each day to his office. Upon con¬
sultation with Dr. Walshe he fully agrees with me in
believing that the nervous disorder in this case
depended upon syphilis, and he treated it accordingly
with iodide of potassium and rel iodide of mercury, the
same remedies which I had employed for the previous
lesion from which he had suffered.
The preceding cases appear to me to go far to establish
the following axioms, viz. :—
1. That there is a form of nervous disorder depend¬
ing upon constitutional syphilitic taint which
closely resembles the so-called “ progressive loco¬
motor ataxy ” of Duchenne (de Boulogne).
2. That the said disorder is amenable to treatment,
and therefore should not be called “ progressive.”
My friend and fonner colleague in this hospital, Dr.
William Moore, the distinguished King’s Professor of
Practice of Physic in the University of Dublin, published
some cases of nervous disorder connected with syphilis in
a recent number of the Dublin Quarterly Journal , to
which I would refer the reader as being well worthy of
perusal.
-♦-—
^iterate.
The Mercurial Vapour Bath, being an Account of its Suc¬
cessful Mode of Employment. By Langston Parker,
F.E.C.S. Churchill, London, 1863. Pp. 48.
Uerer die Behandluno der Syphilis, Ac., ohne Queck-
hilber. Von Carl Drysdale, M.D., aus dem Englischen.
Mit einem Vorworte von Dr. Joseph Hermann, K.K.,
Primararzt in Kraukenhause Wieden. Wien : Sallmayer
and Co., 1868,
The name of Mr. Langston Parker has long been well
known in the literature o? that important disease, syphilis.
The plan of treatment which the little work before us advo¬
cates does away, says its advocate, with all the evils generally
attributable to mercurial treatments, and does not, he pretends,
produce salivation. The bath consists in a vapour bath, given
for twenty or thirty minutes, accompanied by the fumes of
bisulphide or iodide of mercury, or of calomel, to the whole
surface of the body. Eighteen years’ experience of the efficacy
of this plan is claimed by Mr. Parker. Dr. Yandall, of the
United States of America, considers this bath to be to the
treatment of syphilis “ what quinine is to ague. ” The patient
is placed on a chair, on the seat of which is a thin cushion,
and is covered with an oiled cloth or a blanket, the coverings
being made tight about the neck to prevent the patient
breathing the fumes, except in certain cases, when this is
recommended. Under the chair is placed a small tin bath,
holding a pint or two of water, and a stand, supporting a tinned
iron plate, on which the preparation of mercury” is placed ;
under each of these is placed a large porcelain spirit lamp. The
patient remains exposed to steam, heat, and mercurial fumes
for thirty minutes. This bath is actually recommended by
| Mr. Parker in phagedenic ulceration of the throat, and the
author does not seem to be aware how easily such affections are
treated by means of the topical application of nitric acid, and
internally by large doses (gr. xv. f.d.) of iodide of potassium.
Mr. Pari ter tells us that he has used this bath in thousands of
cases, and considers it the most powerful and least harmful
therapeutic agent which can be employed in treating of syphilis.
It is most suited, he asserts, to affections of the tongue, skin
and throat affections, and secondary ulcers. It is more certain
in lepra than in pustular cases. Mr. Parker asserts that
treatments by iodide of potassium are more hurtful than mer¬
curial courses, and says that they produce iodic cachexia. We
have not yet, we confess, seen this form of disease. He men¬
tions that grave affections of the throat in syphilis are especially
likely to occur in weakly subjects, “ where the health has been
broken down by long-continued internal courses of mercury or
iodine.” A case is related in page 17 in which a patient who
had suffered from iritis some three years before, and lost vision,
recovered it by means of the mercurial vapour bath, and the
[ author says this case is not unique. In another case we are
told that a patient had albuminous urine and loss of vision of
the left eye. On using the mercurial vapour bath for three
weeks, the oedema of the legs disappeared, and the sight was
restored. Perhaps this might have been attributed by Borne
of us to the simple diuresis caused by the bath. He claims,
too, for the baths, that it prevents relapses of the disease. In
page 25 we are told of a case which seems to have had plenty
of mercury, the patient having submitted to two courses of
mercury pushed to salivation, and was yet in a deplorable
state. It took six months of the bath to cure him. We
believe that twenty grains of iodide of potassium t.d. would
have done it in three or four weeks. The bath, says its author,
sometimes requires other adjuvants. Mr. Parker uses only
either the bisulphide of mercury or calomel ; 3*s. to 3j* for »
bath of the latter, 3j- to 3ij. to the former. In page 34 our
author says—“ The ordinary modes of conducting mercurial
courses by using the drug internally, not only frequently fail
in curing the disease, or rather in removing the symptoms for
which they are given, but a class of affections are commonly
thereby induced which are the result of the treatment ; so
that on many forms of constitutional syphilis being presented
to our notice, it is difficult to say what has been produced by
the disease and what by the remedy employed for itsproposed
cure. ' * Verily the non-mercurialists, such as Boeck, Hermann,
Dolbian, Dupres, Cooke, Bennett, and C. Drysdale, could not
say anything more against the drug than one of itB admirers.
The fact is that Messrs. Lee and L. Parker are quite of the
infinitesimal admirers of mercury. They give so very little of
it that it is doubtful whether any enters the system. We
have heard of patients taking the mercurial vapour bath for a
year who had no syphilis, and not being a bit the worse for it,
but rather cleaner and better. Of course, when there are open
sores the mercurial vapour is likely to prove beneficial, just as
nitric acid, and chloridum, or other irritants. Our own ex¬
perience shows us that the cases cited by Mr. Parker would all
probably have done better on simple vapour baths, iodide of
potassium in large doses, and energetic cautery by nitric acid
or chloride of zinc. But we advise our readers to peruse this
pamphlet and judge for themselves. It is not long, and can
be read in about a quarter of an hour; and it is most important
that the therapeutics of syphilis should now be carefully
studied, since the diagnosis and pathology of the disease may
now be said to be very nearly perfectly made out.
Dr. Burton, in a work just published on the Pathology and
Treatment of Syphilis, 1868, objects to the mercurial vapour
bath for its uncertain action ; “ sometimes salivation was pro¬
duced rapidly and surely, and again no effect seemed to follow
the treatment” Dr. R. McDongell observes that “ no absorp¬
tion whatever takes place-of the sublimed calomel through the
slrin, and the action depends altogether upon the vapour
breathed by the patient. ”
Dr. Hermann, of the Wieden Hospital, Vienna, is a well-
known foe to the employment of mercury in the treatment of
syphilis, and he has thought Dr. Drysdale’s pamphlet, which is
a collection of the evidence against the mercurial treatment of
this and other diseases, worthy of a place in the medical litera¬
ture of Germany, at the same time adding a few remarks of
his own in a short preface to the translation. It is now ten
years since Dr. Hermann declared his conviction as to the great
amount of mischief done by the administration of mercury in
syphilis and in other diseases ; and he declares, in his preface,
that when the time shall come when mercury shall be con-
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650 The Medical Press and Circular.
TRANSACTIONS OF SOCIETIES.
December 80,1998.
leased to be no remedy, but rather a cause of disease, science
will have to celebrate one of its greatest triumphs—for she
will free us from the belief now some centuries old in a blind
superstition and prejudice ; she will free us from a method of
treatment which is only sanctioned by the rawest empiricism.
Indeed, with the complete banishment of mercury from thera¬
peutics will disappear, he maintains, at the same time a com¬
plete host of forms of disease from the pathological register ;
and, doubtless, the health of future generations, which mercury
does at present so much to impair, will be greatly benefited
by the change. The learned physician of Vienna adds many
complimentary epithets to these remarks in speaking of the
way in which Dr. Drysdale has brought together the evidence
against mercury in his work. Those who read German may
perhaps find the perusal of this translation—the original of
which is out of print—diminish their certainty as to the virtues
of mercury, either in the form of pills, mixtures, or fumigation.
There have recently been two admirable discussions on the
treatment of syphilis carried on in Paris and in Norway, and i
the non-mercurialists were, in our estimation, entitled to the |
honours of the debate, as they adduced much proof of the
injury done by mercury.
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tasarito jof
MEDICAL SOCIETY OF LONDON.
December 14, 1868.
B. W. Richardson, Esq., F.R.S., President, in the Chair.
Four new fellows were elected.
^ Dr. Sansom proposed the election of a committee to inves¬
tigate the subject of gall-stone, the symptoms produced by
them, and their treatment.
The motion was carried, and the following gentlemen nomi¬
nated as members :—Dr. Thudichum, Dr. Leared, Dr. Thorow-
good, Mr. Peter Marshall, and Mr. John Hainworth.
Mr. C. F. Maunder exhibited two patients upon whom he
had performed primary excision of the elbow-joint ; in each
there was considerable mobility of the artificially produced
joint, one patient being able to lift the hand easily to his
mouth; both were able to lift the weight of at least half-a-
hundred weight.
Mr. Henry Smith certified in congratulatory terms to the
success of these cases.
Some observations were made by Mr. Gregory Smith.
The President then made some further remarks on the
effects of exposing animal substances to extreme heat.
He showed specimens of animals and organs which
had been first embedded in various substances, such
as clay, sand, plaster of Paris, Ac., and then exposed
to great heat. He had found that when animal sub¬
stances embedded and enclosed in iron flasks were subjected
to moist heat of 340® Faht. under pressure, they were, as a
rule, completely removed in the course of from one to two
hours. A dead frog placed in sand and plaster of Paris was
found, on opening the iron flask, to have been almost entirely
removed, its exact shape being left as a mould from which a
east could be taken.
Specimens of fish, prawns, oysters, &c., were exhibited in
various stages of change towards complete destruction. The
most striking fact was that the bodies of animals subjected -to
the influences above named would be, with the exception of
one structure destroyed, and, to ordinary observation, removed.
The order of the process of destruction was described. The
osseous system persisted after all - except the pigmentary
matters. The latter were pure exceptions to the rule ; they
seemed quite indestructible at the temperature employed. As
stated on a former oocasion, blood resisted the destructive pro-
cees, becoming a material resembling caoutchouc ; an analogy
therefore existed between blood and pigment.
After some observations by Dr. Routh,
Dr. Thudichum stated that observations, in some respects
resembling Dr. Richardson’s, had been made aforetime by
Papin. The solvent action of the menstruum (water) which he
employed modified the results.
Th e President pointed out the interest of the subject with
i*epect to fossil remains.
Dr. Thudichum then read a paper on *• The Spectrosoope, in
Relation to Physiological and Pathological Research.”
NATIONAL ASSOCIATION FOR THE PROMOTION OF
SOCIAL SCIENCE.
The Municipal Law Section of the Jurisprudence Depart¬
ment held their first meeting on Monday evening, Dec. 7th,
when a paper was read by Thomas Hare, Esq., “ On the
Means of Manifesting Public Opinion in the Election of Re¬
presentatives to Parliament.” Mr. Hare considered the pause
after an election a fitting time for considering the lessons to
be learnt from it. Dissatisfaction was general at the exclusion
by individual localities of men whom the nation demanded
should sit in Parliament. This lod at once to the reflection
how this could be prevented, and the question naturally arose,
whether it was necessary to confine withiu the limits of a cer¬
tain district the power of electing or rejecting men of acknow¬
ledged eminence and national importance. The present sys-
I tern was liablo also to other abases. A knowledge of the
temper of a certain locality taught wireworkers what cry mu3t
be raised to insure success, and what passion must be stirred
up to overthrow a rival candidate. These abuses would be
swept away by enlarging the area of the constituency. He
hod repeatedly advocated the abolishing of all limits, so that
every view and interest might be sure of being represented by
the combination of individual votes collected from every part
of the kingdom. At present their individual opinions and
preferences were swallowed up by a merciless majority. One
object of the present paper was to put forward a tentative
plan suggested to him by Mr. Hastings, the General Secretary
of the Association. Since it was generally agreed that before
long the soats would be taken away from the smaller boroughs,
it was proposed that fifty seats so obtained should be thrown
open to the whole countiy, each voter to have a national, in
addition to his local, vote. Their votes should then be placed
on a general list, and then after ascertaining the quotient of
the general votes divided by fifty, to return each one of the
fifty candidates who obtained such quotient, or who approached
nearest. Tho names of the small boroughs might be retained,
and the representatives might be named the members of the
Wells College, of tho Thetford College, and so on. This plan
opened a favourable opportunity for testing the system, leaving
it easy to advance or recede according to tho result. If the
system prospered, what was corrupt and both would be pos¬
sible to be isolated, and separated from honesty and justice in¬
stead of tainting the whole system. This expansion of choice
from its present narrow limits would be highly satisfactory to
the individual voter and the progress of political education
would be incalculable.
In the discussion which followed,
Mr. Hastings thought the late disastrous campaign had
prepared men’s minds for seeing the necessity of some new
system. The scheme presented by Mr. Hare was capable of
being adopted tentatively, and the disfranchisement of small
boroughs, which, it was generally agreed, must soon take place,
would ofFer a favourable opportunity for trying this plan with¬
out disturbing tlio general system. Under Mr. Hare’s plan
such men as Mr. Gladstone, Mr. J. S. Mill, and Mr. Austin
Bruce, whom tho nation domanded to sec iu Parliament,
would not be thrown upon the mercies of certain localities
which might happen not to appreciate their ideas, which found
favour with the majority of the nation. Intellect and labour
would also find place in Parliament instead of simply wealth
and capital as at present. He farther recommended that the
national vote should be taken after the close of the local polls,
so that the nation might secure the return of any eminent
man who had been rejected.
Mr. Torrens, M.P., opposed the scheme proposed, because
South Australia had been thrown into one constituency for
the election of members to the Upper House, and the plan
bad not realised the expectations entertained. [Mr. Hare ob¬
jected that this was not the same as the plan he proposed.]
Mr. Torrens farther objected because Mr. Hare’s plan was in¬
compatible with the ballot, which he knew from experience to
be necessary to prevent bribery and undue pressure. He ob¬
jected also to voting papers sent through the poet-office as a
system fraught with the greatest dangers. The system might
work in the Universities, but would not do for the masses.
Mr. Hurst thought the scheme unnecessary and unsuitable.
The recent rejections in South Lancashire and Westminster he
considered due to an ill selection of constituency.
Dr. Staleard was greatly in favour of Mr. Hare’s scheme,
believing himself at present to be the worst represented man
in the kingdom every time that he had exercised the franchise,
he had found himself either in an immense majority or an im-
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The Medical Press and Circular.
SUMMARY OF SCIENCE.
December 80,1868. 551
mense minority, so that his individual vote was of no account.
Under Mr. Hare's system he would be able to vote in “ such a
manner that his vote would benefit what he had most at heart
—the advancement of his profession. There were one or two
medical men in Parliament, but taken as a body they were
nothing like adequately represented. He believed the country
also would be benefited by the admission of more medical
members into Parliaments since so many bills came before
them in which sanitary Knowledge would bo of the highest
use. He differed froip Mr. Hare and Mr. Hastings in that he
would limit the area of these general votes to counties, and
not extend them to the whole country, as ho considered local
influence ought to bo preserved. Dr. Staleard also advocated
the adoption of some plan by which large constituencies might
be more commensurately represented, and the periodic adjust¬
ing of the representation to the increase or decrease of popu¬
lation.
Mr. Holland thought the plan a good one, because it would
make it impossible for local jealousies to exclude an eminent
man fro m Parliament. If a candidate obtained a certain qnota
of votes he would be secure of a seat, no matter how many
were against him. It would largely benefit the medical profes¬
sion, and the admission of more medical men to Parliament
would have a beneficial influence on sanitary measures and
sanitary atate of the country. He had never yet been able to
vote for a man whom he cared at all about. By this plan he
would be able to vote directly for the man of his choice.
Mr. Westlake approved of the plan if it could be shown
to be compatible with the ballot, which the majority of the
Liberals had come to consider necessary.
Mr. Suadwell said any considerable religions denomination
would, under Mr. Hare’s plan, be able to have representatives
in Parliament in proportion to their numbers.
After Mr. Hastings had replied to certain strictures and
opposed outbalancing advantages to the objections made, the
Cnairman summed up briefly as it was getting late, and gave
his assent to the scheme with certain modifications. A vote
of thanks was given to the Chairman and the paper was
ordered to be printed.
-♦-
#Kwnrcrg of
(The Editor of this Snmmary’wiahea it to be understood that he is
not responsible for the ideas, theories, or the correctness of statements
jpade in any of the papers quoted in the compilation.]
(Specially Edited and Compiled for the Medical Press and Circular.)
By C. R. C. TICHBORNE, F.C.S., F.R.G.S.I., etc.
EXTRACTUM CARNIS.
Mr. Bbccs Warren has made the observation, that if a
solution of the above-named preparation is digested with a
large quantity of aether, there is found on the surface of the
solution a substance that does not dissolve in the supernatant
aether, but, if mixed mechanically, again separates. In diluted
acetic acid, the oaustic alkalies, and alcohol, it is partially
soluble. Its alkaline combinations yielded no crystals. These
results, the fact of its swelling in water without dissolving, and
its insolubility in aether, shows that it consists principally of
cerebrio acid.
The cerebric acid is derived probably from the nerves which
ramify the parts from which the extract is made.
“ A suggestion arises," says the author, “ that cerebric acid,
as found through the nerves of the muscles, may have a dis¬
tinct modification to that found in the brain, for its insolu¬
bility in water should prevent its appearing in the extract,
even in the smallest quantity.
FEROXIDE OF NITROGEN.
Hyponitric acid vapour decreases rapidly in density up to
43°, then this decrease becomes less noticeable, and at 150T C.,
is nil. At the same time, the vapour assumes a deeper and
deeper tint. M. Wurts supposed that the molecule of per¬
oxide of nitrogen, at a low temperature, contains 0 4 =
2 volumes, and that it dissociated on heating in two molecules
of the body N 0 9> occupying two volumes. Peroxide of ni-
•trogen is colourless at a temperature at which its vapour cor¬
responds to N s 0 4 . It is now supposed that N 2 0 4 is
colourless, and that N O a is coloured.
NOTATION OF MINERAL SILICATES.
Dr. Reynolds, in an elaborate paper published in the Phi’
losophical Magazine for October, endeavours to construct -a
type formula which shall represent the oxygen ratio of these
compounds, which, he says, is disguised in the notations used
by Odling, Wurtz, Frankland, ana Dana. His formula is con¬
structed upon the water type, representing the normal mole¬
cule of silicic acid as Si 0 2 . He is of opinion that the normal
rate of condensation is three, or some simple multiple of that
number. The subject is too foreign to the purposes of this
Journal for us to enter further into this important question,
therefore we must simply draw attention to this interesting
paper.
HARROWGATE WATERS.
Dr. Muspratt gives a fresh analysis of the Harrowgate
water this year. He points out what must be evident, that,
although the general character of mineral waters must, with
some violent volcanic shift of the earth’s crust, be the same,
yet that a continuous partial change is often evinced. Thus,
in the water re-examined, there is an increase of twelve grains
to the gallon, whilst the sulphides of sodium, chlorides of po¬
tassium and magnesia, are augmented.
The waters originally contained sulphate of lime, which has
now all disappeared. The following is the composition, ac¬
cording to this gentleman, of what may be considered the
most important sulphur well in the United Kingdom :—
Grains in the
Imperial Gallon.
Carbonate of lime. 10-545
Carbonate of magnesia . 2*864
Chloride of sodium . 862*412
Chloride of potassium. 69*897
Chloride of magnesium . 61*769
Chloride of calcium. 79*878
Chloride of barium . 4*998
Chloride of strontium, trace.
Chloride of lithium, trace.
Sulphide of sodium. 16*418
Iodides, bromides, and ammonia, traces.
1108*781
Cubic inches of carbonic acid in the gallon, 25*5. Sulphide
of hydrogen, 7*01.
ON THE PRESENCE OF STARCH IN THE YELLOW OF BOGS.
When the yellow of the egg is washed with ether the
yellow oil is got rid of. This operation, says M. Dareste, must
be performed very quickly, or the albuminous matter will coa¬
gulate. The residue is then, on being washed with water,
freed from the substances soluble therein, especially albu¬
minous and saocharine substances. The residue is then treated
with acetic acid for some considerable time (three months).
It then forms a very slight precipitate, the greater part of
which is the amyloid substance.
This presents the usual characteristics of starchy matter.
THE APPROXIMATE ESTIMATION OF THE INTENSITY OF TOTAL
DAY-LIGHT.
Mr. Wright (“ Proceedings of the Royal Society ’’) pro¬
poses an easy method by which the intensity of day-light may
be approximately estimated. His simple instrument consists
of an upright rod, the top of which is painted with a black
spot upon a white ground. The rod is divided into one hun¬
dred parts. Over the rod is a tube, the interior of which is
painted black, and which slides up and down the rod. The
tube is drawn gently down the rod, and at the same time the
operator looks steadily down at the black spot. It will be
found, that as the tube ascends, the black spot will gradually
disappear, and ultimately vanish in the gloom ; it will also be
found, that on different days, and different hours of the same
day, the point at which the black spot vanishes will vary with
the intensity of the light. This point is read off on the scale
connected with the rod. The results are not scientifically
correct, as it will be affected by the eye-sight of the person
who makes the observation. This measurement also has no¬
thing to say to the chemical activity of the light; but, as
Mr. Wright observes, such an instrument is of considerable
practical use.
Erratum.— “Dropsy and its Pathology.” Pago 505, ninth line, for
“ microscopic” read “ necroscopic."
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552 The Medic*] Tna wd Circular.
LEADING ARTICLES.
December SO, 186$.
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“SALU8 POPULI suprema LEX.”
WEDNESDAY, DECEMBER 30, 1868.
EDUCATIONAL REFORM.—No. Y.
In the preceding articles we have principally insisted
upon the necessity of having one portal of entrance into
the medical profession. It is a simple and a sweeping
change, which cannot long be delayed. The Medical
Council must gird up its loins for the work, or be prepared
to give an account of its neglected stewardship. If it
cannot achieve the end under its present constitution the
profession must help it to attain a constitution which will
ensure success. If any other measure would suffice we
should be inclined to favour it, for we know what is in¬
volved in gaining the proposed object. But the fact is,
that nothing less can ever raise the medical profession to
its proper estimation in society; and it must appear ob¬
vious to common intelligence that there are oertain things
which every medical man ought to know, and a certain
order in which he should be tested in them. If so it can¬
not be right that there should be a number of different
bodies issuing contradictory programmes, and selling li¬
cences to practise which afford no guarantee whatever of
proficiency in several important branches of medical know¬
ledge. And if it is not right that such things should exist,
the profession must see these evils abolished. The profes¬
sion can act partly through the journals, partly through
the corporations, partly through the Council, and partly
through independent organisations; and to these means
of action we purpose to call attention hereafter. At pre¬
sent we must start with the supposition (remote as it is
from the fact) that the Medical Council, aroused to a
proper sense of the trust committed to it, enjoys an abso¬
lute power over the corporations in educational matters,
and is determined to exercise it to put an end to all ano¬
malies and to establish uniformity. The first step would
be to affirm the principle of instituting an uniform set of
examinations for a minimum qualification to practise—a
qualification which all medical students would be required
to obtain. Now it is obvious that this end would be ef¬
fected in two ways—namely, either by the creation of
machinery entirely new, for which fresh powers would have
to be conferred by Act of Parliament, or by a combination
of the machineries already existing. If the Colleges of
Surgeons and Physicians in each of the three kingdoms
were made use of, it would be easy enough to arrange
everything satisfactorily; but, in our opinion, it would be
a task of the greatest difficulty and hazard to attempt to
extinguish altogether the privileges of the Colleges, and
to institute new machinery for conducting examinations
and conferring a licence. It is not our present intention
to enter more at large into the mode in which the Colleges
might be made to work under the Medical Council; it is
sufficient to affirm the possibility and the facility of the
plan. The result would be that in each kingdom there
would be Examining Boards appointed jointly by the Col¬
leges of Physicians and Surgeons, that all fees would be
paid to the Medical Council, and that the Council would
possess entire control over the examinations and the condi¬
tions of study. Thenceforth no corporation would be
allowed to issue schedules or regulations for the general
qualification to practise. The duty of doing this would
rest with the Medical Council, and with the Medical
Council alone. The Medical Council would clearly lay
down the subjects in which students must be examined
before they could obtain a licence, the extent to which they
would be required to learn each subject, the certificates
which they would have to produce, and the number of
separate examinations and the intervals between them. If
this were done by the Council all the existing regulations,
contradictory and confusing as some of them are, and all
the existing schedules would cease and determine. Amid
the present enlightenment and advanced growth of rational
conviction it would be impossible to attempt to publish
from head-quarters any minute set of conditions of study
or to attempt to transform students into Scribes and Phari¬
sees, paying “ tithes of mint and anise and cummin ” and
neglecting the weightier matters of the law. The whole
of the curriculum would be divided into periods, and to
each period certain subjects would be assigned, and at the
end of each period there would be an examination in the
subjects assigned to it. No period would be overweighted,
and hence the student would have a considerable amount
of time at his own disposal, which he could employ to the
best advantage. He would not be driven, as he is now,
to do what he is convinced is useless to him and interferes
with studies of greater importance.
A general certificate of satisfactory study and good con¬
duct would be required at the end of each period, and the
extent to which the student would be examined in each
subject of study would be clearly defined. This is abso¬
lutely all that the central authority need lay down. All
the rest belongs to the individual schools. The examina¬
tion is the helm by which the student would be guided,
and the mode of instruction the sails by which he would
progress. If the mode of instruction were faulty, progress
would be slow, the student would fail to reach the haven
where he would be, and the reputation of the school at
which he studied would suffer. Hence, by throwing the
burden of choice of means of instruction on the schools,
by making them select and arrange the amounts of lec¬
tures, reading-class examinations, and examinations for
prizes, the burden would only be throwii on those who for
their own interest would wish, aye, and be glad to bear it
The school which taught the best, which adopted the
best methods, which had the best appliances, and the most
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Hie Vodleal great and Circular.
LEADING ARTICLES.
December M, 1868. 553
abundant educational material, would take the first place.
A healthy competition would be engendered. Competition
exists at present, but it is not a healthy competition. It
is a competition rather of show than of substance ; of ad¬
vertisement, and not of reality. Students are attracted by
prospectuses, by bygone prestige, by respectability, by con¬
nection, by tradition, by scholarships, and by the apparent,
not the actual existence, of educational advantages. It is
because we wish to see the teaching of the schools reach a
higher standard, because we desire that the best men
should occupy the best places, because we are anxious that
neglected material should be utilized for turning out medi¬
cal men thoroughly qualified for the purpose of practice in
all branches of our profession that we so strongly urge the
advantage of a purer and more salutary competition. No
school can be forcibly extinguished. If any dies, it must
die of inanition. Under the new rigime which we antici¬
pate, we should have no longer professors without classes
or professors with inadequate payment. For instruction,
and not for signatures, men would enter the lecture
theatres, mid our well-remunerated professors would feel
the wholesome necessity of teaching well, or accepting the
Chiltem Hundreds, or not teaching at all. As it is now,
a school may have many, or several indifferent lecturers
and teachers, and yet not suffer any appreciable diminu¬
tion, but if the Medical Council possessed a general super¬
vision over our educational institutions, and the numbers
of successful and unsuccessful candidates from each school
were published yearly, side by side, and if the responsi¬
bility of adopting good methods of teaching lay upon the
schools, it would be indispensable for them to have able
staffs, and to provide first-rate instruction. The managing
committee of a school could not afford to elect inferior
men out of its own body in the place of better men from
other quarters. If it did, its school would languish; stu¬
dents might enter to one or two of the courses, but they
would refuse to pay money for worthless instruction. If
the school expenses had to be defrayed out of the fees, as
is sometimes the case, the burden would at once become
too obvious to be ignored, and the inefficient teachers
would have to resign their offices.
The existence of schedules renders it difficult, at the
present time, for a student to escape from entering to the
whole course of instruction ; but with schedules abolished,
with greater freedom of entry at the different hospitals,
with utilization of the workhouse infirmaries, special hos¬
pitals and dispensaries, and possibly with independent
teachers starting up in the metropolis, all the departments
would have to be well worked if the authorities wished to
see their school in a flourishing condition. We advocate
the inauguration of a reign of freedom, that competition,
becoming keener, may culminate from the professional
chair, amiable incompetence, obsolete imbecility, and
drawling dulness; that our lecture rooms may be filled
with men eager for instruction, not meditating mischief
or settling into sleep; that our museums may be made
thoroughly educational, and their contents be easy of
access to the diligent and inquiring; that our pupils may
obtain for their money the money’s worth; that the labours
of professors may be directly requited with adequate re¬
compense ; and that our courses of instruction may be
adapted more thoroughly to the great end of all medical
education—the production of safe and skilful practitioners
of the healing art in all its branches.
FEVERS IN SCHOOLS.
An outbreak of fever in some of our public schools ha3
lately directed public attention to the responsibility that
attaches on the one hand to the managers of those insti¬
tutions, and on the other to the parents of the boys.
There are many points that may be said to be common,
and not worth discussion. There are, again, points where
the interest of the school and the parent is opposed
and as to each party, where interest and duty scarcely
coincide. So far as public opinion is concerned, all
fevers may be placed in the same category. The pro¬
fession, however, will regard scarlet fever with peculiar
interest, both on account of its extreme communicability
and the serious nature of a large proportion of the cases.
It is, further, of greater consequence from the length of
time that must elapse before the patient can be safely
admitted into the society of those who have not liad the
disease. The contagion clings more persistently to the
convalescent from scarlet fever than almost any disease,
and there is little hope of destroying it, except by the
most rigid and complete disinfection, extending over a
considerable period. When a boy contracts the disease
in a public institution, he should at once be separated
from all the others, and medical men with the care of
schools should personally superintend the precautionary
measures they desire to enforce. We would advise the
thorough use iu large quantities of disinfectants through¬
out the establishment. Sulphur fumes are most easily
applied, aud very effective. A spoonful of sublimed
sulphur should be burnt in the room lately occupied by
the patient, and the fumes should be shut in for a whole
night. After that, windows and doors should be opened
for several days, and subsequently carbolic acid may bo
sprinkled about It is superfluous to add that clothes
and linen should be disinfected by these or other means.
The best plan is to subject them to a great heat. Were
similar measures in a less degree resorted to throughout
the establishment we should hear of fewer cases of the
spread of the disease. For instance, we would, as soon os
fever appeared in a school, having removed those affected,
bum a little sulphur in every room every morning after
the boys were up, keeping each room closed for an hour
or two, so as to allow the fumes full play. After that,
windows and doors could be kept open all day, and in
the evening dishes of Condy*s fluid should be placed in
every room, to remain all night. All closets and urinals
should be treated to abundant quantities of carbolic, and
properly diluted. Here we would remind our readers
tEat Professor Parkes’s recent investigations show the
need of using all disinfectants more freely than is com¬
monly done, if we wish to secure their complete action.
Whether children who are attacked by fever should
remain in the convalescent building of a public school,
or how soon they should return to the school, or
whether they should go home to their families, involve
some nice points between parents and managers. As a
rule w'e believe parents will usually prefer to have their
sons at home during the illness. The duty of the medical
iry nn will be to determine whether the patient can safely
be taken—a decision often very difficult, for it involves
the questions of distance, means of transport, and other
things, besides the actual condition of the sufferer, for
the uncertainty that exists at first as to whether the dis¬
ease will prove as suspected is only resolved when the
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appearance of the rash renders the danger of a chill
greater. It is an anxious question for the practitioner,
and he must conscientiously weigh the facts and act for
the best in each individual case.
The question of conveyance meets us both at the first
sickening and on convalescence. We have often sup¬
ported the movement for securing proper carriages for
the use of hospitals, and if they were generally in use
much danger to the public would be averted. Com¬
plaints have been made of convalescents being sent
careering through the country and disseminating disease
wherever they went. But no one can say the precise
moment when there is no longer danger, and no provi¬
sions exist for the conveyance of such invalids.
In the case of scarlet fever, it cannot be too much im¬
pressed on the public that there is more danger of infec¬
tion during desquamation than iu the earlier stages, and
until that process has been completed for some days,
there is great danger to the patient himself if he leave
his own room. To do so is in the highest degree impru¬
dent and has often resulted in a fatal relapse or complica¬
tion. It follows, therefore, that instead of relapsing, we
should redouble our attention to disinfection in the
latter stages. It is want of attention to this that so fre¬
quently gives rise to new cases, when the household has
begun to think all danger over; and to the fact stated
we must look for the explanation of the immunity some¬
times enjoyed by those who have at first been exposed to,
but afterwards removed from, the source of contagion.
What we have said bears directly on one point in
which parents are apt to err—we trust inadvertently and
unintentionally. After a vacation no source of contagion
ought to remain in a school. During the holidays there
is time and opportunity to take every precaution, and we
may presume that wherever, an epidemic has occurred,
the medical man would be sure to enforce the necessity
of the most thorough measures being adopted. And yet
the commencement of an outbreak is almost always at
the beginning of a term. The reason, we believe, may
mostly be traced to fresh importations. We have known
boys who have had scarlet fever in the holidays sent
back to school at the opening of a term before it was safe
for them to mix with others, and that, too, without
regard to proper means of disinfection. Now this is un¬
just to large numbers. It is almost certain that in a
large school some will be peculiarly susceptible, and they
will then fall sick of the fever. It may be that the
schoolmaster knows nothing about it—the parents have
never named the illness of their boy—he seems tolerably
well again. So when the first case occurs there is no
suspicion during the period of malaise, and only when
the doctor is called in to see the rash is it revealed that
the formidable disease has established itself in the school.
A good deal has been said lately about schools giving
boys fevers; but our experience indicates that the parents
of some one lad have usually thus introduced them. A
good deal has also been written, and that too in rather a
bitter spirit, against schoolmasters sending Lome con¬
valescents before it is safe to do so. Surely it is quite as
wrong for parents to act thus towards the schoolmaster.
In truth, our sympathies are rather with the latter, for
the disease is infinitely more formidable to him than to a
small household, and the parent who receives a lad at
home only risks his own family, while he who sends one
to school in an unrecovered state may distribute infection
to every one of the numerous families who send a child
to that Bchool.
TRAINING SHIPS AND THE NAVY.
That a commercial country like Great Britain, with a
large superfluous population and a traditional right to
“ rule the waves,” should be short of sailors is certainly a
reason for some misgivings. The Royal Navy will find
the reserve insufficient in case of active service, and the
mercantile marine is now in the same condition. Yet
we have a vast and appalling number of boys growing up
and being, so to say, regularly apprenticed to the crimi¬
nal trades. “ Homeless and destitute boys ” abound in
London and all our large cities. Waifs and strays, be¬
longing to no one, knowing no home, no father, no
mother, are growing up, and they have no resources by
which to gain an honest livelihood. What a blessing it
would be could we turn all this raw material into sailors,
and thus increase the supply for both the navy and the
merchant service.
According to statistics recently published, the loss of
the mercantile marine alone is at the rate of 8 per cent
per annum. The present gain from boys and apprentices
is only 3 per cent, and that figure is continually decreas¬
ing. This fact has been properly used to stimulate the
philanthropy of those who rejoice at tho success achieved
by the training ships that have been employed in this
good service. There is little reason, we should imagine,
to encourage those who have already interested them¬
selves in the undertaking, and there must be an immense
number of people engaged in other ways in reclaiming
young criminals in esse or in posse , who would gladly
give their influence to aid this plan. We should be glad
to see every port possessed of its training ship, and the
large ones supporting several; for experience has fully
confirmed all the predictions of good that the institutions
have given rise to.
There is another point, too. Where a ship cannot be
obtained, as in inland schools, why should not the plan
that has succeeded in Belgium be tried by us f The Bel¬
gians place in school yards the deck, masts, sails, &c., of
a good-sized ship, and have an experienced sailor to teach
the boys to go aloft, set or furl sails, and, in fact, do
everything they would have to do at sea. This prelimi¬
nary education is found to be very useful to those who
enter the services, as a very large proportion of them do.
The Stepney Union has tried this plan in its school with
great success. We were also lately told that some mem¬
bers of the School Committee of the St Pancras Board
of Guardians would bring forward the subject for dis¬
cussion, in which case we trust it will not be hastily
dismissed. There is no reason why every Union in the
country should not adopt such a scheme. For the ports
undoubtedly an actual ship would be better, and there
should be no difficulty in our large cities supporting an
adequate number. To those inclined to help we may
whisper that it is not difficult to get a ship for this pur¬
pose, and it should be remembered that under the Indus¬
trial Schools Act, the Government allows a capitation
grant on all the boys thus educated on board.
We have said that a ship is better than the appliances
that can be fitted up in a school play-ground; but that
these latter are of great value is incontrovertible. Hr.
C. TufnelPs report has been often quoted in support of
this view, but we may venture to cite the following pas¬
sage :—
“ A captain came to the Stepney School, and said, *1
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LEADING ARTICLES.
December 80, 1868. 555
have seen a little boy at sea scarcely higher than a coil of
rope, who has been trained in this school, and he is so ac¬
tive and useful that I am determined to have a boy like
him, if I can obtain one.* Another day, a shipowner
called at the school and said, ‘ That as his ship was going
down Channel on her last voyage, with one of the boys from
the school on board, the pilot said, 4 It would be ns well
if the royal were lowered; I wish it was down.* Without
waiting for orders, and unobserved by the pilot, the boy
instantly mounted aloft and lowered the royal, and at the
next glance of the pilot to the mast-head, he perceived
that the sail had been let down. He exclaimed,* Who’s
done that job ? ’ The owner, who was on board, said,
* That was the little fellow whom I r>ut on board two (lavs
ago.* The pilot’s rejoinder was, ‘ Why, where could he
have been brought up ] * That boy had never seen the
6ea, or been on a real ship; but these and similar facts
which I could relate, appear to me to prove that it is pos¬
sible to turn bova into not inefficient sailors by appro¬
priate arrangements on dry land/ 1
Nothing could be more encouraging than this official
declaration, and we hope that it may lead to a rapid
development of the plan that we may soon see results as
pleasing as those which have so gratified us on the Con¬
tinent.
We now turn to a more strictly medical part of the
question. It is not only necessary to provide for, but to
preserve the sailor class. The health of these pillars of
the State has never been adequately cared for. Last year’s
Merchant Shipping Act will, we hope and believe, have
some effect in protecting the health of the British sailor,
but we fear that, like many other acts, it leaves numerous
passages through which the shipowners may escape. The
carelessness of all concerned is almost incredible. Men
constantly go to sea who are too ill to do their duty, and
whose illness is protracted for months, although a captain
may easily assure himself that his crew is in good health.
Again, the old routine as to diet is too often adhered to,
in spite of the many improvements that have rendered it
easy to replace the old salt meat with good, varied, and
nutritious food, without increasing the cost.
Shipowners should reflect over their own luxurious
meals on the uniform rations they provide their crews—
ask themselves how long they could subsist in health on
such a diet, and conscientiously discharge their duty to¬
wards those who are so dependant upon them.
-*-
THE INDIAN SANITARY COMMISSIONS.
Sanitary Commissions in India would appear to have
had a short, and in some instances, a somewhat troublous
career. In February, 1864, the Government of India di¬
rected that a Commission should be established at each of
the Presidency towns for the purpose of devising means
whereby effect should be given to the recommendations
by, or, as they were called, from their number, the thirty-
nine articles of the Royal Commission of 1859. Among
other instructions issued for their guidance, the relative
duties of president and members were clearly defined.
The former had, on all occasions, decisive authority, the
members having the right of recording their views in
minutes, and requiring that those minutes should be sub¬
mitted to Government. All civil and military authorities
were directed to afford to the Commissioners every assist¬
ance they might require.
A medical officer of standing was appointed President
of the Commission formed at Bombay, and the propriety
of the step doe3 not admit of question. What was right
there, however, does not appear to have been considered
suitable for Madras or Bengal, in both of which Presi¬
dencies the Commissions were presided over by civilians,
a medical, military, and engineer officer being nominated
as members of each. Another point of difference seems
to have existed in the composition of the Commissions.
In those of Bombay and Madras the medical member be¬
longed to the Indian Medical Service, but in Bengal an
officer of the Army Medical Department was appointed,
not in consequence of the official position he held at Cal¬
cutta, but, a3 recorded iu official documents, because it
was considered desirable to have on that Commission an
officer having special knowledge of European soldiers and
their requirements. It would, moreover, appear, that so
great was the advantage which arose from this arrange¬
ment, that when, on the approach of the hot season, the
president and secretary accompanied Government to its
summer retreat at Simla, where the Inspector-General of
the British Service also resided, documents requiring a
professional opinion were sent to the medical member at
Calcutta, some of the latter functionary’s being probably
among the number. Civil and military authorities had
been ordered by the Supreme Government to afford every
facility to the Commissioners, who were, in their collective
capacity, no more than a consultative body, and, in sub¬
mitting their respective views to the President, had fre¬
quently to comment upon opinions expressed by various
officers holding higher rank than themselves, or even tha n
the President; it is, therefore, a remarkable circumstance,
that among the reasons assigned for breaking up all these
Commissions, was, with reference to the one for Bengal, that
“ there was a constant risk of disagreement between the Com¬
missioners and the head of the Medical Department, British
troops, and other departments, at army head-quarter, but
especially with the former, his own subordinate, the Deputy-
Inspector General at the Presidency, being in the Com¬
mission.” Surely there must have been “ something the
matter ” with the Bengal authorities, for no such complaint
came either from Bombay or Madras. The former dis¬
tinctly asserted, that so far as they were concerned, no such
collisions had occurred ; neither should they have hap¬
pened in Bengal, had the authorities alluded to there been
constituted as are those of the minor Presi dencies.
Biit there is reason to believe that other circumstances
than those just stated really terminated the existence of
the Commissions in question ; that the true cause lay in
the fact that dissatisfaction was felt by the members of the
Bengal Commission at an officer of junior rank being ap¬
pointed to the vacant post of President, and that the op¬
portunity of their expressed dissatisfaction was taken to
reconstitute those of all three Presidencies. Thus ended
in May, 1866, consultative bodies whose births dated only
two years previously. During those two years, however,
the Bengal Commission not only submitted to Government
its views as to the means by which every one of the recom¬
mendations of the Home Commission might be carried
out, but laid down definite rules as to the manner of effect¬
ing needed improvements that bore upon the masses of
native population of that country.
■ +-
DETENTION OF LUNATICS.
Another important lunacy case has been decided in a
manner we can cordially approve. After only two or
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556 The Medical Press and Circular.
SCOTLAND.
December SO, 1808.
three minutes’ deliberation the jury decided that the rela¬
tives who subjected to restraint a man who was proved to
have committed acts of outrageous folly and clear in¬
sanity were justified in so doing. Questions of this kind
will constantly recur, and the profession has the deepest
interest in them. The case to which we allude was con¬
cluded in the Court of Common Pleas on the 18th inst.,
and the violence of the alleged lunatic, who now sought
redress on the ground that he had been improperly con¬
fined in an asylum, according to the medical evidence,
originated in intemperance. In the course of his summing
up Mr. Justice Smith pointed out that it was very im¬
portant that persons should not be shut up in lunatic
asylums from any improper motives ; but it was equally
important that those afflicted with mental disease rendering
them dangerous to others should not be at large. Further,
although it would be unjustifiable to shut up a harmless
imbecile in a lunatic asylum, it was the duty of the friends
of any one afflicted with a disease which made him
dangerous to others to prevent his being at large. To
justify detention the person should be of unsound mind
and dangerous to himself or others at the time when the
restraint was commenced. Mere passionate outbursts or
occasional instances of cruelty should not suffice ; but the
jury should be satisfied u that when the plaintiff was placed
in the asylum his reason had left its throne, and he had
become incapable of controlling bis actions.” We have
said that the jury were so satisfied, and that, so far as we
may judge from the published evidence, we concur in the
verdict. The case is interesting to medical practitioners as
an illustration of the responsibilities they assume in sign¬
ing certificates of lunacy, as well as from the fact thus
brought out that a patient may be in such a state of mind
as to render restraint necessary, but in a comparatively
short time may be so far recovered as to commence a
prosecution for improper detention, and to give his evi¬
dence in a coherent manner. There is nothing new in
this to those who are familiar with lunacy practice ; nor,
indeed, to the immense majority of medical men ; for cases
of delirium tremens and other results of intemperance are
unhappily too frequent. The lesson .to be learned from
the trial, then, is merely one of caution, for it exhibits in a
striking manner the risks of certifying to the unsoundness
of mind of a patient whose welfare seems to demand
restraint.
The profession is by no means careless of the danger;
and we have known practitioners who have uniformly re¬
fused to sign certificates. In large cities this may be no
inconvenience ; but in country districts it is obvious such
a course of action might lead to sad consequences. This
trial shows that a jury will not be necessarily led away by
present appearances from the evidence of what has pre¬
ceded.
- ■ -
SCOTLAND.
THE UNIVERSITIES OF EDINBURGH AND •
ABERDEEN.
These two Universities have not been unanimous in
their choice of a representative in the General Medical
Council. Mr. Syrae’s term of office expired some time ago.
The Edinburgh University re-elected him, but that of
Aberdeen has chosen its own Professor of the Practice of
Medicine, Dr. Macrobin. The Queen, by the advice of
her Privy Council, had to decide, and has selected the
latter gentleman.
THE ROYAL INFIRMARY, EDINBURGH.
Letters are still appearing in the Scotch papers on the
subject of the site of this institution. There seems to be
strong difference of opinion as to the best place for its
erection. Meetings have also been held to discuss the
point. On the 23rd instant a paper was read by Mr.
James Go wan at a meeting of the Architectural Institute
of Scotland, on “ The Edinburgh Infirmary and its Site,”
in which he suggested the extension of the present site by
acquiring additional ground to the east, and advocated the
raising of the level of the present site, and the building of
the new infirmary on the artificial platform so obtained. A
number of gentlemen took part in the discussion to which
the paper led. On the following evening an adjourned
debate was resumed at a special meeting of the Medico-
Chirurgical Society on the infirmary and its site, and was
continued by Dr. Sanders, Professor Balfour, Professor
Syme, and other medical gentlemen. The majority of the
speakers were in favour of the adoption of the site of
George Watson’s Hospital, and building upon it both a
medical and a surgical hospital.
ST. CUTHBERT’S.
The ceremony of opening the new poorhouse for the
parish of St. Cuthbert’s took place on the 21st instant, in
presence of a large number of the members of the acting
committee and of others interested in the parish. Sir
James Gardiner Baird presided, and delivered a brief con¬
gratulatory address, in which he remarked that the bouse
was as handsome and commodious an erection as they
would be justified in building for such a purpose. An
hospital had also been built, and he trusted that those who
suffered from sickness, and required to go to the hospital,
would find it a means of restoring them to health and
strength.
PRIVATE SCOTCH BILLS.
Seventeen of these were deposited in the Parliament
Office for the next session. Among them we find the
Edinburgh and District Water Bifl ; another to obtain
from the Edinburgh Water Company a supply of water
for the new poorhouse and buildings connected with it;
and another, the Edinburgh Royal Infirmary BilL
EDINBURGH.
On the 21st inst., the Edinburgh House of Refuge for
the Destitute held its annual meeting in the Council
Chamber. A number of eminent gentlemen were present,
and after the report had been read by the secretary, took
part in the proceedings.
The same evening the Society for the Relief of the Desti¬
tute Sick held their annual meeting in the Cr&igie Hall,
St. Andrew’s square. The chairman gave a practical
description of the working of the society, and one of the
speakers stated that “ next to the Royal Infirmary no
society in Ediuburgh did so much good.”
THE ROYAL MEDICAL SOCIETY.
The annual dinner of this society was held at the
Douglas Hotel. The toast of the evening was proposed by
the President, Mr. F. Pritchard Davies, and was received
with great enthusiasm. Professor Spence replied to the
toast of “ The Royal College of Physicians and Surgeons,”
and that of “ The Edinburgh Medical School ” was replied
to by Sir James Simpson. The next toast was “ The
Medical Council and Dr. Andrew Wood,” and Professor
Playfair acknowledged “The Sister Universities.” The
remaining toasts were u The Royal Infirmary,” u The
Clergy,” and “ The Ladies,” to which Professors Bennett,
Kelland, and Blackie respectively responded.
SCOTTISH REGISTRAR-GENERAL’S REPORT.
The monthly returns for the eight principal towns of
Scotland are still unfavourable. In November 2,474 deaths
were registered. Allowing for increase of population this
is 117 more than the average number for the month of
e
The Medical Frees and Circular.
NOTES ON CURRENT TOPICS.
December SO, 1806. 557
November in the last ten years, and is 425 more than the
number registered in the corresponding month of last year.
Scarlatina, though on the decrease, continues the most
fatal of the epidemics, having caused 272 deaths in the
eight towns.
-♦-
gobs 0ii tomit Statics.
Charity.
At this season of the year the usual appeals to the
charitable are being made in aid of the various institu¬
tions for the relief of the destitute and needy. No less
than four of these were noticed in the Times of the 23rd
inst. The Dudley-Stuart Refuge, founded upon the prin¬
ciples of discriminating charity ; receiving only those
whose characters will bear a careful investigation. The
Institution for Needle-women ; the object of which is to
find them partial employment when old or widowed, and
yet desirous of work. The Field Lane Refuges for the
homeless poor, which, in addition to affording temporary
relief, is making special efforts to reinstate them in their
former positions. And the Boys* Refuge Farm School,
which was opened on the 22nd inst., for the reformation
and employment of the destitute and homeless boys of Lon¬
don. There are others as well which we have not space to
enumerate, equally deserving of encouragement and su pport
We cannot speak too highly of such efforts, but it becomes
more and more self-evident that voluntary benevolence,
however liberal, can never meet the difficulties arising
out of our wide-spread and increasing pauperism.
Public Health.
From the weekly return of the Registrar General we
select as follows :—In the week ending Saturday, 19th
December, 3,350 deaths were registered in London and
thirteen other large towns, the r..u* id mortality being
twenty -seven per 1,000 persons living.
Active measures have at last been taken to secure a
more general adoption of vaccination in Sheffield, they
are, however, too recent to have yet considerably affected
the mortality from small-pox in that town ; during-the
fortnight ending last Saturday 17 more fatal cases of this
disease were then recorded, raising the total deaths from
this cause since 1st July to 268. Scarlatina, and fever,
principally of the typhus and typhoid type, are still fatally
prevalent iu Manchester, and typhoid fever in Leeds.
The typhus epidemic in Liverpool has declined iu the two
past weeks. In Hull several fatal unvacciuated cases of
small-pox were reported last week.
The deaths registered in London during the week were
1,558. The deaths in the present return exceed by eleven
the estimated amount, and arc more by seventy-two than
the number recorded in the preceding week.
The deaths from zymotic diseases were 332, the cor¬
rect average number being 354. Five deaths from small¬
pox, thirty-three from measles, 100 from scarlatina, seven¬
teen from diphtheria, thirty from whooping-cough, sixty-
one from typhus, and eleven from diarrhoea were regis¬
tered.
One hundred and sixty-six deaths occurred from phthisis,
190 from bronchitis, and 117 from pneumonia.
Diseases of the brain and nervous system proved fatal
to 194 persous, and seventy-eight persons died from dis¬
eases of the organs of circulation.
The Treatment of Consumption by Either.
The dyspepsia of consumptive patients, which is de¬
veloped to the greatest extent in those very stages of the
disease in which perfect assimilation is most needed, and
which thus tends to counteract every effort to introduce
cod-liver oil and other fatty bodies into the system just
at the moment when those remedies are virtually impor¬
tant, has met with a new and physiological system of
treatment in the use of ether and etherised cod-liver oil.
Dr. Foster, of Birmingham, has reprinted the observations
on the subject which he made at the British Medical
Association, and throws considerable light on the princi¬
ples and practice of the new treatment.
“Numerous independent inquiries have all ended by
pointing to tbe difficulty of assimilating fat as the con¬
stant characteristic of the dyspepsia of phthisis ; and
statistical observations tell that, in at least seventy-five
percent of consumptive jjatients, this defective assimila¬
tion occurs. Adding this fact to others, such as the early
and rapid disappearance of the fat stored in the tissues,
the development of the inability to digest fat, antecedent
to the local lesions, and the marked improvement observed
in patients when the digestion of fatty matter is restored,
we have, 1 think, evidence strong enough, in the absence
of any more precise indications, to demand that our first
efforts should be directed to improve this state of defec¬
tive assimilating power/
“ To pour oil into a patient’s stomach, without at the
same time taking measures to ensure its digestion, has
always appeared to me a crude kind of therapeutics.”
tt Experimental physiology has taught us that the only
fluids in the body which have the power of acting upon
fat, so as to render it fit for absorption, are the secretions
of the pancreas and the duodenal glands.”
u As Bernard has shown, the chief of these glands (the
pancreas) is most sensitive to nervous influences, ceasing
to form a healthy secretion from very slight irritation, and
even from emotional influences.”
In this paper I have, however, to propose a mode of
treatment which should, I think, in alt coses precede the
use of such remedies as pancreatic emulsion, because it
aims at remedying the disorder, not by artificially com¬
plementing the defective secretion, but by stimulating
the glands to renew their healthy action. Instead of
throwing into the system a substance that may yet be
formed in physiological quantities, it endeavours to pro¬
mote the normal flow of pancreatic juice.”
u The drug which gives us this power is Ether.”
• ••••••
“ In the out-patient departments of our hospitals, many
such cases occur, which are generally classed as dyspepsia.
Many cases of neuralgia are also to be met with in which
a decided improvement follows the increased power of
absorbing fatty food. To both classes of patients I gave
Ether sometimes in combination with cod-liver oil, some¬
times alone before meals. The results were most satis¬
factory ; the oil was digested more easily, and the nutrition
of the patients greatly improved.”
41 In my first cases, the Ether had been given in water
with hydrocyanic acid and bicarbonate of potash, twenty-
minim doses of Ether to each ounce of the mixture. The
Ether was afterwards added to cod-liver oil, about ten
minims added to every two drachms of oil at first, after¬
wards fifteen and twenty minims were occasionally given
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558 The Medical Press and Circular.
NOTES ON CURRENT TOPICS.
December SO, I 860 ,
in the same quantity of oil. In some cases the Ether was
administered in water alone, and taken a short time before
the oil. The effects were similar in all cases ; but for
convenience sake, and on account of its power of masking
the unpleasant properties of the oil, I now, generally, give
Ether mixed with cod-liver oil in the proportions men¬
tioned. In my second and systematic inquiry, I treated
fifty cases taken as they presented themselves at the
Dispensary.”
Sixteen were admitted in the first stage of the disease;
nineteen in the second stage; and fifteen in the thipd stage.
Of the Sixteen in the first stage (or stage of deposition)
seven improved in general symptoms and in physical
signs, gaining on an average over 7ilbs. each ; five
remained stationary, all gaining weight slightly; and only
four became worse.
Of the Nineteen cases in the second stage, six improved
in all respects, gaining, on an average, about 8lbs. each,
two cases gaining 14k lbs. and lOlbs. respectively ; six
remained stationary; "and seven became worse.
Of the Fifteen cases in the third stage, seven improved,
gaining, on an average, about 5lbs. each ; five remained
stationary ; and three became worse.
Of the total Fifty cases, Twenty improved, Sixteen
remained stationary, and Fourteen became worse.
Army Medical Promotion.
The reported reduction in the Army Medical Service
will, we imagine, if it be carried out, be the signal for very
many resignations of those assistant-surgeons who may not
like the indefinitely distant prospects of promotion. The
half-pay service to which it i3 believed that a large num¬
ber of assistant-surgeons will be consigned, does not
count for promotion ; and as the junior surgeons expect to
participate in the reduction, they will, of course, have
their turn before any of the assistant-surgeons can even
hope for an advance of rank. Were it not for this con¬
tingency the new men now at Netley might fix their hopes
of promotion about twelve years hence, when the large
number of their fellows who gained admission in 1858
were disposed of by death, resignation, or promotion.
Rumoured Reduction in the Army Medical
Department.
We learn, on the authority of a correspondent who
enjoys every opportunity of confirming the information,
that a very extensive reduction in the force of the Army
Medical Department is contemplated. We believe that
the new War Secretary is determined, at all risks, on
making John Bull’s little account more grateful to that
gentleman’s pocket, and is not likely to be deterred in his
economical schemes by any of the urgent claims for medical
services of which we have lately heard so much. If our
intelligence be correct, it is looked upon at Netley as most
likely that at least 100 assistant-surgeons will be placed on
half-pay for a year or two. If this intention is carried
out, we presume that no vacancies in the British service
will be filled up at the competitive examination next
February; and those students who have been looking for¬
ward to that trial to settle themselves in the service will
be compelled either to go to India or to remain unem¬
ployed.
The Vacancy in Vincent's Hospital, Dublin.
We are requested to state that Dr. Laffan is a candidate
for the vacancy in the medical staff of this hospital created
by Dr. O’Farrell’s death. Dr. Laffan is an active member
of the Catholic University medical staff, and as Registrar
to the Faculty of Medicine has a good deal of school work
thrown on him. He is known to the public as the author of a
pamphlet on medical reform, in which, among other
changes suggested, is contained a proposal for throwing
open the Irish dispensaries to competitive examinations.
We learn, on good authority, that it is probable that no
appointment will be made on the working staff of the hos¬
pital in consequence of Dr. O’Farrall’s death ; but it is
possible that the office of Consultant, to which Dr.
O’Farrall has of late years devoted himself, may be
filled up.
Professor Skoda.
We deeply regret to hear that this distinguished pro¬
fessor is dangerously ill, and that the profession in Ger¬
many is likely to lose its great auscultator. Everywhere
the intelligence will be heard with emotion, and we doubt
not that expressions of hope for his prolonged life will
naturally rise to the lips of all who read it. A medical
friend at Vienna writes to us as follows :—
“ Just as I am about going to send this I hear with
sorrow that Professor Skoda is very dangerously ilL When
I saw him a few weeks since he looked an invalid, or as if
some great change had passed over him, and, leaving him,
I remarked to an English Mend,
* There’s something rotten in the state of* our great Skoda.
So I fear that his sickness will be fatal.”
Propagation of Nuisances by the London
Corporation.
There would be a very sufficient cause of complaint on
the part of the citizens of Southwark in the fact that the
London Corporation permitted the filth and putrid offal of
the city markets to be set down in the centre of populous
districts; and it is simply outrageous that the Commis¬
sioners of Sewers, themselves the supposed guardians of
the health of the City, should be themselves the offenders.
To offend through their agents, and, perhaps, without
being fully aware of the existence of the nuisance, would
evidence no greater guilt than gross negligence ; but the
Commissioners of Sewers have done more, for they have
twice appeared in the law courts to plead under the shadow
of a contemptible legal quirk that they ought to be asked
to remove the filth which they had so kindly exported
from their own neighbourhood. The Commissioners have,
however, been brought to book in a very decisive manner ;
and although they endeavoured, in spite of evidence that
their own carts were in hourly use of the ground, to show
that they were not liable to abate the nuisance, the magis¬
trate proved his superior estimate of justice as against
law, by ordering the Commissioners forthwith to purify
themselves, and to pay all the costs.
The Recent Candidature of Sir D. J.
Corrigan.
Our readers will call to mind the “ protest,’’ as it has
been called, which, during the recent candidature of Sir
Dominic Corrigan for the representation of the City of
Dublin, was published with its imposing array of signatures
in our advertising columns. The document declared that,
“the undersigned, while admitting the desirability of
medical representation in Parliament, cannot support the
candidature of Sir D. J. Corrigan in consequence of the
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NOTES ON CURRENT TOPICS.
December SO, 1868. 559
pledge he has given to vote for the disestablishment of the
Irish Church.*
It would seem that some of the signatures appended
were those of persons under censure of the College for un¬
worthy professional conduct, and Sir D. J. Corrigan, there¬
fore, took occasion to bring the matter under the notice of
the College at a recent meeting, and to move the following
resolution, which was seconded by Dr. Hayden :—
“ That the College has no concern with the objects or
intention of a declaration headed, * We, the undersigned
Physicians and Surgeons of Dublin, &c.,* inserted in the
Dublin Evening Mail of Nov. 14th, and previously repeat¬
edly inserted in the several Dublin papers.
“ That, nevertheless, the College is of opinion that the
junction and association in that document of the signature
and title of the President of the College, with the names
of persons under reprobation and censure of the College
for unworthy professional conduct—not qualified as physi¬
cians or surgeons—not registered—with falsely assumed
titles—was a proceeding not calculated to maintain the
dignity of the College, and the position the College should
upnold before the profession ana the public.”
The following amendment was proposed by Dr. Beatty,
and seconded by Dr. Mollan.
“ That the declaration alluded to in Sir D. Corrigan’s
motion was not a collegiate act, but one in which members
of this College, and of other medical bodies took part in
their individual capacities.”
“ That it in no way affected the position and dignity of
this College. That this College has no power to interfere
with the right of its fellows to express their political
opinions, in any lawful manner; outside the walls of the
College.”
The amendment was carried.
Death of Sir Richard Mayne, K.C.B.
Sir Richard Mayne, K.C.B., died at half-past ten on
Saturday night, at his residence in Chester square. The
deceased who was born in Dublin in 1796, and was there¬
fore in his seventy-second year, was the son of the late
Hon. Edward Mayne, one of the judges of the Court of
Queen’s Bench in Ireland,
Sir Richard died with a very large abscess between the
peritoneum and the abdominal and iliac muscles. It was
opened two days before his death.
Although some of Sir Richard Mayne’s regulations sub¬
jected him to much adverse criticism, aud occasionally to
ridicule, his organization of the metropolitan police force,
which in these days has assumed almost the proportions
of an army, won for him several marks of approbation of
successive governments. He received the honour of a
Commandership of the Bath in 1847, and was knighted
in 1851, immediately after the Great Exhibition of that
year.
Medical Sooiety of London.
On Monday, January 4th, 1869, Mr. Henry Hancock,
F.R.C.S., will read a paper on “ Perforating Ulcer of the
Foot”
Children’s Hospital in Brighton.
It has been determined by several of the nobility and
gentry who are residents or visitors of Brighton to estab¬
lish at once an institution upon the plan adopted in many
of the large towns of this country and the Continent, to
be called the Brighton Hospital for Sick Children and
Convalescent Home. The latter will be supported by a
separate fund, provided partly by subscriptions and
partly by payments from the friends of the patients.
As it will be supported by voluntary contributions,
patients will be admitted from any part of the kingdom.
The objects of the institution are—1. The medical and
surgical treatment of sick children of the poor. 2. The
training of nurses for sick children. The medical officers
appointed are :—Physicians—W. Addison, F.R.C.P.,
F.R.S.; S. Barker, M.D., St. And. ; R. P. B. Taaffe, M.D.,
London. * Surgeons—J. Cordy Burrows, F.R.C.S., Eng. ;
Athol A. W. Johnson, Esq., F.R.C.S., Eng. (Exam.) ;
Thomas Moore, Esq., F.R.C.S., Eng. (Exam.) We con¬
gratulate the committee upon such a distinguished list of
patrons, and heartily wish them success in so desirable
an undertaking.
Professor Odling will deliver two lectures on “ The
Properties of Carbon,” at the Royal Institution, at three
p.m., on Thursday and Saturday next.
Dr. Joseph Father, surgeon, Bengal Establishment,
has been made a Companion of the Most Exalted Order of
the Star in India.
An annual sum of £50 has been granted by the Coun¬
cil of the Chemical Society for the purpose of scientific in¬
vestigation.
Subscriptions are being raised to build an asylum in
the Midland counties for non-pauper idiots. Large dona¬
tions have been already forthcoming.
At St Pancr&s the guardians are still rendering them¬
selves notorious. We understand they propose to have
only two, instead of three, medical officers to attend on
700 sick inmates.
The guardians of Bermondsey have raised the salaries
of their medical officers from £100 to £150 a-year ; and
the resident medical officer of the Leeds Public Dispensary
will receive £150 the first year, and £200 a-year after¬
wards, besides board and residence. This is a step in the
right direction.
MEDICO-SOCIAL PENCILLINGS OF LONDON
LIFE AND PRACTICE.
No. V.
At length the tinsel, in my case, met the fate of that on
the gingerbread of divers youths that figured ere my time,
and since, I have no doubt. It got brushed off, leaving
the surface beneath, sound and firm, if not lustrous and
“ dandifiedthe curtain that separated the real from the
ideal was drawn aside, and the broad outline of an horizon
supercharged with medical elements in a convulsed state
appeared, to surprise, if not to confound me, thanks to a
relation interested in my welfare, who, during a momen¬
tary calm and lull in the storm of evening parties and of
routs, that had been raging from all points of the social
compass—as a consequence ot my late success—took the
opportunity to inquire of me—with the determined serious¬
ness of one whose mind, heavily taxed and fully burthened,
evidently resolved at length to throw off the load at any
risk, callously regardless of consequences—“When did
I suppose it was probable that all this stuff and nonsense
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MEDICO-SOCIAL PENCILLINGS.
D-ce tuber 30, W g.
was likely to cease, and what did I really intend to do
with myself now that I was in a position to obtain a live¬
lihood ?”
The query was a distressing poser to me, for, up to the
time of it being thus pointedly put, I had not given the
subject one second’s consideration. Consequently, when
my guide, friend, and bursar thus took me to task, I be¬
came utterly bewildered ; the few words that he spoke
were equal ia effect upon me to what might have been
printed in a folio volume—physiologically speaking—they
might be regarded as a tiny portion of “ Liebig’s Extract
of Beef," possessing equal, if not superior, “ nutritive”
properties to a sliver “ off the round.”
I assured my relation that I had not paid any attention
to the “ worldly ” side of life’s picture ,* that, as he desired
it, I should do so, and finally I promised to inform him,
ere the close of the week, the result of my deliberations.
Within the time specified, I duly kept my promise, and
took the opportunity to state that I had thought over
the subject of my medical future, but had not arrived
at a satisfactory result, sought from him an extension of
time for the purpose, obtained it, and promised to decide
speedily.
The fact was—this is entre nous —as my relation, bless
his heart! is yet in the flesh—the fact was, that Cupid had
enslaved me ; I was desperately in love—fell into it
sudden—as an apoplectic sparrow drops from an eave into
a water-butt that may be beneath it, and I knew what
would occur—which did occur subsequently—whenever I
concluded my deliberations. I should be called on to pack
up and be off without further delay or procrastination, a
calamity in such cases generally regarded as most disas¬
trous in its consequences. Yet philosophers affirm that
love, and absence from the object of it, is far less fatal
to the human constitution than the “ red gum ” to babies.
At length the crisis came.
“ Well,” said my relation to me one night,—“ well, are
you for the Army, eh ?”
“No, Sir,” I replied.
M Why, eh ? No more parrying.”
“Well, Sir?”
“ Well what, Sir, eh ? Why not the Army, eh ?”
“Well, Sir, the fact is I know many fellows in the
Army, and they consider it nothing to boast of as a field
for the employment of professional skill, or as a means to
realise an income proportionate to the position a fellow is
compelled to maintain, unless private resources be em¬
ployed to fill up any deficiency, and you know too well,
Sir, that my resources—monetary, I mean—are nil.”
“Well, there’s the Navy ; the pay, I believe, is good,
and the opportunity to be frugal unlimited. There’s young
Buffkins, of Beefstown; he’s in the Navy. He was at
home, on leave, last summer—a tremendous swell, and
happy as a lark—the Navy, eh ?”
“The Navy is worse than the Army, Sir. Scalenus,
and many fellows that I know, left the service in disgust”
“ Not steady fellows. Scamps, I presume ?”
“ No, Sir; steady fellows, and many more would leave
the Naval Service too, if a fair chance to succeed other¬
wise offered for their acceptance.”
“ You astonish me; you object to become an Army Sur¬
geon; well, I don’t much mind that. You reject the Naval
Service; why you do so I should much like to be in¬
formed ; at the same time, now listen. I do not want to
force you into either service, yet I decidedly insist on re¬
questing you to commence active professional life, both
for your own sake, for your family’s sake, and for my ease
of mind. So choose your own path, and I shall assist you
to tread it as a gentleman should; you understand I”
“ I do, Sir. I told you why I objected to the Army.”
“ Yes; but you did not tell me why you objected to the
Navy.”
“ Well, Sir, Scalenus and others often tell our fellows
that a surgeon in the Navy is not a privileged person—
he is only tolerated—tolerated for the “ ship’s ” com¬
fort and preservation, and looked on as a piece of ma¬
chinery to be put in requisition when desirable—for
although styled a “commissioned officer,” he is always told
on board that he holds no rank. This may be hard enough
for a gentleman of education to stand, but he is also
compelled to make an animated pump-handle of his right
arm, and to salute when off duty in the public streets
(like a private soldier), not only the commander of the
vessel in • which he serves, but likewise that of any and
of every other vessel, whether small or large, on promenade
or at concert, anywhere and everywhere they may crop
up ! Now, imagine Cerebrum, well and respectably brought
up, highly educated and gentlemanly, having to raise his
pump-handle to Sartorius, who joined the service at the
mature age of fourteen years, and who is son of Nell
Gwynn,the bumboat woman, or of Barbary Pegof Brighton.
Why Private Juniper of the Guards is not obliged to
salute any but the officers of his corps.
“ Do you tell me so ?”
“ I do; and I also tell you that a naval surgeon has
often to wait the personal convenience of the officer on
duty for many of the necessary privileges he may be en¬
titled to, such as the use of a boat to go on shore, &c.,
although I have heard that in the French and other
Naval Services part of the system is that, at a certain
hour daily, a boat is in readiness with its crew waiting
orders to carry on shore all officers off duty, and who may
desire change of scene.”
“ That’s as it should be, and it is otherwise in the British
Navy ?”
“I have been told so, and have full faith in the
credibility of my authority. Yet there is a worse feature
in the service. It is this—that in the Navy you are nearly
one-fifth portion of the entire time on half-pay,and such
time does not count in your promotion nor in your
pension ; thus, before a naval surgeon can retire on what
is called twenty-five years’ service, he is compelled to
actually be from thirty to thirty-five years in the service.
Nor has he a claim for promotion nor for pay proportionate
to the gross time he may be in the service, but only
for the actual time served , so that the whole of the time
which he may be on the half-pay list is absolutely so much
time lost to himself and to his future prospects, which
prospects we can scarcely assume to be brilliant, if we
consider for a moment that his age, on retiring after
twenty-five years’ active service, must be three score years
or thereabouts.”
This is a glaring injustice to the naval surgeon. Eh ?
I couldn’t stand it 1 Bless me no !,”
“ But Sir, in the army full time from date of entrance,
whether on the Staff or otherwise, is allowed to him in
promotion and in his retiring pension. In a word, an
Army surgeon retiring on twenty-five years’ service ranks
as Deputy Inspector-General A Navy surgeon may he
thirty or thirty-five years in the service, and may not
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CORRESPONDENCE.
Deeeteto UUL 061
have served twenty-five years, consequently, he cannot re¬
tire with equivalent advantages to those of the Array
surgeon.
Well, well, what a pickle, go on boy.
You see Sir, there is a difference in the Navy between
time in the service and active service ; the former is the
grain with the hull and the stalk, the latter the grain only.
Labour and seed and a fertile soil are employed to pro¬
duce the hull for the winds and the grain for the market.
Regard the grain as the active service in the Navy, the
hull as the time on the half pay list, and the stalk, bearing
both grain and hull, the full time a fellow serves.”
“What robbery! Then if two brothers join the Army
and Navy as surgeons, at the same time, the naval sur-
eon must remain many more years than the Army surgeon,
ere he can retire on pay and with rank equal to his brother
owing to this half-pay list bugbear, eh ?
“ Precisely so, Sir, that's correct ; and although he may
have seen far more perilous service, and have roughed it
in all quarters of the globe.”
“Well, I never.”
“ Nor I, Sir; and now that we're on the subject I just
remember having read something to the effect that naval
surgeons should not fc be entitled to receive their shares of
prize money nor decorations, unless on extraordinary occa¬
sions.
“ Monstrous. Who is to blame for all this, the Admi¬
ralty, eh ?”
“ Both the Admiralty, the surgeons in the service, and
the profession outside of it. Would you believe, Sir, that
I have been told that at Boards for medical survey, non¬
medical officers—naval officers, in fact—sit, discuss, and
vote on thosh purely medical questions!”
“ Then the Naval*Medical Service must be a muddle of
red tape and humbug.
Above all, Sir, surgeons are denied not only rank on
board ship, but even on shore in their social capacity. Now
as an example of this, let us suppose a medical officer in
company with a sub-lieutenant, or even a midshipman in¬
vited to dine at a private gentleman's table, either officer,
the very “middy” according to the Admiralty regula¬
tions, takes precedence of the medical officer, no matter
what his supposed rank may be, even were it that of a
deputy-inspector General of fleets, &c.
“ You are right my boy, not to join, don't.”
“ Indeed I will not, Sir, nor will I advise any fellow with
whom I am acquainted to do so until those glaring wrongs
be rectified.”
“ Bravo ! But what do you intend to do, try a Poor-law
appointment, and eat your way up, as lawyers do, eh ?”
“ No, Sir, until the Poor-law Boards are by Act of Par¬
liament compelled to pay their medical officers .£365 per
annum, which is less than a guinea a day,—certainly not
exorbitant pajr for ,which to get thoroughly competent
medical practitioners to conscientiously discharge the duties.
I do not purpose to try that quarter ; and you know full
well, Sir, that local interest ana influence are at present the
great sources through which candidates, in most instances,
obtain dispensary and union appointments. Competency
and ability to perform the duties of the appointments are
quite a secondary consideration.”
“ Well, what’s your game, eh ?”
“ I think, Sir, I’ll seek in London fame and fortune.”
“ London, eh ? London, eh ?”
“Yes, Sir.”
“ Well, well, likely you're wise. I'm satisfied. Bow
Bells, Whittington, and London; ding dong; good night.”
Quid Nunc.
THE PROJECTED APPOINTMENTS AT THE
DUBLIN COLLEGE OF SCIENCE.
In our recent notice of the changes which art pending
in this Institution, we stated that Professor Wyrille
Thompson would probably occupy the chair of Ecology,
now held by Professor Traquair in addition to that of
Botany. This statement is not accurately correct. The
Professorships of Zoology and that of Botany are per¬
fectly distinct at present, and their amalgamation is only
a surmise. Professor Traquair is now, and will remain
(unless he should seek for and obtain the chair, about to
be vacated by Professor Thompson at Belfast) Professor of
Zoology at the College of Science. Professor Thompson
has been already appointed to be Botanical Professoriate,
but whether he will accept the election and leave Belfast,
whether Professor Traquair will succeed him there, or
whether, if so, the Professorships of Botany and Zoology
in the College of Science will be incorporated into one, U
at present matter for speculation.
The impression is current that Professor Thompson will
hardly vacate his present office unless he is appointed to
the Professorship of Botany in the University of Dublin,
without which his acceptance of office at the College of
Science would envolve a very serious loss of income.
-♦-
$0rmg0tilmu.e.
[We are happy to give space to the following letters, which
have been forwarded to us for publication ; if, on enquiry, the
facts stated prove true, the sooner the stigma be removed the
better for the credit of the profession.]
TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR,
Sir, —I forward by this post a copy of the Somerset Gazette ,
ublished this day, containing what I believe to be a gross
bel on the profession of surgery, of which the College is the
natural guardian. The passage to which I refer, is to the effect
that—“ in past times Mr. Oakley (the governor of the jail) has
actually had application from members of the surgical profes¬
sion to perform the duties of hangman,” and I think it devolves
on the College of Surgeons to demand some explanation of this
most extraordinary statement. I wrote to the editor a note,
of which I enclose a copy, but feel quite powerless to enforce
justice against such odds.
I have the honour to be, Sir,
Tour very obedient humble servant,
J. Caret, M.D. University of London,
and Member of the College of Surgeons.
To the Secretary of the
College of Surgeons.
TO THE EDITOR Of THE SOMERSET GAZETTE.
Sib, _An article in the Somerset Gazette of to-day, contains
a statement that “ in past times Mr. Oakley has actually had
application from members of the surgical profession, (why did
he not include the clergy and legal professions?) willing
to perform the office of hangman.” A gentleman such as Mr.
Oakley would not wantonly slander a noble profession, every
natural instinct of which is the saving of human life, without
some colourable pretext for so doing.
Tramps and scoundrels of every kind have from time to time
applied to me for money and assistance on the plea that they
were medical men, but in every case in which I have taken the
trouble to investigate, I have found their statements wholly
false, that they never were members of the profession at all; the
highest c laim to that title ever found by me amongst them was
that at some time or other they had been employed by medical
men to assist them when in want of help.
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562 4h§ Medical Press and Circular.
NOTICES TO CORRESPONDENTS.
Deoembsr SO, 1868.
Surely Mr. Oakley will not refuse to giye the names and
degrees of those (< members of the surgical profession” to whom
he alludes, for / must, until he does, consider that he has been
groady imposed upon in the matter to which I have referred,
or otherwise that this statement is a pleasant invention of his
own.
I have the honour to be, Sir,
Your very obedient servant,
* J. Cabst, M.D. University of London,
and Member of the Royal College of Surgeons, London.
2 Hamden Villas, Taunton,
December 26th, 1868.
— -4 -
DEATH OF DR. OTERRALL, OF DUBLIN.
We sincerely regret that we have to announce the death
of Dr. Joseph M. O'Ferrall, whioh oocurred on Wednesday
last, the 23rd inst, at his residenoe, 15 Merrion square,
North. For some years he had suffered from defective
vision, yet, nevertheless, so valuable was his diagnostic
skill, and so excellent his judgment, that he was exten¬
sively consulted by his professional brethren and the
public up to the week in which his lamented decease took
plaoe. He commenced his professional career as an ap¬
prentice of the illustrious Richard Carmichael, the teacher
of so many eminent surgeons. His industry was remark¬
able from the outset, and he utilised to the fullest extent
the great opportunities which the House of Industry Hos¬
pitals then afforded. Professer R. W. Smith has informed
us that he resided in the Richmond Hospital for no less a
period than five years. He became a licentiate of the
Royal College of Surgeons in 1818, and five years after¬
wards, an unusually short interval, was chosen a member
of that body. Having located himself in Sackville street,
the public soon became aware of the fulness of his profes¬
sional knowledge, and he rapidly acquired an extensive
practice.. Unable to procure an appointment to any of the
then existing hospitals, he gladly availed himself of the
connection with St. Vincent’s Hospital, which he retained
from 1834, when it was founded, to the day of his death.
At first he was the sole medical officer, but afterwards, the
late lamented Dr. Bellingham was his colleague, and since
his decease, Dr. O’Ferrall acted as Chief of the present
staff. Many of the clinical lectures therein delivered, and
most of the numerous essays on the cases there presented
to his observation, have been published in the Dublin
Quarterly Journal , the Transactions qf the Pathological
Society, the various series of the Hospital Gazette, and in
this Journal.
His various contributions number 125, and as all ex¬
hibit a diagnostic skill rarely equalled, contain valuable
practical suggestions, and are written in a clear, concise,
and scholarly manner, they are well worthy of republica¬
tion. A few of the more original of these essays may be
enumerated “ On Ileo-caecal Abscess “ The Pathology
and Treatment of Varicose Veins ;* u On the Cure of Pop¬
liteal Aneurism by Compression of the Artery at the
Groin “ The Diagnosis of Hip Disease “ On Abscess,
with Fistulse of the Breast;” “On the Structure and
Diseases of an Apparatus surrounding the Eye-ball, and a
New Operation lor Extirpation of that Organ “ The
Treatment of Anthrax.” The operative procedure which
has made his name most famous is the elevation of a tu¬
mour, or other part about to be removed, for the purpose
of emptying it of blood as fully as may be.
.The disease, which, after several months of suffering, ter¬
minated fatally, was of a paralytic character, first attacking
one lower extremity, and then the other. A few hours
before his death, he was attacked with difficulty of breath¬
ing, which his professional brethren who attended him re¬
garded as solely due to paralysis of the diaphragm, and
wholly beyond the power of remedies. In private life
Dr. O’Ferrall was most warmly esteemed, and his removal,
as a generous patron of art, will be deeply felt. ,
DR^YAN.
A most brilliant career of usefulness and talent has
been brought to a termination by the early death, last
week, of Dr. Ryan, late of Middleton, Co. Cork, who, at
the early age of twenty-four years has been shorn of the
rewards of a very zealous studentship in medicine. He
had gained the highest qualification in his profession—the
Directorate in Medicine, the Mastership in Snigery, and
the Baccalaureate in Arts, and had signalised his competi¬
tion for these by obtaining a gold medal in Medicine, and
another in six languages in the Queen’s University in Ire¬
land. 0 .
Our profession can ill spare so promising a mem be., and
it could, perhaps, have better spared one whose genius had
had time to germinate.
SULPHATE OF NICKEL IN NEURALGIA
The interest of the following remarks does not lie in the em¬
ployment of the sulphate of nickel in neuralgia, but in its
therapeutic effects. We are told that it is a gentle tonic,
acting like the preparations of iron and quinia. In this case,
however, it seemed to exercise a sedative influence, more closely
resembling that of the bromide of potassium.
Mrs. B. has suffered with neuralgia more than three years.
During the last two months the paroxysms have been very
violent and frequent—occurring every few minutes. She has
taken iron, quinine, arsenic, strychnine, colchicum, aconite,
morphine, chloroform, valerian, zinc, mercury, electricity, and
many other remedial agents, with only temporary relief. A n
Prof. Simpson had used the sulphate of nickel successfully in
a case of severe and obstinate periodic headache, I concluded
to try it, and began February 19th by giving her half-grain
doses three times a day. In less than a week the paroxysms
were reduced to only one within twenty-four hours ; this came
on at noon. On last Sunday (March 1st) it did not commence
until about 3 p.m. I was present and gave one grain of the
sulphate, notwithstanding she had taken her regular doses
that day. Its sedative action was speedily manifested in re*
ducing the pulse and producing sleep. All symptoms of the
paroxysm disappeared, and Mrs. B. states that they did not
return until 7 o'clock. In this case the sulphate of nickel has
given more permanent relief than anything else; Mrs. B. tells
me that it soothes her quicker than morphine, and is not fol¬
lowed by any unpleasant effects .—Richmond Medical Journal.
- ♦ .
NOTICES TO CORRESPONDENTS.
A. B. I*—You will find ths subject treated in the lest volume of the
“Philosophical Transactions.”
Ahti-Blomoeopath.—Y ou were right in declining to meet in consulta¬
tion, as there oould be no discussion between parties, one of whoa is
committed to dogma the other denies.
Ma Adams —The case shall appear if a report be sent.
Da. Hon by. —The opinion of our contemporary in questions of prac¬
tical medicine is not likely to arrest the attention of the profession.
8ulphur Pastilles.— A correspondent has triod Duncan end Floek-
art’s, and those of Messrs. Bailey, of Wolverhampton. He prefers the
latter, as they more completely bum out. They eanbe had in London
from Hooper, of Pali Mail, and most chemists.
Dr. Pratt, Pool*.— Your kind suggestion shall secure our best atten¬
tion. We propose to devote a port.on of onr space for tte future to a
record of Continental progress in the English language.
Dr. Lamprey. —The “Case of Eachondromi" received with thanks.
The illustrations, though very graphic, are hardly finished with sueh
accuracy as to fit them for our eolurans. We have sent them to the en-
G iver for his opinion. Do wo understand your letter to imply that you
ve had them already engraved in a different form from the proofs sent ?
We shall be glad to receive the other cases.
In onr lsst attention was drawn to an * ■* Extraordinary Oase of Epilepsy ”
communicated to the Surgical Society by Dr. Kirkead. Tbs authors
name should have been Kinkead, and not as erroneously printed.
To the Editor of the Medical Press and Circular.
Sir,
Seeing my name mentioned in connection with the Belfost Chair;
(about to become vacant), will you allow ms tp stats that I havt no inten¬
tion of offering myself for the rrofessorshfp, which, however, ten years
•go would have been for me an extremely inviting opportunity.
I am. Sir,
Your obedient servant,
T. 8 . Cobbold, M.D., F.R.8.
Swiney Lecturer on Geology.
Dr. Alvrxd Clark*, Shorncltwr.— We shall at all times be glad to
publish the transactions of the society mentioned, should the reports uot
be too lengthy,
t. WtiAoif
Dr.
ox Yarm will please receive our beet thanks,
“Dr. Sarto* on Syphilis H fe unavoidably held over tfilMr next
Tux valuable proceedings at the meeting or the Junior Surgical Society
will appear in our next
Digitized by kjOOQle
CONTENTS
♦
VOLUME VI. JULY TO DECEMBER, 1868.
Abattoir* and tho haunt of animals,
91.
Abdominal aneurism, 330. I
Abergele catastrophe, the victims of i
the, 107. .
Aberdeen Koyal Infirmary and Lunatic
Asylum, 536.
Aberdeen University, 261.
Abortion as a cause of insanity, 342.
Abyssinian rewards, the, 219.
Aconite and quinia in neuralgia. Dr.
H. M. James on, 5.
Address delivered at tho opening of 1
the General Medical Council, 9.
Alleged poisoning, case of, 513, i
Althaus, Dr., on certain points in tho i
physiology and pathology of the''
fifth pair of cerebral nerves, 525. |
Analysis of potable water, 85.
Anderson’s University, Glasgow, 264.
Antidote for strychnia, 138.
Aortic valves, Dr. & Jaccoud on in¬
sufficiency of the, 1.
Apothecaries’ Society of London, 259.
Appointments, 20, 155, 176, 197,
220, 286, 20$ 324, 342, 364, 402,
422, 440, 490, 500, 520, 54$
Army medical department—examina¬
tion papers, 174.
Army medical department—official
regulations—see Student’s No.,
VoL 6, 249.
Army medical service, 245. !
Army Medico-Chirurgical Society of
Portsmouth, the, 170.
Association for Promoting the Ex¬
tension of the Contagious Diseases'
Act, 20. .
Austria and the cattle plague, 47.
Bamberger, Professor, on acute poi¬
soning with phosphorus* 106, .132.
Bandages and splints (Review), 57.*
Belfast branch of the Royal Medical
Benevolent Fund Society of Ireland,
154.
Bequests to medical charities, 530'.
Births, 70, 134, 197, 220, 286, 884,
402, 422, 500, 520.
!
Bismuth, adulteration of sub-nitrate I
of, 208.
Black varnish, 86.
Boiler explosion in St. James's, 364.
Bris, Madame Alexandrine, 196.
British Association for the Advance¬
ment of Science—meeting at Nor¬
wich—Professor Tyndall’s address,
214.
British Association, the, 134 ; at
Norwich, 176.
British Medical Association, meeting
at Oxford, 148.
British Pharmaoentical Society’s Con¬
ference, 387.
Bristol Board of Guardians, 401.
Bristol Medical School, 267.
> Burials (Ireland) Bill, 47.
Byelaws and regulations of licensing '
bodies in Scotland, 260.
Cambridge University, 251
Carbolic acid, 86
Case of alleged poisoning, 516
Case of Dr. Macdonald, 14 ; 1
Cattle plague orders, the, 191
Chancellorship of the University of
Edinburgh, 286
Chemistry, elements of (Review), 123
Chemical reactions produced by light,
on a new series of, 527
Children’s Hospital, East London, 1
280.
Chcjlera and diarrhoea, last summer's, ‘
m . i
Cholera at Paris in 1865-6, 177 1
Chloroform, 460
Chloroform in convulsions, Dr. J. j
Dickie on the value of, 827 !
Cinchona in Jamaica, 90
Cockchafer, the, 156
College of Surgeons of Edinburgh,
Royal, 261
College of Surgeons in Ireland, Royal,
288 I
Colon in young children, length of I
the, 516
Colonial degrees, registration of, 13 I
Colohial Practitioners’ Act, the, 10 *
Colour-blindness, 3 i \
Colourless iodine, 208
Communicability of phthisis, 519
Composition of comets, the, 207
Condition of the Thames, tho, 196
Consumption and dyspepsia, 479
CORRESPONDENCE.' -
A Conservative M.D. Ediu., on the
reform of the Medical Council,
direct and indirect, 193
A Conservative M.D. on thb contest
lor tho Universities of Edinburgh
* 8ml St. Andrew's, 421
A Governor of a London hospital 6n
tfie ailment of tho medical body
corporate, 300
A medical student on fistula in ahq,
175
A member of the profession on tho dis¬
tinction of general practitioners,
sprgeons, ana physicians, 17
A member of the Senate of tho Uni¬
versity of Cambridge on representa¬
tion in the Medical Council, 175
A member of three Corporations on
tho London College of Physicians,
240
An hospital physician on sick clubs,
184
Armstrong, Dr. C., on the representa¬
tion of the Universities of Glasgow
and Aberdeen, 286
Ashe, Dr., on medical reform, 68, 153
Atkins, Mr., on the Pharmacy Bill,
68
Azygos on chilblains, 460
Barfon, Dr., on the nature and treat¬
ment of syphilis, 507
Butler, Mr. N. J., on the treatment ,,
1 of actrte rheumatism, 133
Cantab on medical rdfonn, 109 J
Car^y, Dr., on a stigma on the pro¬
fession, 561
Cogfiovi on reform in medical educa¬
tion, 540 1 1 y J °*
j : . r.l* . HW
| i'.i r
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vi
CONTENTS OF VOLUME VI.
The Medical Press and Circular.
Crisp, Dr., on the Carmichael prize
essayB, 88 ; on medical reform, 505
Croft/Dr., on the Norwegian self¬
acting cooking apparatus, 858
Davey, Dr. J. G., on the Fellow¬
ship of the Royal College of Physi¬
cians of London, 218; on the title
of doctor, 285
Dermatologist, an historical sketch of
dermatology, 506
Donovan, Dr., on iodide of sulphur in
the treatment of “ porrigo favosa,"
69
Drysdale, Dr., on Dr. P. James’ plan
of reforming the Medical Council,
19; on large families and public
health, 478 ; on the Fellowship of
the College of Physicians, 497
£. L on the Contagious Diseases
Act, 109
Graham, Dr., on the poisonous effects
of “cytisus laburnum,” 110
Griffith, Mr., on the Turkish bath in
acute bronchitis, 18; on urea and
uric acid, 188
Griffith, Dr., on Dr. MacCormac’s
Plan of Ventilation, 497
Hargrave, Dr., on the General Council
or Medical Education and Registra¬
tion, 108
Hearae, Mr. E., on the medical
journals and medical candidates,
440
Hutchinson, J., on the Oxford Meet¬
ing of the British Medical Associa¬
tion; arrangements for an annual
museum, 188
Hyne, Mr., on medical representation
in Parliament, 497
Lewis on treatment of the apparently
drowned, 17
MacCormac, Dr. H., on ventilation,
507
Madden, Surgeon-major, on com¬
pound and comminuted fracture of
the patella, 285
Mapotner, Dr. E: D*, on medical re¬
presentation in Parliament, 459
Medical elector, a, on Sir D. J. Corri¬
gan’s candidature. 477
Memo, Mr., on Liebig's food for in¬
fants, 18
M.D. on the title of dootor, 240, 801
M. P. A. on the representation in the
Medical Council, 192
Not a Disciple of Malthus on* Lord
Amberley, 240
Noune, Mr., on the Sanitary Museum
at Brighton, 858
Phelan, Mr. D., on puerperal fever in
lying-in hospitals, 198; on lying-
in hospitals and extern maternities,
877; on statistics of scarlatina, 477
Pitman, Mr. H., on a history of the
licensing system, 506
Reid, Dr., on underpaid poor-law
medical officers in England, 183
Rivington, Walter, on the represen¬
tation of the profession on the
Medical Council, 801; the “ Lan¬
cet ” exposed, 312 ; on timidity, 439
R. N. on the scarcity of medical
officers in the Navy, 891
St. Pancras, jun., on dining, 109
Sanitas on dining, 46
Williams, Dr., on reform in the
Medical Council, 88
Croup, lime inhalation in, 194
Cupping g las se s in the treatment of
anthrax, 194
Daylight, the approximate estima¬
tion of the intensity of total, 551
Deaths, 20, 184, 286, 202, 824, 342,
364, 384, 402, 422, 500
Diabetes mellitus, 212
Dickie, Dr. J., on the value of chlo¬
roform in convulsions, 827
Diplomas in state medicine, 80
Dipsomaniacs, 134
Discovery in regard to blood-letting,
530
Dismemberment of pharmacy from
medicine, Donovan, Mr. M., on,
523
Diseases and injuries of the eye, Dr.
A. H. Jacob on, 521
Disease caused by heat in America,
176
Donovan, Mr. M., on the dismember¬
ment of pharmacy from medicine,
523
Drainage in the metropolis, 410
Drysdale, Dr. C., on prostitution, 45
Dublin College of Science, projected
appointments at the, 561
Dublin University, 256
Duke of Brabant, health of the, 828
Durham University, 258
Dyspepsia and consumption, 479
Earth closets, 479
Early pregnancy, 175
East London Children's Hospital, 280
Edinburgh and St Andrew's Univer¬
sities, 489
Edinburgh Philosophical Institution,
134, 456
Edinburgh Royal College of Surgeons,
261
Edinburgh Royal Infirmary, 613
Edinburgh University, 460
Education and training considered as
a subject for legislation (Review),
58
Elements of chemistry (Review), 128
Election of Chancellor, Edinburgh
University, 476
Elections at the King’s and Queen's
College of Physicians in Ireland,
888
English Poor-law medical service, 244
Entozoa in carbuncle, 508
Epilepsy, Dr. C. Little on, 184
Epilepsy, lactate of zinc in, 105
Experiments on blood, 86
Explosion of a boiler in St. James's,
Extractum carnis, 551
Eye diseases and injuries, Dr. A. H.
Jacob on, 521
Faculty of Physicians and Surgeons
of Glasgow, 262 ; election of offi¬
cers, 897
Fever and inflammation, Dr. B. Kelly
on, 208
Food
92
question. Dr. MacCormac on,
FOREIGN MEDICAL LITERA¬
TURE.
Case of Hemiopia, communicated by
Dr. M. K. Loewegren, translated
by Dr. W. D. Moore, 390, 420
On diabetes mellitus and paresis of
the right extremities, in consequence
of a tumour in the medulla oblon-
Professor Bamberger on acute poison¬
ing with phosphorus, translated by
Dr. W. D. Moore, 106, 132
Recent contributions to the theory of
the innervation of the heart and
blood-vessels, translated by Dr. W.
D. Moore, 142, 279, 808
Transactions of the Swedish Society
of Physicians, translated by Dr. W.
D. Moore, 28
Forensic medicine (Review), 102
Fractures of the elbow joint, 516
Gall-stones, 519
Gamgee’s experiment on blood, 86
General Council of Medical Education
and Registration, 12, 19, 30, 37,
56, 61, 76
Glasgow and Aberdeen Universities,
489, 513, 536
Glasgow Faculty of Physicians and
Surgeons, election of officers, 397
Glasgow University, 261
Glasgow University new bnildings,
laying the foundation stone of the,
by tne Prince and Princess of
Wales, 337
Groundless charge against a medical
officer, 528
Guy’s Hospital, London, 89
Hamilton, Mr. E., on the spinal ice-
bag in the treatment of delirium
tremens, 291
Hargraves, Dr. William’s introduc¬
tory lecture at Royal College of
Surgeons in Ireland
Harley, Dr. John, testimonial to, 90
Harrowgate waters, 551
Hayden, Dr. Thomas, on the patho¬
logy and significance of certain endo¬
cardial murmurs, 205
Health of London, the, 19
Health of Sootland, 456
Health of the Duka of Brabant, 828
Heat-apoplexy, on, 519
Heat-stroke, Dr. C. Handheld Jones
on, 428, 445, 464
Homoeopathy in the Aberdeen Infir¬
mary, 514
HOSPITAL REPORTS.
City of Dublin Hospital.—Remark¬
able and very rare cate of spreading
gangrene of the left upper extremity,
resulting from dislocation of too
head of humerus into the axilla;
fatal termination: under Mr. Croly,
6 ; cases of onychia, with operation
for removal of the diseased nail,
under Mr. Croly, 28; double an¬
thrax on the abdomen, single an¬
thrax on the abdomen, noma,
pudendi, under Mr. Croly, 65;
ranula of large size; harelip, under
Mr. Croly, 74 ; retention of urine
in a child, equino-varas in both
feet; tenotomy, under Mr. Croly,
101; cancrum oris, under Mr. Croly,
122; luxation of lower jaw, under
Mr. Croly, 189; two cases of chorea
treated by the ice-bag, under Dr.
J. H. Benson, 168; case of bent
knee, in which division of the ham¬
string tendons was performed, under
Mr. Croly, 164.
Cork street Fever Hospital.—Cases
under Dr. Grimshaw, 488.
County Limerick Infirmaiy.—Circum¬
scribed femoro-popliteal aneurism of
left leg; failure of pressure liga¬
ture of femoral artery in Portal's
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The Medical Press and Circular.
CONTENTS OP VOLUME VI.
vii
space: death from pyamia and
gangrene of foot and leg, under Dr.
T. J. Elston, 207.
Dr. Steeveua’ Hospital.—Retention of
nrine, with puncture of bladder—
large malignant tumour of breast,
under Mr. Colles, 76; Holt's opera¬
tion for stricture, under Mr. Hamil¬
ton, 100 ; cystic bronchocele, under
Dr. McDonnell, 123; exophthalmia,
under Mr. Colles, 139; the antiseptic
treatment, 165 ; case of leucocy-
thsemia, under Dr. H. Freke, 205 ;
fracture of the clavicle, caused by
muscular action, under Mr. Hamil¬
ton, 225 ; chronic larvgngitis, un¬
der Mr. Swan, 277; abscess of the
prostate gland, under Mr. Swan,
299; ptynasis versicolor and idrosis,
under Dr. Freke, 804.
Edinburgh Royal Infirmary.—Cases of
aneurism treated by iodide of potas¬
sium, under Dr. G. W. Balfour,
829, 805, 890.
King's College Hospital.—Atuemia,
phthisis, and cancer of liver, under
Dr. Beale, 99, 122, 189, 165, 186,
206, 226, 871, 888, 409, 488.
London Hospital—Case of varicocele
dependent on self-abuse, under Mr.
Rivington, 486.
Mercer* Hospital.—Case of ilius,
under Dr. Eames, 851; popliteal
aneurism cured bv double compres¬
sion, under Dr. Morgan, 870; cal¬
culus in the bladder—lithotrity—
successful issue, by Mr. Morgan,
486; remarkable fistulous commu¬
nication with the kidney in the
lumbar regioo, and discharge of
several calculi therefrom—lateral
Sharpey, 505, 624; locomotor ataxy
supervening upon syphilitic taint-
successful results from anti-syphi¬
litic treatment, under Mr. D. B.
Hewitt, 548.
Richmond Surgical Hospital.—Epi¬
thelioma of fourteen years' duration
situated on left cheek over the
malar eminence, under Mr. Wm.
Stokes, 8 ; enormous incarcerated
and subsequently strangulated in-
guino-scrotal hernia, probably con¬
genital, under Mr. Stokes, 26;
excision of the upper jaw, under
Mr. W. Stokes, 54 ; strangulated
inguino-scrotal hernia, under Mr.
W. Stokes, 75 ; urethral stricture,
under Mr. W. Stokes, 224 ; multi-
locular ovarian tumour, ovariotomy,
unsuccessful results, under Mr. W.
Stokes, 486.
St George's Hospital.—Abdominal
tumours, under Dr. Ogle, 227, 278,
805, 456, 547.
Westmoreland Lock Hospital.—Pri¬
mary uterine sores, under Mr. Mor¬
gan, 889; suppuration of the in¬
guinal glanas simulating the
“ Bubon d'Emblee," with uterine
primary sore, under Mr. Morgan,
How to deal with our criminals, 541
Hughes, Dr. J. S., short notes on
Hice, 52, 118
Hunterian Medical Society of Edin¬
burgh. 460
Hydrophobia, 822
Hypodermio use of morphia during
ansesthesia, 195
Illness of Dr. R. B. Guinness, 499
Inebriate asylums, 401
Infirmary at Oldham, 897
Interesting case of labour, an, 195
INTRODUCTORY LECTURES.
City of Dublin Hospital, Dr. J. H
Benson, 408
Guy's Hospital, Dr. Moxon, 822.
Jervis Street Hospital, Dr. S. M.
MoSwiney, 461.
King’s College, Dr. Guy, 818
London Hospital, Mr. G. Cutchell,
315
Liverpool Royal Infirmary, Mr. Fred.
T. Roberts, 889, 860
Meath Hospital, Dublin, Mr. Rawdon
Macnamara's inaugural address,
481
Pharmaceutical Society of Great
Britain, Mr. G. W. Sandford, 841
Queen's College, Birmingham, Lord
Lyttelton, 820
Royal College of Surgeons in Ireland,
Dr. Wm. Hargreave, 441
University College, Prof. Eriohsen,
821.
Ireland, the Apothecaries' Hall of,
260
Irish oyster culture, the, 281
Irish Poor-law medical service, 245
Irish Schools of Medicine :—
School of Physic, University of
Dublin. School of Surgery, Royal
College of Surgeons. The Ledwich
School of Medicine, Peter-street.
Steeven's Hospital School. The
Carmichael School of Medicine.
The Medical School of the Catholic
University. The City of Dublin
Hospital. The Meath Hospital and
County Dublin Infirmary. St.
Vincent's Hospital. The Adelaide
Hospital. Sir Patrick Don’s Hos¬
pital. The Mater MisericorcUa
Hospital Mercers' Hospital. Jer¬
vis street Hospital. Rotnndo Lying-
in Hospital. The Coombe Lying-
in Hospital, 268, 269
Irish universities and licensing bodies,
the, 64
Is the administration of wine in acute
diseases a mere fashion ? Dr. T. W.
Grimshaw on, 177
Jackson, Dr. J. H., on the physiology
of language, 237
Jacob, Dr. Archibald H., on diseases
and injuries of the eye, 521
Jervis Street Hospital introductory
lecture, Dr. S. M. McSwiney, 461
“ Journal of the Irish Medical Asso¬
ciation, the," 48
Jnnior Surgical Society of Ireland,
517, 518
Killed daring the elections, 476
King and Queen's College of Physi¬
cians in Ireland, 259, 302
King's College, 318
Klob, Dr. J. M., on pathological.*na-
tomy of the female sexual organs
(Review), 102
Lactate of zinc in epilepsy, 195
“ Lancet" exposed, the, 812
Large families and public health, 478
Leeches, how to utilise, 176
LEADING ARTICLES.
Fortiter in Re, notes on the Abyssi-
nians, 10-11
The constitution of the Medical
Council, notes on the great debate
in the Medical Council, 34-5
Sent to Coventry, notes on the debates
of the Medical Council, 58-9
The medical department of the Abyssi¬
nian expedition, the election at the
Dublin College of Physicians, notos
on the Abyssmians, 80-1.
Movement of troops in India, election
of the King's professor of physic in
Dublin, specialists and specialism,
** noctes, ccenisqae doctoram,” 102-
The 86th Regiment at the Mauritius,
English Poor-law Medical Officers'
Association, medical degrees in the
United States of America, the medi¬
cal element in Parliament, 124-7
Army medical officers, 146
The Royal College of Physicians of
London, the Medical Council, Par¬
liament or Convocation, the reports
of tho medical officer of the Privy
Council the Army Medioo-Chirnr-
gical Society of Portsmouth, 168-
70
Cholera and water, 188
“Doctors," civil and military, Lord
Amberley’s views on abortion, 209-
10
The ailments of the medical body cor¬
porate—No. I., the materiel of the
profession, a few words abont fees,
280-1
The selection of a profession, recom¬
mendations of the General Medical
Council, 243*4
The puigatory of London hospitals,
270
Squeamish lieutenants, Parliamentary
representation, Sir D. Corrigan, 298
The Bruther^od of St. Luke's, bar-
jacks, 884
Local sanitary committees, the Medi¬
cal Club, 852-853
Ventilation of troop-ships, 374
Married soldiers, professional auto¬
cracy in medical journalism, the
Edinburgh Association for Improv¬
ing the Condition of the Poor, 392-4
Reform of the Medical Council, certi¬
ficate signatures, 411
The influence of medical politics on
the elections, Glasgow and Aber¬
deen Universities, the enfranchise¬
ment of the Scottish Universities
and the Lancet, 431-8
A few words abont combatants and
non-combatants, the British fool,
the Navy Report, 450-1
Educational reform, smoke nuisance
and magisterial justice, report of
the Army Medical Department for
1866> 472-8
Educational reform—No. II., homoeo¬
pathy in the Aberdeen Royal Infir¬
mary, Army Medical Department
for the year 1866, 490-1
Educational reform—No.IIL, winter
climates, scarlatina or soarlet fever,
508-9
Edncational reform—No. IV., the cat,
extra professional medical publica¬
tion, the superannuation of Irish
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CONTENTS OF VOLUME VI.
The Medical Press and Circular.
Poor-law medical officers, Army
Medical Report for the year 1866,
531-4
Educational reform —No. V., fevers
in schools, training ships and the
navy, the Indian sanitary commis¬
sions, detention of lunatics, 552-5
LECTURES.
Cummins, W. Jackson, Dr., on the use
and abuse of “ stimulants,’* 128,
135
Grimshaw, T. W., Dr., is the adminis¬
tration of wine in acute disease a
mere fashion ? 177
Jaccoud, S., Dr., on insufficiency of
the aortie valves, 1
Jacob, Archibald, H., on eye diseases
and injuries, No. 1, Introductory,
521
McDonnell, Robert, Dr., on venereal
diseases, 234, 271
Macnamara, Rawdon, on stricture,
343, 365, 385
Legal Intelligence :—
Conviction of a surgeon under the
Vaccination Act, 239
Lewis, Mr., on the treatment of the
apparently drowned, 17
Licensing bodies in Ireland, regula¬
tions and bye-laws of, 256
Licensing system, history of the, 506
Ligature of the first stage of the right
subclaviau artery, 539
List of entries in the register of the
Branch Medical Council, Ireland,
48, 175, 241
Little, Dr. W. J., on spinal weak¬
ness (Keview), 101
Liverpool Royal Infirmary School of
Medicine, 267
London hospitals and schools, 264-266
Londou Medical Benevolent Fund, 19
Longuet, M., on a new sphymograph,
Macdonald, Dr., the case of, 14
Magdalene Asylum, Edinburgh, 514
Malvern College, speech day, 154
Malvern Hospital, 90
Marriages, 286
Medical Acts Amendment Act, the, 9
Medical Assistant, his duties and pri¬
vileges, the, 247
Medical calling, the, 400
Medical Club, the, 458
Medical Council, Dr. James' plan of
reforming the, 19 ; Dr. Williams*
reform in, 88; representation in
the, 192; Rivington, W., “on the
representation of the profession in
the," 301
Medical manners, 359
Medical officers of health, 219
Medical practitioners’ (colonies) bill,
copy of, 48
Medical reform, Ashe, Dr., ou, 68,
153; Cantab, on, 109 ; Crisp, Ed¬
wards, Dr., on, 505 ; Cognovi, on,
561
Medical remuneration, 540
Medical training, 359
Medico-Chirurgical Society of Glas¬
gow, 241
. Medico-legal inquiries, 47
Medico-social pencillings of London
life aud practice. Quid Nunc on,
455, 496, 514, 541, 559
Meeting of London and provincial
poor-law medical officers, the, 16
Metropolitan Board of Works, 20
Medulla oblongata, tumour in the,
212
Middlesex hospitals, 265
Military hospital arrangements in
Prussia, 175
Minntc investigation of the kidney,
342
Mitchell, the late Mr., 379
Mitral disease, Lawson Tait on, 51
Mortality by enthetic disease, 19
Njevus maternus, 364
National Association for the Promo¬
tion of Social Science, 550
Naval medical service, 13
Naval Medical Department, official
regulations. (See Students’ No.,
vol. vi., 25U)
Netley Hospital, 245
New examination for pharmaceutical
assistants, the, 240
New nomenclature, the, 358
New President of the Poor-law Board,
the, 499
Neuralgia, sulphate of nickel in, 562
Nice, short notes on, by Dr. J. S.
Hughes, 52, 118
Nomenclature, the new, 358
Non-efficacy of the bromide of potas¬
sium in chordee, the, 843
Notatation of mineral silicates, 551
Notes on the great debate in the
Medical Council, 35, 59
Notes on tho metals (Review), 479
NOTES ON CURRENT TOPICS.
The Carmichael prizes, the next army
examination, public prosecutors,
convenient indispositions, the new
anaesthetic, the new penny paper on
the public health, 11-12
The future president of the Medical
Council, the Royal College of
Physicians of London, Royal Col¬
lege of Surgeons of England, medi¬
cal parliamentary representation,
medical statistics of the Abyssinian
expedition, first fruits of sanitary
reform in Liverpool, what should
we drink ?> poor-law salaries in
England, 36-37
Royal College of Surgeons of Eng¬
land, University of Edinburgh, the
Abyssinian medical service, chloro¬
form, glazing the streets, evils of
bad cooking, muzzling dogs, dust¬
bins, 59-60
Royal College of Physicians of Lon¬
don, Medical Department of the
Privy Council, medical candidates
for Parliament, aneurism in the
army, the Lothian’s Medical Asso¬
ciation, 82-83
The Duke of Edinburgh, St. Andrew’s
Medical Graduates’ Association,
the Registrar-General’s quarterly
return for Ireland, prevention of
cruelty to animals, accidentally
poisoned, 104-5
Figures not, fears, the public health,
127
Medical honours at Oxford, nomen¬
clature of diseases, Sir James Simp¬
son, the late Mr. Travers, the cattle
plague, sunstroke. Junior University
Club, Dublin ; the plague of flies,
bathing, pepsine biscuits, 140-8
Representation of the profession in
the Council, the fellowship of the
Royal College of Physicians of Lon¬
don, the chair of botany in the
University of Dublin, death of Dr.
Mackenzie, of Glasgow ; the medi¬
cine of the future, the Thames,
yellow fever, real and apparent
death, vaccination, the onion as a
disinfectant, bathing, conveyance
of food, water companies, sickness
in Dublin* 171-3
Oxford University, London Hospital,
the “Dreadnought” Hospital Ship,
the West Middlesex coronership,
the British Association for the Ad¬
vancement of Science, the annual
report of the Scottish Registrar-
General, the penalty of unqualified
practice, the chair of botany in
Trinity College, Dublin ; the naval
medical service, 189-91
Doctors in the legislature, the quar¬
terly examinations at the Royal
College of Surgeons in Ireland, the
Dublin city prisons, reproduction
extraordinary, the perils of the sea¬
side, 211-2
The public health, the city police
(London), a medical man fined,
over laying and death certificates,
medical capacity for c ownerships,
the Medical Act against quacks,
qualification of medical a ss is ta n ts,
Scottish longevity, professional ap¬
peal, 282-4
University of Cambridge, Lord Am-
lierley and the Fenians, an insulted
coroner, full dress and disease,
register, lodgers and graduates, the
coming medical session in Lon¬
don, Coombe Lying in Hospital,
Dublin, 232-5
Tweedledum v. Tweedledee, the mo¬
rality of Lord Amberley’s platform,
vaccino-maniacs, public health, is
smoking injurious ? the new water
supply of Dublin, the health section
of the Social Science Association,
the Indian pharmacopoeia, parish
doctors and the franchise, Dr.
Humphrey Sandwith, scientific
popular lectures, examination and
prize scheme, the purgatory of Lon¬
don hospitals, the value of a diploma,
294 7
The introductories, the dinners, prizes,
Queen’s College, Birmingham ; a
medical lecture in a chapel. Univer¬
sity of Cambridge; the fall of the
leaf, the Aberdeen and Glasgow
Universities election, another medi¬
cal candidate for Marylebone, poison
in socks, an unfinished infirmary,
311
Medical auction bidding, gas analyst,
Radcliffe Infirmary, Oxford; un¬
qualified interlopers, the societies,
treatment of the apparently drown¬
ed, 335*6
Over-population, health of Dublin,
Queen’8 University in Ireland, Sir
Dominic Corrigan, repreasion of
syphilitic disease, disease in Dublin
during the last quarter, arrival of
the “ Mauritius ” at Portsmouth,
scarlet fever, health of Salford,
West Kent Medical Society, the
elections, British Pharmacopoeia,
1867 ; alleged pauper ill-treatment
in workhouses, medical auctioneer¬
ing, domestic torpedoes, Hotbom
union, the stage doctor, the Queen’s
University in Ireland, 353-7
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The Medical Prw« rmU Circular.
CONTENTS OF VOLUME VI.
Medical Society of London, alleged
lunatics, homoeopathy, the late Dr.
Sibbald, University of Aberdeen,
the Kegistrarship of the College of
Physicians of Ireland, King and
Queen’s College of Physicians,
conmosition of Welsh lake water,
the Golden Bridge Cemetery, Dublin;
the Corrigan election fund, storage
of petroleum, the Varty water
supply for Dublin, honour to sur¬
gery, arrival of the ship * ‘ Clara ”
at Portsmouth, the Dublin Quar¬
terly Journal, Woolwich dockyard
drainage, bitter beer, pauperism,
Sir D. Corrigan 8 candidature,
374-7
Army medical officers and reduction
in the army, certificates of purity,
Royal College of Physicians of Lon¬
don, tobacco, Royal Commission on
sanitary organisation and laws,
asylum for the imbecile poor, the
late Mr. Henry Brown, the quar¬
terly return of the Registrar-Gene¬
ral, verdict of murder against a
surgeon, military hospitals, Sir D.
Corrigan’s candidature, death of
Dr. Hardy, of Dublin ; Beaumont
Medical Society, the Scotch Uni¬
versities, 395-7
Royal College of Physicians of ^Lon¬
don, Royal College of Surgeons of
England, nurses for the sick poor,
Charing Cross Hospital, ovariotomy,
death from chloroform, the late Mr.
Partridge, of Colchester ; the late
Professor Griesinger, Dr. Wolfe,
the mastership of the Rotundo
Lying-in Hospital, Dublin; Sir
Dominic Corrigan, Gresham lec¬
tures, by E. Symes Thompson,
M.D., E.R.C.P., Graham Professor
of medicine; Colonial Benefit So¬
cieties, 412-4
Hospital v. Workhouse, the New
Pharmacy Act, Dublin Obstetrical
Society, homoeopathy at Aberdeen,
the late Dr. Hellier, excision of
joints, physician or surgeon, Dr. or
Mr., Royal South Hants Infirmary,
the array blue book, Lord Rector
Moncrieff, 433-5
Scarlet fever, sudden death of a sur¬
geon, Edinburgh and St. Andrew’s
Universities’ election, the Pharmacy
Act in Scotland, medical club, a
champion of medical reform, Dublin
Obstetrical Society, the Pathological
Society, health of Dublin for the
past week, over-housing, election
to the Meath Hospital, Dublin:
medical men in Parliament, 452-4
Death from starvation, guardians v.
Poor-law board, the Abergele Co¬
roner, H.M S. “Ariadne,’’ death
from hydrophobia, hints on quack¬
ery, the new Pharmacy Act and
the dispensary practitioners, the
health of Dublin, Thames purifica¬
tion from the sewage of Oxford,
Eton, Windsor, and Abingdon;
Royal Medico-Chirurgical Society,
payment of medical officers, killed
during the elections, St. Andrew’s
Medical Graduates’ Association,
474-6
New examination in operative surgery
in the Koyal College of Surgeons in
Ireland, superannuation of Irish
Poor-law medical officers, Sir Do¬
minic Corrigan, Junior Surgical
Society, the last appointment of the
late Government, medical evidenoe,
French medical bibliography, the
manslaughter of a medical student
in Dublin, Goodsir’s anatomical
works, public health, inquests in St-
Pancras, testimonial to Dr. Chowne,
Bridewell and Bethlehem Hospitals,
fever in London, civic honours to
medical men, a new principle of
medical editorship, the preservation
of meat, 492-5
Th© New Sanitary Act, 1868 ; Spanish
quarantine, Royal College of Sur¬
geons of England, the St. Pancras
medical officer of health, disin¬
fectants, dry and damp soils, twice
Lord Mayor of Dublin, prevalence
of scarlatina, the evils of sewing
machines prevented, Dublin Hos¬
pital reports, the Under-Secretary¬
ship, health of Dublin, Turkey and
Greece, the Registrar Chief of the
King and Queen’s College of Physi¬
cians of Ireland, 510-13
Mrs. Gladstone’s Convalescent Home,
the vestry of St. Pancras and the
medical officer of health, the Indian
cholera epidemic, the late lunacy
case, small-pox at Sheffield, Anglo-
German Ophthalmic Hospital,
French Hospital and Infirmary, the
sanitary condition of Falmouth, a
Royal Commission on the Sanitary
Laws, the Royal College of Science,
Dublin ; ligature of the first stage
of the right subclavian artery, Uni¬
versity of Cambridge — natural
science scholarships, 538-9
Charity, public health, the treatment
of consumption by ether, army medi¬
cal promotion, rumoured reduction
in the army medical department, the
vacancy in Vincent’s Hospital,
Dublin ; Professor Skoda, propaga¬
tion of nuisances by the London
Corporation, the recent candidature
of Sir D. J. Corrigan, death of Sir
Richard Mayne, K.C.B. ; Medical
Society of Dublin, Children’s Hos¬
pital in Brighton, 557-9.
Note-taking, 359
Notices to Correspondents :—20, 48,
70, 90, 155, 176. 197, 220, 242,
286, 202, 324, 342, 364, 384, 402,
422, 440, 460, 479, 499, 520, 542,
562
Novel treatment of sunstroke, 373
OBITUARY.
Bradshaw, Mr., 155.
Cowon, Dr. C\, 499.
Donovan, Dr. J., 520.
Edwards, Dr. G., 542.
Elliotson, Dr., 155.
Hobson, Dr., 499.
Reunion, Dr., 57.
Mntteueci, Sig. t 57.
O'Ferrall, Dr., 562.
Ponillet, 57.
Ramsbotham, Dr., 57.
Ryan, Dr., 562.
Sichel, M., 520.
Stevens, Dr., 155.
Occlusion of hydrogen gas by
metals, 207
Opening of the General Medical
Couucil, 9
Opening of the Winter Session of the
Royal College of Surgeons in Ire¬
land, 383
Operative snrgery, 499
Opium and belladonna, 542
Oppert, Dr. O., on the progress of
sanitary improvements in existing
hospitals, 21
ORIGINAL COMMUNICATIONS.
Alison, Dr. Scott, on morbid con¬
ditions of the throat in their rela¬
tion to pulmonary consumption ;
their diagnosis &ud treatment, 3,
49, 97, 113, 199, 221, 275, 287,
347.
Aspray, Dr. C. O., on rapid dilatation
with the screw dilator, with cases,
427.
Benson, Mr. J. H., on purpuric fever,
114.
Chambers, Dr. T. K., on how shall
we make our daily experience ad¬
vance science ! 179
Croly, Mr. H. G., ou a case of stran¬
gulated femoral hernia, 202 ; am¬
putation of the penis for cancer
224.
Dickie, Dr. John, cases in illustration
of the value of chloroforn in convul¬
sion, 327.
Donovan, Mr. M., on the dismem¬
berment of pharmacy from medi¬
cine, 523.
Freke, Dr. H., on the nature of the
phenomena of paroxysm and inter¬
mission, 182.
Gray, Mr. H. C.. on a remarkable and
curious case of foreign body iu the
larynx, 91.
Gordon, Dr. C. A., experiences of a
regimental surgeon iu India, 289,
348, 387, 429, 468.
Hamilton, Mr. E., on the spinal ice-
bag in the treatment of delirium
tremens, 291.
Hayden, Dr. Thomas, on the patho¬
logy and significance of certain
endo-cardial murmurs, 205.
Hughes, Dr. J. S., short notes on
Nice, 52, 118.
Jackson, Dr. J. Hugh lings, on the
physiology of language, 237.
Jones, Dr. C. Haudfield, on heat¬
stroke, 423, 445, 464.
Jones, Dr. H. M., on the actiou of
aconite and quinine in neuralgia, 5
Kelly, Dr. B., on urea and uric acid,
72, 93 ; on fever and inflammation,
203.
Kinkead, Mr. Ii. J., on some points
connected with the operation for
hare-lip, and excision of the lip for
cancer, 160.
Little, Mr. P. C., on epilepsy, 184.
Longnet, Mr. M., on a new sphymo-
grapb, 485.
Macalister, Mr, A, on the anatomy
and physiology of the corouary
arteries of the heart, 117.
MacCormac, Dr., on the food ques¬
tion, 92 ; on artificial restraints on
population, 277 ; ventilation, 449.
McEvoy, Mr. F., ou a fracture of both
bones of the leg in two places, ana
the leg re-fractured after eleven
weeks st the lower break—reco¬
very, 408.
Martin, J., cases occurring in the
practice of, 97.
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CONTENTS OF VOLUME VI,
Tht Medical Pita tad Cbwokr.
Maunsell, Dr. 8. &, on the influence
of temperament on the diseases
peculiar to India, 501.
Morgan, Mr., a two months’ summary
of cases treated at the Westmore¬
land Lock Hospital, 95 ; pemphi¬
gus syphiliticus. 303 ; syphilitic
affections of the larynx, 325 ; syphi¬
litic deposit in the heart, 425.
Oppert, Dr. 0., on the progress of
sanitary improvement in existing
hospitals, 21.
Porter, Dr. Angus M., notes on some
peculiar cases of syphilis, 25, 50.
Pnrdou, Dr. H. S., on the nerrous
connection of certain skin diseases,
157 ; on carbolate of quinia, 328.
Roberts, Mr., on a case of compound
fracture of frontal bones, with frac¬
ture of clavicle and acromion, 71.
Sandham, Mr. W. H., on a case of
melancholia treated by ice to the
spine, 508.
Sturges, Dr. O., on the forms of pneu¬
monia, 200, 368.
Tait, Lawson, on three cases of mitral
disease, 51.
Tidy, Mr. C. M«, gleanings in toxi¬
cology—No. I., on poisoning by
nitrate of baryta, 447 ; No. IL, on
poisoning by colocynth, 529.
Vesey, T. A., on a case of ileus suc¬
cessfully treated by electricity, 224.
Waring-Curran, Dr., on ovarian neu¬
ralgia treated by hydrochlorate of
ammonia and tincture of aconite,
162; cannabis indicus in catarrhus
seniles, 222; fractures of the pubes,
870 .
Williams, Dr. H. W., on practical
schemes for extending the Con¬
tagious Diseases Act to the civil
population, 180.
O'Sullivan, Dr., against the Limerick
Guardians, 499
Ovariotomy, 378
Overdose of laudanum, 111
Over-population and public health, 84
Oxford University, 219, 250
Parish nurseries, 400
Pauperism, 55
Pemphigus syphiliticus, Mr. Morgan,
on, 803
Peroxide of nitrogen, 551
Pharmacy Bill, the, 41
Physicians of Edinburgh, Royal Col¬
lege of, 262
Physicians v. Surgeons, 201
Physiology of language, Dr. J. H.
Jackson on the, 287
Pleuro-Pneumonia, 458
Poison of toads, the, 530
Poor-law and medical inspectors
. (Ireland) bill, 47
Poor-law medical officers' association,
373, 400
Poor-law Reform, 498
Poor relief (salary of auditors), 47
Primipara, an aged, 342
Private Scotch Bills, 556
Projected appointments at the Dublin
College of Science, the, 561
Prolapsus ani, 342
Provincial Colleges op Ireland :—
Queen's College, Belfast. Queen's
College, Cork. Queen's College,
Galway, 270
Provincial Schools of Medicine, 266
Public health, the, 47, 69, 89, 111,
154, 195, 286, 323, 363, 401, 449
Puerperal convulsions, a case of, 194
Purgatory of London Hospitals, the
296
Pure carbonate of lime, 208
Purpuric fever, Mr. H. J. Benson,
on, 114
Queen's University in Ireland, 257
Quid Nunc on medico-social pencil-
lings of London life and practice—
No. i, 455 ; ii, 496; iii, 514 ; iv,
541; v, 559
Qainia, carbolate of, Dr. H. S. Par¬
don, on, 328
Rabbits and sparrows in Australia,
528
Recruiting of the army, 473
Reform in medical education, Cognovi,
on, 540
Registration of Colonial degrees, 13
Registration in Scotland, 70
Registration of students, 31
Regulations and bye-laws of licensing
bodies in England, 250
Rejections at tne London College of
Surgeons, 89
Representation of the general prac¬
titioner in the Medical Council, 10,
89
Representation of the medical pro¬
fession, 32
Retirement of Dr. M. Prosser James
from his candidature for the repre¬
sentation of the Universities of
Edinburgh and St. Andrew’s, 415
Retroflexion of the uterus, 518
REVIEWS OP BOOKS.
A oolleetion of the published writings
of the late Thomas Addison, M.D.,
Physician to Guy's Hospital, 145
Barton on the nature ana treatment
of syphilis, 498
Cameron's stockfcoder's manual, 124
Chapman on sea-sickness, and how to
prevent it, 437
Clark on bandages and splints, 57
Drysdale's Ueber die behandlung der
syphilis, 549
Garrod on the essentials of materia
medica and therapeutics, 57
Guy's principles of forensic medicine,
102
Half-yearly abstract of the medical
sciences, vol. 47—Jan. to June,
1868. The retrospect of medicine,
edited by W. Braithwaite, M.D.,
and James Braith waite, M.D., vol.
57—Jan. to June, 1868, 58
Hebra on diseases of the skin, 527
Heiberg's researches on syphilis, 872
Klob »n pathological anatomy of the
female sexual organs, 102
Little on spinal weakness and spinal
curvatures ; their early recognition
and treatment, 101
Miller’s elements of chemistry—inor¬
ganic chemistry, 123
Moore on rodent cancer, with photo¬
graphic and other illustrations, 57
Mosler on the treatment of typhus
fever, 79
Parker, Langston, on the mercurial
vapour bath, 549
Perpetual almanack and calendar for
the investigation of dates, 479
Physician, a, on education and train¬
ing considered as a subject for
legislation, 58
Prince on plastics; a new HK-
tion and brief exposition of plastic
surgery, 102
Seaton’s haudbook of vaccination, 57
“The British army in 1868,” 187
Thorowgood on consumption and its
treatment by the nypophosphites,
390
Trousseau’s lectures on*clinical medi¬
cine, 145
Wanklyn on water analysis, 515
Watt’s dictionary of chemistry, five
vols., 124
Wood’s notes on the metals, 479
Rodent cancer (Review), 57
Kogan, Dr., death of, 242
Royal College of Physicians in Lon¬
don, 111, 134, 253
Royal College of Surgeons in England,
111, 254
Royal Hospital for Imbeoiles, Putney,
241
Royal Infirmary, Elinburgh, 556
Royal Medical Benevolent Fund of
Ireland, 47, 134
Royal Medical Society of E ilnburgh,
556
Royal Sea-Bithing Infirmary, Mir-
gate, 241
Royal S Kjiety of Edinburgh, 514
Rules for registration in the Scottish
Universities, 108
Sr. Andrew's University, 263
8t. Cuthbert’a, 556
St. Pancras New Infirmary, 99
Sale of porous, 77
Salt-cure of Rsichenhall, the, 342
Sea-sickness, 437
8ecret poisonings at Marseilles, the,
5 37
Sohools of Medicine, provincial, 266
Scotch double qualifications, the, 262
Scotland, registration in, 70
Scottish Hospital in London, 489
Scottish Medical Intelligence, 414,
456, 476, 489, 513, 535
Scottish Registrars, 489
Scottish Rigistrar-General's Quarterly
Return, 196
Scottish Universities, rules for regis¬
tration in, 108
Secondary school education, 30
Sewage experiments at Tottenham, 70
Sheffield School of Medicine, 267
Sick poor of East London, the, 410
Site of the new Edinburgh Infirmary,
the, 535
Social Science Congress, 832
Social Science Association.
Address by Dr. H. W. Ramsey,
361, 380, 398, 416.
Pr esidenf s address, 332.
Solubility of oxide of iron, 86
South Dublin Union, 377
Sparrows and rabbits in Australis,
528
Spectra of potassium and barium, 208
Spinal weakness (Review), 101
Starch in the yellow of eggs, on the
presence of, 551
Statistics of insanity, 90—in Scot¬
land, 134—in Ireland, 154
Stiffened bandages, on, 518
14 Stimulants,” Dr. W. J. Cummins,
on, 128, 135
Stricture, Mr. R. Macnamara, on,
343, 365, 385
Students, registration of, 31
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The Medical Preoe and Circular.
CONTENTS OF VOLUME VI.
Subcutaneous injections in the radical
cure of varicose veins, 846
Sulphate of nickel in neuralgia, 568
Sulphate of zinc in dyspepsia, 851
Summary of Science, by Mr. C. R.
C. Tichborne, 85, 207, 382, 527,
551.
Sunstroke, novel treatment of, 373
Surgical separation of the Siamese
twins—Chang and Eng, 196
Tait, Lawson, on three cases of
mitral disease, 51
Testimonial to Dr. Chowne, 494
“The British Army in 1868,” 187
“ The Navy report,” 451
“The representation of the profession
in the Medical Council,” 801
Tichborne, Dr. C., summary of
science, 85, 207, 882, 527, 551
Tidy, Dr., on poisoning by nitrate of
baryta, 447
Title of doctor, M.D., on, 240
Tobacco, 896
Torture in Russia, 241
Toxicology, gleanings in, 447, 529
Training ships and the Navy, 554
Transactions of the Swedish Society
of Physicians, 28
TRANSACTIONS OF SOCIETIES.
Aray-Medioo-Chirurgical Society of
Portsmouth.—Sporatic cholera, 302;
on the use of carbolic add in the
treatment of wounds, 802; aneurism
of the aorta, 802; on delirium tre¬
mens, 822; abdominal aneurism,
880; aortic aneurism, 330; suicidal
gunshot wound of the skull, 831;
yellow fever, 831 ; pleuro-pneumo-
nia, 458; mortality in India ac¬
cording to temperament, 458 ;
malingering, 458; on heat-apoplexy,
519; on the communicability of
phthisis, 519
Dublin Obstetrical Society.—On retro¬
flexion of the uterus, 518
Forfarshire Medical Association, 108
Junior Surgical Society of Ireland.
—The President's address, 617 ; on
some points in the physiology of
respiration, 618 ; on stiffened band¬
ages, 518
Medical Society of London. On blood¬
letting as a point of scientific prac¬
tice, 879 ; dilatation of the urethra,
488; on the medio-lateral operation
of lithotomy, 489 ; on the phases of
physio in the 19th century, 458;
on gall stones, 519; the spectro¬
scope in relation to physiological
and pathological research, 550
Medi<x>-Chirurgic&l Sodetyof Glasgow.
—Sanitary aspect of the sewage
question, 881
Pathological Society of Dublin.—Non-
malignant tumour, 526
Royal Medical and Chirurgical So¬
ciety.—Certain points in the physio¬
logy and pathology of the fifth pair
of cerebral nerves, 525
St Andrew's Medical Graduates' As¬
sociation, 107.
Transfusion of blood, 479
Treatment of a severe case of whooping-
cough by vaccination, 195
Treatment of consumption by the
hypophoaites, 890
Treatment of the apparently drowned,
886
Troop-ships, ventilation, 874
Trousseaus lectures on clinioal me¬
dicine (Review), 145
Turkey and Greece, 513
Turpentine, as an antidote to phos¬
phorus, 503
Twice Lord Mayor of Dublin, 512
Typhus fever (Review), 79
University of Cambridge, 19, 70
University of Edinburgh, 260, 518
Universities of Edinburgh and Aber¬
deen, the, 556
University of London, 252, 842, 460
Urea and uric add, Kellyon, Dr. B. f
72,93
Urticaria, notes on, Pardon, Dr. H.
S>, on, 546
Value of a diploma, the, 296
Venereal diseases, Dr. Robert McDon¬
nell, on, 234, 271
Vital statistics ot the Navy, 176
Water analysis (Review), 515
Water potable, analysis of, 85
Water supply of Edinburgh, 536
Westminster hospital, 265 .
Wheaten floor, 530
Whooping-cough, treatment of a
severe case, by vaccination, 195
Wine, report on, and its adultera¬
tions, 140, 167, 192, 297
Withdrawal of Dr. Richardson from
the contest for the Universities of
Edinburgh and St Andrew's, 888
Word for introductory lectures, a, 400
END OF THE SIXTH VOLUME.
Whited fer the Proprietor by M’Oovak & Dawks, and published every Wednesday Morning, by Albsbt Anno Tikdall. London:
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